<Customer Name (please do not include a logo) and Project/Deliverable Name>

Site Survey Form ersion <!"y>

Contents
Contents"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" # $ables"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" % Figures""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" & 'bout $(is Site Survey Form"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ) *istory"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ) +evie,"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ) Site Details"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" .lectrical Considerations""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" /0 Cabling"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" /) Net,or1 Sync(roni2ation""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" #3 Carrier Circuits""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ## Perip(eral Data Communications .4uipment""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""#0 Perip(eral oice Communications .4uipment""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""#5 Site Survey Completion""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" %3 'cceptance Certi6icate""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" %3 'cceptance Certi6icate""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" %/

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$ables
$able / +evision *istory"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ) $able # +evision +evie,"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ) $able % Site Details""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" $able 0 Site Details (cont")""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" // $able & .lectrical Considerations""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" /0 $able 5 Cabling""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" /) $able ) Net,or1 Sync(roni2ation""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" #3 $able 7 Carrier Circuits"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ## $able - Perip(eral Data Communications .4uipment"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""#0 $able /3 Perip(eral oice Communications .4uipment"""""""""""""""""""""""""""""""""""""""""""""""""""""""""#5

<Customer Name (please do not include a logo) and Project/Deliverable Name>

$ables

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<Customer Name (please do not include a logo) and Project/Deliverable Name>

Figures
Figure / Site 8ayout""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" //

<Customer Name (please do not include a logo) and Project/Deliverable Name>

&

Figures

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'bout $(is Site Survey Form

Author: !hange Authorit": <Author Name> <Organi ation> <!hange Authorit"> #eference Number: < $ocument #eference Number>

*istory
Table 1 ersion <%.&> Revision History 9ssue Date <dd'mmm' """"> Status <$raft, #eleased> +eason 6or C(ange <(irst release, update, and so on>

+evie,
Table 2 Revision Review ersion <)ersion number> Date <dd'mmm'""""> +evie,er:s Details <Name> <Organi ation>

!hange (orecast: <*igh/+edium/,ow> This document will be kept under revision control. A printed cop o! this document is considered uncontrolled.

<Customer Name (please do not include a logo) and Project/Deliverable Name>

'bout $(is Site Survey Form

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<Customer Name (please do not include a logo) and Project/Deliverable Name>

Site Details
<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table 3

Site Details

/" ;(at is t(e site location/name< #" ;(at is t(e site C889/code< %" ;(at is t(e site address<

0" ;(at is t(e s(ipping address< (if different from the above) &" ;(o is t(e site contact< Name: Title: Telephone: +obile: (a0: 1ager: 2mail: Out of hours contact number: 5" 9s t(is site o,ned and maintained by t(e customer< )" 9s t(is a manned site< 7" ;(at are t(e (ours o6 operation< -" ;(at is t(e number o6 t(e Telephone: 3es/No 4ho: 3es/No

<Customer Name (please do not include a logo) and Project/Deliverable Name>

Site Details

telep(one nearest to t(e Cisco e4uipment and its location< /3" ;(at are t(e building and room access procedures< (For example, must visiting personnel be escorted by customer personnel?) //" 're t(ere any special security/sa6ety procedures< (such as safety glasses, safety shoes, and hard hat areas) /#" ;(at is t(e name and number o6 t(e site coordinator ,(o is responsible 6or ensuring t(at t(e site is prepared ade4uately 6or t(e installation o6 t(e Cisco e4uipment< /%" ;(at ,ill t(e cabinet location be<

,ocation:

3es/No 4hat:

Name: Telephone:

(loor: #oom: 1osition:

1rovide a diagram/s or s.etch/es of the e-uipment location/s to include the following: All !isco e-uipment locations 1ower receptacle locations 5wall, post, or under raised floor6 !ircuit brea.er locations and circuit brea.er number Telco demarc locations $$( locations !able tra" locations ,ocation of other devices

