Appendix4 C

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

Site Survey Form
Version <x.y>
Contents
Contents 2
Tables 3
Figures 5
About This Site Survey Form 7
History 7
Review 7
Site Details 9
Electrical Considerations 15
Cabling 19
Network Synchronization 22
Carrier Circuits 24
Peripheral Data Communications Equipment 26
Peripheral Voice Communications Equipment 28
Site Survey Completion 32
<SECTION BREAK
To avoid header/footer and page setup problems, do not remove the carriage return following this line.>
<Customer Name (please do not include a logo) and Project/Deliverable Name> 2

Tables
Table 1 Revision History 7
Table 2 Revision Review 7
Table 3 Site Details 9
Table 4 Site Details (cont.) 12
Table 5 Electrical Considerations 15
Table 6 Cabling 19
Table 7 Network Synchronization 22
Table 8 Carrier Circuits 24
Table 9 Peripheral Data Communications Equipment 26
Table 10 Peripheral Voice Communications Equipment 28

Tables
<SECTION BREAK

Figures
Figure 1 Site Layout 11

Figures
<SECTION BREAK

About This Site Survey Form
Author: <Author Name>

<Organization>
Change Authority: <Change Authority>
Reference Number: < Document Reference Number>
History
Table 1 Revision History
Version Issue Date Status Reason for Change

<1.0> <dd-mmm- <Draft, Released> <First release, update, and so on>
yyyy>
Review
Table 2 Revision Review
Reviewer's Details Version Date

<Name> <Version number> <dd-mmm-yyyy>
<Organization>
Change Forecast: <High/Medium/Low>
This document will be kept under revision control.

A printed copy of this document is considered uncontrolled.

About This Site Survey Form
<SECTION BREAK

Site Details
<Complete or provide in this document additional questions or table lines that might be applicable to this
customer network. Include international country codes for telephone numbers. Mark sections that are not
applicable. If space is insufficient for any answer, continue on separate pages, but indicate that you have
done this in an appropriate place within this document.>
Table 3 Site Details
1. What is the site

location/name?
2. What is the site
CLLI/code?
3. What is the site address?
4. What is the shipping

address?
(if different from the above)
5. Who is the site contact? Name:
Title:
Telephone:
Mobile:
Fax:
Pager:
Email:
Out of hours contact number:
6. Is this site owned and Yes/No

maintained by the
customer? Who:
7. Is this a manned site? Yes/No
8. What are the hours of

operation?

Site Details
9. What is the number of the Telephone:

telephone nearest to the
Cisco equipment and its Location:
location?
10. What are the building and
room access procedures?
(For example, must visiting
personnel be escorted by
customer personnel?)
11. Are there any special Yes/No
security/safety
procedures? What:
(such as safety glasses, safety

shoes, and hard hat areas)
12. What is the name and Name:
number of the site
coordinator who is Telephone:
responsible for ensuring
that the site is prepared
adequately for the
installation of the Cisco
equipment?
13. What will the cabinet Floor:
location be?
Room:
Position:
Provide a diagram/s or sketch/es of the equipment location/s to include the following:
All Cisco equipment locations

Power receptacle locations (wall, post, or under raised floor)
Circuit breaker locations and circuit breaker number
Telco demarc locations
DDF locations
Cable tray locations
Location of other devices
Where applicable, also include diagrams that the route equipment must follow to reach this location when
it is delivered to the customer site.
<Diagrams inserted in the Windows Metafile format, .wmf, offer significant file size savings over the Visio
equivalent and should be used where the original Visio files are being maintained as separate files. You can
use other reduced file size formats where appropriate.>

Site Details
[example]
Figure 1 Site Layout

Cisco Project Team
Anti-static table
NMS - VPNsc
Gigabit Switch Router

12016
Customer:
Project Manager: P2 7206VXR Router

Customer racks
Project Engineer:
PE1 7206VXR Router
Description:
Original Date: S1 Catalyst Switch

Revision #:
AC power disribution
Cisco Project Team

Bay 3
Storage
Chancery Lane Telehouse Manchester Leeds
VPN solution
Bay 2
PE1 PE1 PE1
S2 S1 P2 P2
P2
Earth
P1 LINX AS1299 P1 P1 P1
DC power
AC power
P1 LINX AS1299 P1 P1 P1 P1
P2 P2 P2
S2 S1 PE1
PE1 PE1 PE1
Earth
Bay 1
Storage
Gloucester Road Harbour Exchange Birmingham Edinburgh Reading

Site Details
Table 4 Site Details (cont.)
14. What is the agreed plan to

rectify any outstanding
points from this section
and any notes or special
comments for the
implementation team?

