Visionstream - close approach and visual inspection form checklist
Compiled by visionstream
What does this form include?
This form contains 25 sections:
Pole Owner
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?
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
Pole ID
Pole address
Pole GPS Co-ordinates Address
Location details
Pole asset number?
Photo showing pole asset number
Pole address Address
Look for rust, exposed concrete, or any other risks
The minimum distance of 500mm needs to be adhered to when working close to lowest power (LV). Use a n
What will be the NGA clearance from the LV power on this connection?
Pole visual inspection for Provisioning services
Issuer name
Issuer Company
Parent Company - Visionstream
What WTC's do you hold?
By signing I accept all terms and conditions for self-CAP
Refer to SCHWMS 4 in your Risk Management Folder, and Chorus Technical Standards
Tech information
Remember to send the completed form to poles@visionstream.co.nz today and keep a copy for your own records
Use this template