4here applicable, also include diagrams that the route e-uipment must follow to reach this location when it is delivered to the customer site. <$iagrams inserted in the 4indows +etafile format, .wmf, offer significant file si e savings over the )isio e-uivalent and should be used where the original )isio files are being maintained as separate files. 3ou can use other reduced file si e formats where appropriate.>

<Customer Name (please do not include a logo) and Project/Deliverable Name>

/3

Site Details

7e0ample8 Figure 1 Site Layout

-isco Pro.ect !eam )M& 9 6P)sc 1$314
-ustomer/ Pro.ect Manager/ Pro.ect ngineer/ 0escription/ 2riginal 0ate/ ,evision 1/ &1 P$

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+igabit &7itch ,outer

5$346*, ,outer 5$346*, ,outer -atalyst &7itch

-ustomer rac:s

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6P) solution

#ay $
P 1 P$ P1
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Table 4

Site Details (cont.)

/0" ;(at is t(e agreed plan to recti6y any outstanding points 6rom t(is section and any notes or special comments 6or t(e

<Customer Name (please do not include a logo) and Project/Deliverable Name>

//

Site Details

implementation team<

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/#

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/%

.lectrical Considerations
<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table

!lectrical "onsi#erations 3es/No )oltage range: ,ocation: 3es/No )oltage range: ,ocation: 3es/No 91:/;atter" 3es/No !apacit": 3es/No $etails: 3es/No $etails: 3es/No *ow man": $istance: ,ocation: 3es/No $istance:

/" 9s t(e correct 'C po,er source available< (fused 7ithin $m of the -isco e;uipment position) #" 9s t(e correct DC po,er source available< (fused 7ithin $m of the -isco e;uipment position) %" ;ill t(e Cisco e4uipment be po,ered 6rom a =PS ('C) or battery bac1up (DC)< 0" Does t(e bac1up po,er source (ave su66icient capacity 6or t(is ne, e4uipment< &" Does t(is site (ave additional bac1up 6rom generator po,er< 5" 're t(ere any restrictions as to ,(en t(e Cisco e4uipment mig(t be po,ered up< )" 're t(ere any #03v 'C outlets available ,it(in #m o6 t(e Cisco e4uipment 6or perip(eral e4uipment< (such as P-s, test e;uipment) 7" 9s t(ere an isolated eart( point available close to t(e Cisco e4uipment

<Customer Name (please do not include a logo) and Project/Deliverable Name>

/0

.lectrical Considerations

position< -" ;(at is t(e agreed plan to recti6y any outstanding points 6rom t(is section and any notes or special comments 6or t(e implementation team<

,ocation:

<Customer Name (please do not include a logo) and Project/Deliverable Name>

/&

.lectrical Considerations

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/5

Cabling
<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable as such. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table $

"abling 3es/No

/" *as t(e cable sc(edule 6rom t(e S+S document been discussed> and does t(e customer understand/agree ,it( t(e re4uirements< #" 're cables t(at are e!ternal to t(e cabinets to be installed< (such as rac: to rac:, 00F to patch panel) %" 're e!ternal cabling lengt(s ,it(in t(e distances re4uired by t(e e4uipment to avoid signal degradation< 0" ;(ere Cisco ,ill be installing cables t(at are e!ternal to t(e cabinets> are t(ere restrictions on ,(en cables mig(t be pulled over cable trays or under t(e 6loor< &" Do local 6ire codes stipulate t(at special cables are mandatory< 5" 're additional over(ead cable trays> drop posts> or ot(er trun1ing re4uired to install t(e Cisco e4uipment<

3es/No !able run length 5m6: !able run route: 3es/No +a0 cable length:

3es/No $etails:

3es/No !able spec: 3es/No #esponsible part": !ompletion date: $etails:

<Customer Name (please do not include a logo) and Project/Deliverable Name>

/)

Cabling

)" 9s t(ere su66icient clearance under over(ead cable trays< 7" 96 a raised 6loor e!ists> is su66icient space available 6or routing cables< -" ;(at is t(e agreed plan to recti6y any outstanding points 6rom t(is section and any notes or special comments 6or t(e implementation team<

