Drop & Splice Form Please enable JavaScript in your browser to complete this form.What market is this for? *--- Select Choice ---BNAHSVWhat kind of drop do you need to report? *DropSpliceNanoUnable to CompleteSurveySelect ALL that applyTemp or Permanent *TempPermanentCompany *--- Select Choice ---CUIAREIssue ID or Ticket # *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Work *Drop Type *--- Select Choice ---Underground (Regular)Underground (ENTIRELY in conduit from vault to house)AerialTransitionResidential or Small Business *ResidentialSmall BusinessIs splice needed? *YesNoPre-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 6MBPre-Work Photo 2 * Drag & Drop Files, Choose Files to Upload This should be a photo of the site BEFORE work begins. Max file size is 6MBPre-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 6MBAerial QuestionsHow 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?YesNoHardscape QuestionsDid you BORE any hardscape or use any existing hardscape conduits? *YesNoConcrete cutting is NOT a bore. Please list concrete cutting in the notes.Drop Length (In feet) *Drop depth photo * Drag & Drop Files, Choose Files to Upload Max file size is 6MBExceptions - Drop Depth Not Reached *SprinklersRocksRootsOtherExplain other exception *Length of precut drop cable used. *--- Select Choice ---1002505001000Conduit 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? *YesNoJob NotesSplice Questions Questions of hardscape Light Level ( -8 to -25.99 is acceptable) *for no lights, put -50Was a "ring cut" and NEW coyote box installed at this location? *--- Select Choice ---No ring cutSmall (1-4 ports)Large (5 ports or more)Did you use the "assigned fiber" or another one? *AssignedOtherWhich 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 6MBPhoto of VeEx QR code * Drag & Drop Files, Choose Files to Upload Max file size is 6MBSplice Exceptions (ie. NIU placement, height, distances, etc.) *NANO QuestionsIf you cut a NANO for this drop, how long was it? *2nd Address served by this Nano *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWas this a cut or fill or both? *--- Select Choice ---Cut onlyFill onlyCut & FillHeld up by? *--- Select Choice ---Bore neededCustomer canceledCustomer constructionDrop already completeNo accessNo lightNo main line markedResceduleSurvey QuestionsDoes this address need a NEW vault installed? *YesNoDoes this address need a driveway bore?YesNoIs this a Temp to Perm job? *YesNoNearest cross street *Whitelined Date *Will this be a "high cost" drop? *YesNoDoes the property have any of the following: *--- Select Choice ---Sprinkler / Irrigation SystemInvisible Dog FenceNoneIf so, was the customer contacted or a voicemail left? *--- Select Choice ---Spoke to the customerLeft VoicemailPhone number unavailableNo phone call neededSurvey Photo 1 * Drag & Drop Files, Choose Files to Upload Max file size is 6MBSurvey Photo 2 * Drag & Drop Files, Choose Files to Upload Max file size is 6MBSurvey Photo 2 * Drag & Drop Files, Choose Files to Upload Max file size is 6MBFlyer on the door photo * Drag & Drop Files, Choose Files to Upload Max file size is 6MBSurvey Notes *Additional Photo's Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Max file size is 6MBSubmit