Site Survey The site survey will include: Walk through of End User site Wiring closet and

nd equipment cabinet reviews Check Phone Room for space to mount IAD and related 66 blocks and a Checkpoint SOHO MFW (Managed Firewall) in close proximity to the existing phone system. If adequate, clearly label space (tape a piece of paper to the area indicating it is for IAD and MFW) where the hardware is to be mounted, and where dmarc is to be extended o If space/backboard is not adequate, install Customer-provided backboard to accommodate IAD and MFW and label space where hardware is to be mounted. Review, document, and photograph the current telephone and data wiring configurations for both customer MPOE and customer phone system location if not co-located. Location of the IAD, IADs 66-block Determine if the new punch-down block can be installed in close proximity to the existing phone punch-down block (note: Vital installs the 66 block along with the IAD and MFW in a separate visit) Determine and document requirements for rerouting PSTN access from existing system to new Customer IAD access o Determine if the current telephone wiring scheme is adequate in order to move current telephone wiring to new Customer IAD be completed with minimal downtime. Provide tone test if necessary on each line (no more than 10 lines) to determine which lines are active Verify which of lines determined to be active are IN USE (voice, fax, modem, or alarm) Compare End User-provided CSR (Customer Service Record) or circuit invoice/bill for the site (lines being billed) to lines actually in use. o If site/cable infrastructure cannot be toned and tested due to site constraints i.e. lack-of-organization, closet conditions etc. Vital will not be able to complete this item. AC power and UPS system requirements verification Adequate cooling and ventilation check Appropriate cable measurements, including any cable run obstructions noted Tasks required for installation/maintenance readiness Notify End User and Customer teams of number of lines calls rollover to when first dialed line is busy, POTS lines in use by fax/alarm (to be retained) and POTS lines not in use (customer to disconnect).

Mental Health Systems, Inc. Site Survey Form

Date of Site Survey: Technician Performing Survey: CSR Available: ____Yes ____No Program Name: Site Physical Address: City: State: Zip: Suite #: Floor: Building Name:
(If applicable)

Hours of Operation: Other MHS Programs co-located in same Building: Suite #s:
(Additional Site Survey Form should be completed separately)

Program Contact Information Primary Contact Name: Primary Contact Telephone #: Primary Contact Cell Phone #:
(If available)

Primary Contact email: Alt. Contact Name: Alt. Contact Telephone #: Alt. Contact Cell Phone #:
(If available)

Alt. Contact Email:

MPOE Location:
(If co-located with Program phone room, indicate co-located and provide location details under Phone Room Location)

Contact Information for MPOE access:

(if necessary)

MPOE Access Contact Name: MPOE Access Contact Telephone #: MPOE Access Contact Cell Phone #:
(If available)

MPOE Access Contact email: Additional Notes/requirements for MPOE access:

Phone Room Location: Adequate Wall Space Current Location for installation of Adit unit: ____Yes _____No If yes, is there an existing backboard: ____Yes ____ No If yes, is there adequate space on current backboard. ____ Yes ____No If yes, backboard space labeled for equipment installation. ___Yes ____ No Notes: If no, is there adjacent wall space for backboard mounting: ____Yes ___ No If yes, is wall space labeled for backboard mounting ____ Yes ____ No Notes: If no, recommendations of possible solutions:

Determine if the new punch-down block can be installed in close proximity to the existing phone punch down block. ___Y ___N

Program Phone System:

(Manufacturer and model)

If phone system is digital need the following information: Current Phone Configuration: Current Hunt sequence for Program: 1) Main number/ Hunt 12) Extra line/ Hunt 2 3) Extra line/ Hunt 3 4) Extra line/ Hunt 4 5) Extra line/ Hunt 5 6) Extra line/ Hunt 6 (Add additional lines as needed)

PORT DO NOT PORT DO NOT PORT DO NOT PORT DO NOT PORT DO NOT PORT

Total Number of lines tied into Phone system for surveyed program:
(If additional lines are connected to phone system beyond Hunt Group- e.g. Testing Line (i.e. specialized line that needs VM), backdoor number not tied to hunt group)

1) Additional Line 1Purpose2) Additional Line 2Purpose3) Additional Line 3Purpose4) Additional Line 4PurposeDoes another Program share this phone system? _______ Yes _______No If yes, Program Name: Do they have a separate Hunt Group? _______ Yes _______No
(Additional Site Survey Form should be completed separately)

Additional POTS Lines NOT tied to Phone system but in USE at Program:
(Examples: Drug Testing Line, Alarm, DSL/Fax, Modems, Billing Applications (e.g Insyst, SIMON, )

1) Additional Line 1Purpose-

2) Additional Line 2Purpose3) Additional Line 3Purpose4) Additional Line 4PurposeWhen CSR(s) are compared to actual lines, are discrepancies found? If yes, please describe: Is network equipment/infrastructure co-located with phone system? _____ Yes ______ No
(data jack patch panel, switch, server, etc.)

If no, please provide detail on location of equipment, noting additional cabling needs and any possible cable run obstructions: Additional Needs/Requirements: Outgoing Caller ID Other Caller ID issues: External Voicemail boxes with LEC Specialized lines details: Does program have any 800 numbers and what line does each ring to?

(If backboard is needed)

PLACE BACKBOARD HERE

ADIT

66 BLOCK

CHECKPOINT SOHO MFW

(Managed Firewall)