3es/No !learance 5mm6: 3es/No $epth of space 5mm6:

<Customer Name (please do not include a logo) and Project/Deliverable Name>

/7

Cabling

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/-

Net,or1 Sync(roni2ation
<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table %

&etwor' Sync(roni)ation 3es/No :T#AT9+ level: ,ocation: $etails:

/" 9s an e!ternal cloc1 source present at t(is site< #" 96 yes> ,(at level o6 S$+'$=? accuracy does it con6orm to< %" 're t(ere ot(er @uilding 9ntegrated $iming Sources con6igured at t(is site<

3es/No ,ocation: $etails:

0" 96 t(e cloc1 source (as yet to be implemented> ,(at is t(e due date 6or its completion<

$ate: :T#AT9+ level: ,ocation: $etails:

&" *ave primary and secondary timing connection assignments 6or t(e Cisco e4uipment been reserved< 5" ;(at is t(e agreed plan to recti6y any outstanding points 6rom t(is section and any notes or special comments 6or t(e implementation team<

3es/No $etails:

<Customer Name (please do not include a logo) and Project/Deliverable Name>

#3

Net,or1

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#/

Carrier Circuits
<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table *

"arrier "ircuits Destination Circuit $ype/Presentation

/" ;(at is t(e p(ysical presentation o6 t(e telco circuits< (e<g< 8 7ith 5=ohm #)-, !8 7ith !ype >8, &!M91 7ith single9mode fibre and &- connector) %" 96 telco circuits are to be presented via a DDF> ,(at are t(e termination bloc1 identi6iers 6or bot( t(e telco circuits and t(e cables t(at connect to t(e Cisco e4uipment< (such as frame (0, hori?ontal@vertical locator, termination (0) &" ;(at is t(e agreed plan to recti6y any outstanding points 6rom t(is section> and any notes or special comments 6or t(e implementation team<

Destination

Carrier Circuit DDF $ermination @loc1 9D

Cisco .4uipment DDF $ermination @loc1 9D

<Customer Name (please do not include a logo) and Project/Deliverable Name>

##

Carrier Circuits

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#%

Perip(eral Data Communications .4uipment

<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table +

,eri-(eral Data "o..unications !/ui-.ent Customer Device 9D ?anu6acturer/ ?odel 9nter6ace/Cabling

/" ;ill a data communications CP. be connected to t(e Cisco e4uipment at t(is site< (such as 0(,2A1@-isco $=31@*$1 interface 7ith existing 0#1= male cable running Frame ,elay at 1'B> :bps)

&" ;(at is t(e agreed plan to recti6y any outstanding points 6rom t(is section> and any notes or special comments 6or t(e implementation team<

<Customer Name (please do not include a logo) and Project/Deliverable Name>

#0

Perip(eral Data Communications .4uipment

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#&

Perip(eral oice Communications .4uipment

<!omplete or provide in this document additional -uestions or table lines that might be applicable to this customer networ.. /nclude international countr" codes for telephone numbers. +ar. sections that are not applicable. /f space is insufficient for an" answer, continue on separate pages, but indicate that "ou have done this in an appropriate place within this document.>

Table 10

,eri-(eral 1oice "o..unications !/ui-.ent Customer Device 9D ?anu6acturer/ ?odel 9nter6ace/Cabling

/" ;ill any voice communications CP. be connected to t(e Cisco e4uipment at t(is site< (such as 0(P#*1@ ricsson M0113@ 1 +<53> 0P)&& to remote site P#*)

&" 96 P@A circuits are to be presented via a DDF> ,(at are t(e termination bloc1 identi6iers 6or bot( t(e P@A circuits and t(e cables t(at connect to t(e Cisco e4uipment< (such as frame (0, hori?ontal@vertical locator, termination (0)