Site Details
<SECTION BREAK

Electrical Considerations
Table 5 Electrical Considerations
1. Is the correct AC power Yes/No

source available?
Voltage range:
(fused within 2m of the Cisco
equipment position) Location:
2. Is the correct DC power Yes/No

source available?
Voltage range:
(fused within 2m of the Cisco
equipment position) Location:
3. Will the Cisco equipment Yes/No

be powered from a UPS
(AC) or battery backup UPS/Battery
(DC)?
4. Does the backup power Yes/No
source have sufficient
capacity for this new Capacity:
equipment?
5. Does this site have Yes/No
additional backup from
generator power? Details:
6. Are there any restrictions Yes/No

as to when the Cisco
equipment might be Details:
powered up?
7. Are there any 240v AC Yes/No
outlets available within 2m
of the Cisco equipment for How many:
peripheral equipment? Distance:
(such as PCs, test equipment)
Location:

8. Is there an isolated earth Yes/No

point available close to the
Cisco equipment Distance:
position? Location:


comments for the

<SECTION BREAK

Cabling
applicable as such. If space is insufficient for any answer, continue on separate pages, but indicate that you
have done this in an appropriate place within this document.>
Table 6 Cabling
1. Has the cable schedule Yes/No

from the SRS document
been discussed, and does
the customer
understand/agree with the
requirements?
2. Are cables that are Yes/No
external to the cabinets to
be installed? Cable run length (m):
(such as rack to rack, DDF to Cable run route:

patch panel)
3. Are external cabling Yes/No
lengths within the
distances required by the Max cable length:
equipment to avoid signal
degradation?
4. Where Cisco will be Yes/No
installing cables that are
external to the cabinets, Details:
are there restrictions on
when cables might be
pulled over cable trays or
under the floor?
5. Do local fire codes Yes/No
stipulate that special
cables are mandatory? Cable spec:
6. Are additional overhead Yes/No

cable trays, drop posts, or
other trunking required to Responsible party:
install the Cisco Completion date:
equipment?
Details:

Cabling
7. Is there sufficient Yes/No

clearance under overhead
cable trays? Clearance (mm):
8. If a raised floor exists, is Yes/No

sufficient space available
for routing cables? Depth of space (mm):

comments for the

Cabling
<SECTION BREAK

Network Synchronization
Table 7 Network Synchronization
1. Is an external clock source Yes/No

present at this site?
2. If yes, what level of STRATUM level:
STRATUM accuracy does
it conform to? Location:
Details:
3. Are there other Building Yes/No

Integrated Timing Sources
configured at this site? Location:
Details:
4. If the clock source has yet Date:

to be implemented, what is
the due date for its STRATUM level:
completion? Location:
Details:
5. Have primary and Yes/No

secondary timing
connection assignments Details:
for the Cisco equipment
been reserved?
comments for the

Network
<SECTION BREAK

Carrier Circuits
Table 8 Carrier Circuits
1. What is the Destination Circuit Type/Presentation

physical
presentation of the
telco circuits?
(e.g. E3 with 75ohm
BNC, T3 with Type 43,
STM-1 with single-mode
fibre and SC connector)
3. If telco circuits are Destination Carrier Circuit DDF Cisco Equipment DDF
to be presented via Termination Block ID Termination Block ID
a DDF, what are the
termination block
identifiers for both
the telco circuits
and the cables that
connect to the
Cisco equipment?
(such as frame ID,
horizontal/vertical
locator, termination ID)
5. What is the agreed
plan to rectify any
outstanding points
from this section,
and any notes or
special comments
for the
implementation
team?

Carrier Circuits
<SECTION BREAK

Peripheral Data Communications
Equipment
Table 9 Peripheral Data Communications Equipment
1. Will a data Customer Device ID Manufacturer/ Model Interface/Cabling

communications
CPE be connected
to the Cisco
equipment at this
site?
(such as
EDIROU1/Cisco
2501/X21 interface with
existing DB15 male
cable running Frame
Relay at 1984 kbps)

plan to rectify any
outstanding points
from this section,
and any notes or
special comments
for the
implementation
team?

Peripheral Data Communications Equipment
<SECTION BREAK

Peripheral Voice Communications
Equipment
Table 10 Peripheral Voice Communications Equipment
1. Will any voice Customer Device ID Manufacturer/ Model Interface/Cabling

communications
CPE be connected
to the Cisco
equipment at this
site?
(such as
EDIPBX1/Ericsson
MD110/E1 G.704
DPNSS to remote site
PBX)
5. If PBX circuits are Circuit ID PBX Circuit DDF Cisco Equipment DDF
to be presented via Termination Block ID Termination Block ID
a DDF, what are the
termination block
identifiers for both
the PBX circuits
and the cables that
connect to the
Cisco equipment?
(such as frame ID,
horizontal/vertical
locator, termination ID)

Peripheral Voice Communications Equipment
7. Detail the PBX

primary and
secondary clock
sources as
currently
configured.
plan to rectify
outstanding points
from this section,
as well as any
notes or special
comments for the
implementation
team?

