Information
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Address
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Date
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Prepared by:
Customer / Job Details
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Name
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Contact
Next Actions
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What outside installation method is to be completed?
- 1. Aerial
- 2. Existing Duct
- 3. Surface Mount Cable
- 4. Shallow Trench
- 5. Drill or slot Trench in Concrete
- 6. Hard Surface Trenching
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Chorus approval required
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Other requirements? I.e TMP, Arborist
- No
- L2 TMP
- Arborist
- Obstruction plans required
- Other
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What is required?
Health, Safety and Environmental Issues
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Underfloor access?
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Ceiling access?
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Back to Back Install?
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Location of ETP?
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FTP location photo
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Dogs on site?
Internal information
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Location of ONT?
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ONT location Photo
Additional job instructions
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Detailed description of works- If required
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Add labelled photos using the 'inote HD' app
Consents Required
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Right of way?
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Multi dwelling unit?
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Heritage site or Building?
Additional notes
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Notes
Outside property consent - Boundary to ETP
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Hole excavation and trenching?
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Removal of concrete/tiling/pavement?
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Installation of pipe(s)?
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Special instructions
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Clean up: We will leave the property in a clean and tidy state on completion. This does not include reinstatement to the same condition.
Inside property consent
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Drilling small holes and installation of hardware ?
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Cutting holes in walls?
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Exposed surface wiring?
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Give Chorus consent to contact RSP?
Signed consent
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I confirm that:
- I have seen, read and understood this information and the end user terms and accept those terms; and
- I agree to Chorus undertaking the installation works and method chosen at or on the property; and
- If I am not the owner of the property, I have obtained the consent of the owner for the installation works; and
- I understand that there may be an impact on the operation of burglar and medical alarms, particularly monitored alarms. [Note: check with your alarm provider or telecommunications service provider] -
End user signature:
