Information
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Service order number
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Customer Address
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Prepared by
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Pole Inspection Date
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Date of installation (For dispatch purposes)
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Pole Owner
- Wellington Electricity
- WCCL - Trolley Bus Poles
- Electra
- Power Co
- Vector
- Aurora / Delta
- Unison
- Eastland Energy
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Network Waitaki poles@visionstream.co.nz
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Have you been inducted by Aurora/Delta and do you have a Work Authority Permit number for this job?
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Enter Work Authority Permit number from the Delta Control Centre
Pole visual inspection for Provisioning services
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Pole type
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Vierendeel pole?
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V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
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Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
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Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
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Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
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Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
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Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
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Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
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Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
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Number of services
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Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
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Photo of pole showing pole ID
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Photo showing the full pole including the top of the pole
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Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
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Pole GPS Co-ordinates
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Electra - Do not continue unless you have completed the Electra induction. Send completed form to poles@visionstream.co.nz. If inducted then continue install after notifying Electra Control Centre on 0800 800 109 prior to climbing pole.
Pole visual inspection for Provisioning services
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Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
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Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
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Number of services
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Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
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Photo of pole showing pole ID
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Photo showing the full pole including the top of the pole
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Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
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Pole GPS Co-ordinates
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Eastland Energy - Do not continue unless you have completed the Eastland Energy induction for Gisborne. Send completed form to poles@visionstream.co.nz.
Pole visual inspection for Provisioning services
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Pole type
-
Vierendeel pole?
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V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
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Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
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Photo of pole showing pole ID
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Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
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Pole GPS Co-ordinates
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WCCL - Trolley Bus Pole - Send completed form to poles@visionstream.co.nz for approval. Do not complete pole work without pre-approval.
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
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Pole GPS Co-ordinates
-
Power Co - Do not continue unless you have completed the Power Co induction. Send completed form to poles@visionstream.co.nz for approval. If pole passes personal inspection continue with install.
Pole visual inspection for Provisioning services
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Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
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Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
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Pole GPS Co-ordinates
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Vector - Continue with the work and send the completed form to poles@visionstream.co.nz
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
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Pole GPS Co-ordinates
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Unison - Complete the form and continue with the work if you have been inducted by Unison. If you haven't been inducted then complete the rest of the form. All forms need to be sent to poles@visionstream.co.nz on completion.
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
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Pole ID
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Pole address
-
Pole GPS Co-ordinates
-
WE Pole - Complete the form and send to poles@visionstream.co.nz. Once you have completed the form, it will instruct you on next steps, either to proceed with a self CAP or you require to send for an engineer assessment. If an engineer assessment is required, DO NOT continue with build work until the approval has been granted by WELL.
Type of approval request
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Has this order been Desktop Approved for Self CAP?
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As job has already been desktop assessed by Wellington Electricity, you can proceed with the self CAP below
Pole Information
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Pole asset number?
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Photo showing pole asset number
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Pole address
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Is the pole tagged with "Do not climb"?<br>
-
If the "Do not climb" tag is red - Do not climb and do not attach any service, please escalate to your FM. If a yellow or blue tag, you can attach to the pole by using an EWP - please ensure you have the WTC 2 accreditation to operate the EWP.
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Visual inspection
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Look for rust, exposed concrete, or any other risks
-
Any issues with pole head?
-
What is the highest voltage connected to this pole?
-
Hammer and probe test
-
The minimum distance of 500mm needs to be adhered to when working close to lowest power (LV). Use a non-conductive rod with a 500mm measure marked out to ensure you are adhering to the MAD
-
What will be the NGA clearance from the LV power on this connection?
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
-
Pole ID
-
Pole address
-
Pole GPS Co-ordinates
Tech information
-
Issuer name
-
Issuer Company
-
Parent Company - Visionstream
-
What WTC's do you hold?
- WTC1
- WTC2
- WTC3
- WTC4
-
By signing I accept all terms and conditions for self-CAP
-
Refer to SCHWMS 4 in your Risk Management Folder, and Chorus Technical Standards
-
We may need to seek approval for this order.
