Equipment Maintenance Splicing Log Form
Record operational details for each splicing maintenance event on equipment.
Equipment ID or Serial Number
*
Equipment Type
*
Please Select
Cable
Splice Enclosure
Connector
Panel
Distribution Box
Other
Date of Maintenance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Splicing Job Type
*
Please Select
Fusion Splicing
Mechanical Splicing
Re-Splicing
Testing Only
Other
Technician Name
*
First Name
Last Name
Materials Used (select all that apply)
*
Splice Sleeves
Heat Shrink Tubing
Connectors
Cleaning Supplies
Protective Gel
Other
Condition Before Maintenance
*
Please Select
Good
Fair
Poor
Damaged
Other
Condition After Maintenance
*
Please Select
Good
Fair
Requires Further Attention
Other
Work Performed (describe actions taken)
*
Completion Notes / Additional Remarks
Submit Log
Should be Empty: