THIS IS BRIEF FOR EXAMPLE ONLY

Ø SEE REPORT Structure # ______________

CHECKLIST (General)

SEE ATTACHMENTS FOR ADDITIONAL INFORMATION

NOTE: This checklist is designed to inventory a pole from top to bottom.

► (Pole ground 4 or 8 per mile) Rule 96C & 92D

→Identify Button Info #________ _________ ___________

→Identify phases __ 1 ph ___ 2 ph ___ 3 ph ___Other _________________

→Identify conductor’s ______________________

→Identify Neutral _____________________

→Identify Equipment (transformers) most are single phase _______amps?

○ □ Verify Equipment is grounded.

○ □ Verify Equipment ground bonding and bonding location.

( ) Bonded to Neutral (Transformer ground to neutral)?

( ) Bonded to Ground wire (Equipment ground to ground)?

○ □ Verify other Equipment, (cutouts, etc. Arresters to ground).

NOTE: EQUIPMENT must be GROUNDED / BONDED

TRANSFORMER MUST BE GROUNDED TO GROUND ROD.

→Identify Secondary’s

○ □ Secondary Crossover roads, sidewalks, driveways, ___16 ft _______ Other Rule 230C2) 232(1)

○ □ Clearance yards, ____12 ft ______ Other Rule 230C

○ □ Verify Secondary Rack to ground wire (bonded)

→GUY/INSULATOR/GUARDS

○ □ Verify Guy grounding / Insulated Rule 92C2

○ □ Verify Insulators attached (as required) If guy wire is close or crossover Primary, Secondary, Equipment.

○ □ Verify guards are installed as necessary. (Public access) Rule 93D2

○ □ Verify Insulators are installed a minimum of 8 ft from ground. Rule 279A2 (b) (1)

→Identify Street Lights (as applicable)

○ □ Verify Secondary source to requirements (2”) Rule 238D

□ Verify Grounding and bonding. Rule 230C(3)

ATTACHMENTS

→Identify Vendor attachments ( _____Cable, ____Teleco, _____ Fiber, )

○ □ Verify Attachment clearance to lowest power source on pole (Primary or Secondary) (40”) Rule 238B

○ □ Verify Attachment along roads/ Crossover roads/alleys/commercial driveways ______ 15.5 ft. Rule230E1(24)

○ □ Verify Attachment, over residential driveways, ___11.5 ft _______ Other Rule 232A & 232-1

○ □ Verify Attachment Clearance sidewalks, yards, house attachment, ____9.5ft ______ Other Rule 232-1

NOTE: Street light power source (exceptions)

○ □ Verify clearances between attachments. (12”) See exceptions if applicable Rule 235C(1) ex(3)

○ □ Verify grounding of attachment messengers. Bonding Rule 92C3

GROUNDING

○ □ Verify ground wire to ground rod.

○ □ Verify ground rod below top of ground Rule 94B2

RISER

○ □ Verify Secondary from/to top of Riser is 40” clearance from communication cables Rule 236E & 235C1

○ □ Verify bottom Riser attachment are separated 8 ft apart. Minimum Rule 217A2(c)

○ □ Verify ground of Riser (as required) Rule 239D

POLE

○ □ Verify setback of 6” from edge of street (curb) ______ Rule 231B(1)

○ □ Verify pole steps 8 ft above ground Rule 217A & 239D

MID-SPAN

○ □ Verify Cable to Cable clearance 12”. (See exceptions) Rule 235C1 & 235H

Communication clearance from Neutral / Secondary - __30” ____ Other Rule 232B1

SPECIAL CLEARANCES

○ □ Verify RAILROADS _______23.5 ft. Exception _______26.5 FT. Rule 231C

○ □ Verify Fire hydrants _______4’ft. Exception _______3’ FT Rule 231A

THIS FORM IS CONFIDENTIAL AND MAY NOT BE COPIED OR REPRODUCED IN ANY FORM WITHOUT THE WRITTEN CONSENT FROM QUALITY RESOURCE & SERVICES.