Peripheral Voice Communications Equipment
<SECTION BREAK

<SECTION BREAK

Acceptance Certificate
Site Survey Completion

Certificate type: <Description of Sign-off>
System description: <Customer Name (please do not include a logo) and Project/Deliverable Name>
Document version: Version <x.y>
This Site Survey Form has accurately captured the status of relevant physical, electrical, and environmental
requirements for all the equipment to be installed at <Customer> premises at <Site>.
The site survey at <Site> has been completed and agreed actions recorded for all sections.
Please note any comments below.
For and on behalf of Cisco Systems:

Name: Signature: Date:
(Print) (Sign)
For and on behalf of <Customer>:

Name: Signature: Date:
(Print) (Sign)
Comments, variations or caveats:
This ACCEPTANCE CERTIFICATE is to be completed/signed and returned to the Cisco Systems project
manager.
Corporate Headquarters: Cisco Systems, Inc., 170 West Tasman Drive, San Jose, CA 95134-1706 USA
Copyright 2003 Cisco Systems, Inc. All rights reserved.

Acceptance Certificate
<Check this document against the following quality criteria:
Has this SSF been checked to ensure consistency and accuracy in:
Spelling and grammar
Chapter references
Question numbering
General formatting and location of page breaks
Page numbering and date formats
Does this SSF detail how unresolved items will be corrected and how they will be fed back to the
customer and project teams?
Does this SSF clearly spell out the responsibilities of different partiesCisco/partner and customer?
Has this SSF been discussed and agreed with the customer/user and a sign-off obtained?
Is the process for dealing with test failures clearly understood?
Is it clear that if the site is not ready, or if subsequent problems are found, such issues could delay the
implementation?
Have all instances of "<Customer>" been replaced by the customer name?
Is there any remaining text in <> or [] brackets?
If a partner has produced this document, has the original Cisco formatting and styling been
retained?
Cross-references should be included where applicable to ease PC-based reading. (Insert -> Cross-
reference -> Reference type -> Heading -> Insert reference to -> Heading text).
Where possible, documents should be sent to the customer in PDF format. This saves on the
document file size as well as securing the information contained within it. You can download the
software to convert Word, Excel, and other documents to PDF format from SoftTracker (at
http://wwwin-download.cisco.com) under the heading Adobe Acrobat 4.0.6 (not Acrobat Reader) for a
small charge. Even with the charge, however, this software should be considered as necessary for
your work as Visio or other purchased software. The project manager and customer should agree to
any changes, as necessary.
Please remove these quality criteria before customer distribution.>

<SECTION BREAK

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<Customer Name (please do not include a logo)

and Project/Deliverable Name>

About This Site Survey Form 7

Peripheral Data Communications Equipment 26

Peripheral Voice Communications Equipment 28

Site Survey Completion 32

<Customer Name (please do not include a logo) and Project/Deliverable Name> 2

Table 1 Revision History 7

Table 2 Revision Review 7

Table 3 Site Details 9

Table 4 Site Details (cont.) 12

Table 5 Electrical Considerations 15

Table 7 Network Synchronization 22

Table 8 Carrier Circuits 24

Table 9 Peripheral Data Communications Equipment 26

Table 10 Peripheral Voice Communications Equipment 28

<Customer Name (please do not include a logo) and Project/Deliverable Name> 3

<Customer Name (please do not include a logo) and Project/Deliverable Name> 4

Figure 1 Site Layout 11

<Customer Name (please do not include a logo) and Project/Deliverable Name> 5

<Customer Name (please do not include a logo) and Project/Deliverable Name> 6

Author: <Author Name>

Version Issue Date Status Reason for Change

Reviewer's Details Version Date

Change Forecast: <High/Medium/Low>

This document will be kept under revision control.

<Customer Name (please do not include a logo) and Project/Deliverable Name> 7

<Customer Name (please do not include a logo) and Project/Deliverable Name> 8

Table 3 Site Details

1. What is the site

4. What is the shipping

6. Is this site owned and Yes/No

7. Is this a manned site? Yes/No

8. What are the hours of

<Customer Name (please do not include a logo) and Project/Deliverable Name> 9

9. What is the number of the Telephone:

(such as safety glasses, safety

Provide a diagram/s or sketch/es of the equipment location/s to include the following:

All Cisco equipment locations

<Customer Name (please do not include a logo) and Project/Deliverable Name> 10

Figure 1 Site Layout

Gigabit Switch Router

Project Manager: P2 7206VXR Router

Original Date: S1 Catalyst Switch

Cisco Project Team

Chancery Lane Telehouse Manchester Leeds

PE1 PE1 PE1

<Customer Name (please do not include a logo) and Project/Deliverable Name> 11

Table 4 Site Details (cont.)

14. What is the agreed plan to

<Customer Name (please do not include a logo) and Project/Deliverable Name> 12

<Customer Name (please do not include a logo) and Project/Deliverable Name> 13

Table 5 Electrical Considerations

1. Is the correct AC power Yes/No

2. Is the correct DC power Yes/No

3. Will the Cisco equipment Yes/No

6. Are there any restrictions Yes/No

<Customer Name (please do not include a logo) and Project/Deliverable Name> 15

8. Is there an isolated earth Yes/No

<Customer Name (please do not include a logo) and Project/Deliverable Name> 16

9. What is the agreed plan to

<Customer Name (please do not include a logo) and Project/Deliverable Name> 17

<Customer Name (please do not include a logo) and Project/Deliverable Name> 18

1. Has the cable schedule Yes/No