Circuit 9D

P@A Circuit DDF $ermination @loc1 9D

Cisco .4uipment DDF $ermination @loc1 9D

<Customer Name (please do not include a logo) and Project/Deliverable Name>

#5

Perip(eral oice Communications .4uipment

)" Detail t(e P@A primary and secondary cloc1 sources as currently con6igured" 7" ;(at is t(e agreed plan to recti6y outstanding points 6rom t(is section> as ,ell as any notes or special comments 6or t(e implementation team<

<Customer Name (please do not include a logo) and Project/Deliverable Name>

#)

Perip(eral oice Communications .4uipment

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#7

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#-

'cceptance Certi6icate

Site Survey Completion

!ertificate t"pe: "#escription o! Si$n%o!!& :"stem description: "Customer N'me (ple'se do not include ' lo$o) 'nd *ro+ect,#eliver'ble N'me& $ocument version: -ersion ".. & This :ite :urve" (orm has accuratel" captured the status of relevant ph"sical, electrical, and environmental re-uirements for all the e-uipment to be installed at <!ustomer> premises at <:ite>. The site surve" at <:ite> has been completed and agreed actions recorded for all sections. 1lease note an" comments below. /or 'nd on beh'l! o! Cisco S stems0 Name: 51rint6 /or 'nd on beh'l! o! "Customer&0 Name: 51rint6 !omments, variations or caveats: :ignature: 5:ign6 $ate: :ignature: 5:ign6 $ate:

This A!!21TAN!2 !2#T/(/!AT2 is to be completed/signed and returned to the !isco :"stems pro<ect manager.

Corpor'te 1e'd2u'rters0 Cisco S stems3 Inc.3 456 7est T'sm'n #rive3 S'n 8ose3 CA 9:4;<%456= >SA !op"right = >&&? !isco :"stems, /nc. All rights reserved.

'cceptance Certi6icate
"Check this document '$'inst the !ollowin$ 2u'lit criteri'0
1's this SS/ been checked to ensure consistenc 'nd 'ccur'c in0 Spellin$ 'nd $r'mm'r Ch'pter re!erences ?uestion numberin$ @ener'l !orm'ttin$ 'nd loc'tion o! p'$e bre'ks *'$e numberin$ 'nd d'te !orm'ts

#oes this SS/ det'il how unresolved items will be corrected 'nd how the will be !ed b'ck to the customer 'nd pro+ect te'msA #oes this SS/ cle'rl spell out the responsibilities o! di!!erent p'rtiesBCisco,p'rtner 'nd customerA 1's this SS/ been discussed 'nd '$reed with the customer,user 'nd ' si$n%o!! obt'inedA Is the process !or de'lin$ with test !'ilures cle'rl understoodA Is it cle'r th't i! the site is not re'd 3 or i! subse2uent problems 're !ound3 such issues could del' the implement'tionA 1've 'll inst'nces o! C"Customer&C been repl'ced b the customer n'meA Is there 'n rem'inin$ te.t in "& or DE br'cketsA I! ' p'rtner h's produced this document3 h's the ori$in'l Cisco !orm'ttin$ 'nd st lin$ been ret'inedA Cross%re!erences should be included where 'pplic'ble to e'se *C%b'sed re'din$. (Insert %& Cross% re!erence %& Re!erence t pe %& 1e'din$ %& Insert re!erence to %& 1e'din$ te.t). 7here possible3 documents should be sent to the customer in *#/ !orm't. This s'ves on the document !ile siFe 's well 's securin$ the in!orm'tion cont'ined within it. Gou c'n downlo'd the so!tw're to convert 7ord3 E.cel3 'nd other documents to *#/ !orm't !rom So!tTr'cker ('t http://wwwin'download.cisco.com) under the he'din$ Adobe Acrob't <.6.= (not Acrob't Re'der) !or ' sm'll ch'r$e. Even with the ch'r$e3 however3 this so!tw're should be considered 's necess'r !or our work 's -isio or other purch'sed so!tw're. The pro+ect m'n'$er 'nd customer should '$ree to 'n ch'n$es3 's necess'r .

*le'se remove these 2u'lit criteri' be!ore customer distribution.&

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