-
Is there an existing fibre attached to the pole?
-
As this job has no existing connections we will require a site assesment of the pole to take place for Wellington Electricity to complete a desktop audit, do not proceed with any build work, email the completed scope form to poles@visionstream.co.nz before COB on day of the scope visit. If there are multiple poles you are required to complete an iauditor per pole not per job.
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
-
Pole ID
-
Pole address
-
Pole GPS Co-ordinates
-
Is this a year 2 or greater UFB area (please check this on Mango Maps)?
-
YES - As this is a year 2 or greater UFB area, and has an existing fibre connected, you can now generate a self CAP assessment
Pole Information
-
Pole asset number?
-
Photo showing pole asset number
-
Pole address
-
Is the pole tagged with "Do not climb"?<br>
-
If the "Do not climb" tag is red - Do not climb and do not attach any service, please escalate to your FM. If a yellow or blue tag, you can attach to the pole by using an EWP - please ensure you have the WTC 2 accreditation to operate the EWP.
-
Visual inspection
-
Look for rust, exposed concrete, or any other risks
-
Any issues with pole head?
-
What is the highest voltage connected to this pole?
-
Hammer and probe test
-
The minimum distance of 500mm needs to be adhered to when working close to lowest power (LV). Use a non-conductive rod with a 500mm measure marked out to ensure you are adhering to the MAD
-
What will be the NGA clearance from the LV power on this connection?
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
Tech information
-
Issuer name
-
Issuer Company
-
Parent Company - Visionstream
-
What WTC's do you hold?
- WTC1
- WTC2
- WTC3
- WTC4
-
By signing I accept all terms and conditions for self-CAP
-
Refer to SCHWMS 4 in your Risk Management Folder, and Chorus Technical Standards
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
-
Pole ID
-
Pole address
-
Pole GPS Co-ordinates
-
NO - As this is a UFB year 1 area, you will be required to complete the site assessment and email a copy to poles@visionstream.co.nz and retain a copy for future reference. You cannot start any build work
Pole visual inspection for Provisioning services
-
Pole type
-
Vierendeel pole?
-
V1 - Less than 395mm on the wide face. Do not climb this pole, scope for underground solution. V2 - between 395mm and 415mm. Continue with form to apply for use, access will be from EWP only. V3- 6 - Greater than 415mm. Continue with form to apply for use.
-
Is the pole tagged? If yes then consult your FM, if no proceed to pole test).<br>
-
Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms - if YES is selected then tech is not able to climb and UG solution will be required)
- Yes > Unsuitable pole
- No
-
Accessibility
Assessment for Provisioning services
-
Does the pole support electrical conductors crossing elevated motorways, overpasses or navigable waterways?
-
Does the pole support electrical conductors crossing limited access motorways, overpasses, waterways or railways?
-
Is the pole located inside boundary on a ROW, shared driveway, long driveway or any private land?
-
Is the pole, a double or H-frame pole, supporting transformers, switches (air break switch) or supporting spans longer than 100m?
-
Is there/will there be Chorus UFB/NGA connection from the top to bottom of the pole? (Please ensure when selecting your category that, if you are required to attach the service lead up or down a WELL pole this will be UG-OH. Please ensure your photos show the route up or down a pole if UG-OH is selected).
-
Does the pole have multiple aerial cables attached ? (only 3rd Party distribution cables like VF)
-
Number of services
-
Does the pole have an 11kV or higher electricity underground cable riser attached to the pole or does it have electricity earthing conductors installed?
Photos
-
Photo of pole showing pole ID
-
Photo showing the full pole including the top of the pole
-
Photo of full aerial fibre route annotating the ownership of each pole
Location details
-
Pole ID
-
Pole address
-
Pole GPS Co-ordinates
-
Remember to send the completed form to poles@visionstream.co.nz today and keep a copy for your own records
