Drop & Splice Form

What market is this for? *

What kind of drop do you need to report? *

Select ALL that apply

Temp or Permanent *

Temp
Permanent

Company *

Issue ID or Ticket # *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Work *

Drop Type *

Residential or Small Business *

Residential
Small Business

Is splice needed? *

Yes
No

Pre-Work Photo 1 *

Drag & Drop Files, Choose Files to Upload

This should be a photo of the site BEFORE work begins. Max file size is 6MB

Pre-Work Photo 2 *

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This should be a photo of the site BEFORE work begins. Max file size is 6MB

Pre-Work Photo 3 *

Drag & Drop Files, Choose Files to Upload

This should be a photo of the site BEFORE work begins. Max file size is 6MB

Aerial Questions

How many Pole-to-Pole spans were run? *

How many pole risers did you install? *

Is there a pole attachment that required a J-hook to be used?

Yes
No

Hardscape Questions

Did you BORE any hardscape or use any existing hardscape conduits? *

Yes
No

Concrete cutting is NOT a bore. Please list concrete cutting in the notes.

Drop Length (In feet) *

Drop depth photo *

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Max file size is 6MB

Exceptions - Drop Depth Not Reached *

Sprinklers
Rocks
Roots
Other

Explain other exception *

Length of precut drop cable used. *

Conduit over 200' (adder) *

Use this field to report any conduit pulls that were longer than 200' in the conduit. Please just put how many feet of CONDUIT were over 200'.

Did you install a NEW vault? *

Yes
No

Job Notes

Splice Questions

Questions of hardscape

Light Level ( -8 to -25.99 is acceptable) *

for no lights, put -50

Was a "ring cut" and NEW coyote box installed at this location? *

Did you use the "assigned fiber" or another one? *

Assigned
Other

Which fiber was used? *

Photo's of Splice Work *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Max file size is 6MB

Photo of VeEx QR code *

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Max file size is 6MB

Splice Exceptions (ie. NIU placement, height, distances, etc.) *

NANO Questions

If you cut a NANO for this drop, how long was it? *

2nd Address served by this Nano *

Address Line 1

Address Line 2

City

State

Zip Code

Was this a cut or fill or both? *

Held up by? *

Survey Questions

Does this address need a NEW vault installed? *

Yes
No

Does this address need a driveway bore?

Yes
No

Is this a Temp to Perm job? *

Yes
No

Nearest cross street *

Whitelined Date *

Will this be a "high cost" drop? *

Yes
No

Does the property have any of the following: *

If so, was the customer contacted or a voicemail left? *

Survey Photo 1 *

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Max file size is 6MB

Survey Photo 2 *

Drag & Drop Files, Choose Files to Upload

Max file size is 6MB

Survey Photo 2 *

Drag & Drop Files, Choose Files to Upload

Max file size is 6MB

Flyer on the door photo *

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Max file size is 6MB

Survey Notes *

Additional Photo's

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Max file size is 6MB