Information

  • Service order number

  • Customer Address

  • Prepared by

  • Pole Inspection Date

  • Date of installation (For dispatch purposes)

  • Pole Owner

  • 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.

  • Trolley Bus Pole - Send completed form to poles@visionstream.co.nz for approval. Do not complete pole work without CAP.

  • 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.

  • Vector - Continue with the work and send the completed form to poles@visionstream.co.nz

  • WE Pole - Send completed form to poles@visionstream.co.nz for Consent to utilise pole followed by CAP. Do not climb pole without a valid CAP.

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.

  • Pole Tagged?

  • Special Purpose Pole? (Is it a stub pole, brace pole, or pole with jockey arms)

  • 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?

  • 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?

Testing

  • Will testing beyond normal standards (hammer, probe or visual inspection) be required?

  • If yes please explain briefly why testing is required

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
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.