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Grha 9 Building

Jl. Penataran No.9, Proklamasi


Jakarta Pusat 10320, Indonesia

SURVEY REPORT FORM


Prepared by

: M . Lutfi dan Puji

EWO Number

: 1629 - 12042011

Approved by

Date EWO

: 12 April -2011

1. CUSTOMER DESCRIPTION :
Customer Name

: Yayasan TZU CHI

PIC Name

: Bp . Danny

Contact Number

: 0811824979

Date of Survey

: 13 April - 2011

Address

: Jl . Kapuk Bolevard Raya , Komp Tzu Chi . Pantai Indah Kapuk ( PIK )

City

: Jakarta Barat

Postal Code

2. SERVICES
Service Type

Fiber Optic

Interface Device

Fiber Optic

Aplication

Capacity

x
x

Wirelless

HRB

Other (specify) ______________________

Ethernet

E1 / T1

Other (specify) ______________________

Leased Line

Internet
2

Mbps

Other (specify) ______________________

IP : / 29

Point to Point

Other ________

Note :
3. SURVEY STATUS :
FAR END (if different from above)
Address

: Yayasan TZU CHI

City

: Jakarta Barat

Postal Code

Latitude

Longitude

EXISTING EQUIPMENT

READY

NO

PROPOSED NEW EQUIPMENT:

STP / UTP

NO
:____m

Tower / Triangle / Pole /

:____m

SST

Electricaly / AC / DC / UPS /

: _ _ _ _ KVA

Triangle : _ _ _ _ m

Electricaly : _ _ _ _ m

Grounding / Arraster / Busbar

: _ _ _ _ ohm

Pole

Grounding : _ _ _ _ m

Other (specify)
______________________________________________
______________________________________________
______________________________________________
______________________________________________

:____m

YES

:____m

Other (specify)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

NEAR END
POP / BTS / SITE Name :
Address

Latitude

EXISTING EQUIPMENT

Longitude
READY

NO

PROPOSED NEW EQUIPMENT:

STP / UTP

NO
:____m

Tower / Triangle / Pole /

:____m

SST

Electricaly / AC / DC / UPS /

: _ _ _ _ KVA

Triangle : _ _ _ _ m

Electricaly : _ _ _ _ m

Grounding / Arraster / Busbar

: _ _ _ _ ohm

Pole

Grounding : _ _ _ _ m

Other (specify)
______________________________________________
______________________________________________
______________________________________________
______________________________________________
(pop / bts Moratelindo)

:____m

YES

:____m

Other (specify)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

Grha 9 Building
Jl. Penataran No.9, Proklamasi
Jakarta Pusat 10320, Indonesia

SURVEY REPORT
1. ONSITE DESCRIPTION :
DIFFICULTY LEVEL FEEDER CABLE / DATA AND COST ESTIMATES DETAILS :

2. CAPTURE IMAGES

Grha 9 Building
Jl. Penataran No.9, Proklamasi
Jakarta Pusat 10320, Indonesia

SURVEY REPORT
3. CONCLUSION

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