USL Pole Survey Form

Survey App
Date*

DayMonthYear
Date
Hour MinutesAM/PM Option
Please enter your name below, capitals for the start of your forename & surname:
Surveyor Name*
Surveyor Email*
example@example.com
Managers Email*
example@example.com

1 - Contract*
2 - Order Number*
3 - Estimate Number*
4 - Exchange*
5 - Works Description*

Pole Replacement
6 - DP Number*
6a - CP Number*
6b - Region of the works*
6c - Grids (Current Location), You Can Drag The Pin If An Alternation Is Required*
6d - Existing Plant (Further info required)*
6e - Required Plant (Further info required)*
6f - Are There Any Other CP's Equipment Present On The Pole
Pole Provide
7 - DP Number*
7a - CP Number*
7b - Region of the works*
7c - Grids (Current Location), You Can Drag The Pin If An Alternation Is Required*
7e - Required Plant (Further info required)*
7f - Are There Any Other CP's Equipment Present On The Pole
Recover Redundant Pole
8 - DP Number*
8a - CP Number*
8b - Region of the works*
8c - Grids (Current Location), You Can Drag The Pin If An Alternation Is Required*
8d - Existing Plant (Further info required)*
8e - Are There Any Other CP's Equipment Present On The Pole
Network Rearrangement
9 - DP Number*
9a - CP Number*
9b - Region of the works*
9c - Grids (Current Location), You Can Drag The Pin If An Alternation Is Required*
9d - Existing Plant (Further info required)*
9e - Required Plant (Further info required)*
9f - Are There Any Other CP's Equipment Present On The Pole
Overhead Only
10 - DP Number*
10a - CP Number*
10b - Region of the works*
10c - Grids (Current Location), You Can Drag The Pin If An Alternation Is Required*
10d - Existing Plant (Further info required)*
10e - Are There Any Other CP's Equipment Present On The Pole
Stay Only
11 - DP Number*
11a - CP Number*
11b - Region of the works*
11c - Grids (Current Location), You Can Drag The Pin If An Alternation Is Required*
11d - Existing Plant (Further info required)*
11e - Required Plant (Further info required)*
11f - Are There Any Other CP's Equipment Present On The Pole
12 - Description / Comments
13 - Is The Pole Situated In Public or Private Land*

PublicPrivate
14 - Permit Required?*

YesNo
15 - Road Speed*

20 MPH30 MPH40 MPH50 MPH60 MPH70 MPH
16 - TM Required*

No Carriageway IncursionSome Carriageway IncursionGive & Take2-Way Lights3-Way Lights4-Way LightsRoad ClosureLane ClosureTemporary Obstruction / MORTM Survey
16.1 - TM Survey Images*

Cancelof
16a - TM Required*

No Carriageway IncursionSome Carriageway Incursion2-Way Lights3-Way Lights4-Way LightsPriority WorkingRoad ClosureLane ClosureTemporary Obstruction / MORTM Survey
16.2 - TM Survey Images*

Cancelof
17 - Road Width (Meters)*
18 - Bus Stop Suspension*

YesNo
19 - FW Closure Required*

YesNo
19a - Type of FW Closure*
20 - Parked Cars - Does this require a pre-cone*

YesNo
21 - Parking Bay Suspension Required*

YesNo
22 - Tree Cutting Required*

NoGangThird Party
23 - Suspected Rock*

YesNo
24 - HV Power In Vicinity*

YesNo
24a - Is the HV Power Within 3 Meters*

YesNo
24b - Is the HV Power Within 25 Meters*

YesNo
24c - Height of HV Power In Meters*
24d - Height of Existing BT Pole In Meters*
24e - Pole to EL Clearance In Meters*
25 - LV Power In Vacinity*

YesNo
25a - Action Required*
26 - Visible Markers*
27 - Customer Notification Required*

YesNo
A55 Needed?*

YesNo
A55 Attachment*

Cancelof
27a - Customer Contact Name*

First NameLast Name
27b - Customer Contact Number*
Please enter a valid phone number.
28 - Vehicle Type*
29 - Have Images Been Uploaded To The Relevant App?*

YesNo, Not Needed
Fibre Info, If Required
DFE Comments, If Required
DFE Images, If Required

Cancelof
Please Upload Images Here If You Require Further Uploads For Any Reason

Cancelof
Should be Empty:

Survey App

Pole Replacement

Pole Provide

Recover Redundant Pole

Network Rearrangement

Overhead Only

Stay Only