Onsite Survey Form

Surveyed by: …………………………………………………………………………. (Company Name)

…………………………………………………………………………. (First Name, Last Name)

…………………………………………………………………………. (Date)

End Customer: XXX

Customer: XXX
Project Name: YYY
To be installed onsite: (Description of Expereo service to be installed)

SITE & ONSITE CONTACT DETAILS

Site Details Expereo Information Corrected Information

Company Name:
Address 1:
Address 2:
Postal Code:
City:
State/Province:
Country:

Onsite Contact 1 Expereo Information Corrected Information

Name: [M] Mr./Mrs.
Job Title:
Email: [M]
Phone: [M] + +
Mobile: + +
Skype:

Onsite Contact 2 Expereo Information Corrected Information

Name: Mr./Mrs.
Job Title:
Email:
Phone: + +
Mobile: + +
Skype:
[M] = Mandatory

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Onsite Survey Form
BUILDING & INFRASTRUCTURE DETAILS (see also Annex A – Site Diagram)
# Question
1 In which type of building is the office located?
2 Does (End Customer) own the building? If not, please
provide contact details of the owner/property
manager/landlord.
3 Is there any building construction work pending or
planned, which might impact the installation of the
service?
4 On which days, and between which hours, can the
installation work be performed?
5 Are there any access authorizations required (passes,
keys, etc.)? If authorization is needed, how and how
long in advance do we need to request
authorization?
6 Where is the ‘carrier demarcation room’ in the
building (the room/location where the copper/fiber
infrastructure enters the building)?
7 Where is the ‘(End Customer) data room’ in the
building i.e. the room/location where the service
related terminating equipment is installed (typically a
modem, switch or router) ?
8 What is the distance between the ‘carrier
demarcation room’ (see 6) and the ‘(End Customer)
data room’ (see 7)?
9 Is there existing internal wiring between the ‘carrier
demarcation room’ (see 6) and the ‘(End Customer)
data room’ (see 7) and can it be used for the Internet
service?
Answer
 Single-tenant office building
 Multi-tenant office building
 Data center
 Other: …………………………………………………..
 YES  NO
If NO, please fill out the following for owner/property
manager/landlord:
Company Name: ……………………………………………………
Address: ……………………………………………………………..…
City: ………………………………………………………………….……
Country: …………………………………………………………………
Contact Name: ………………………………………………………
Phone: ………………………………………………………………..…
Mobile: …………………………………………………………….……
Email: ……………………………………………………………….……
Days: …………………………..
Hours: From …….. until ………
Floor:
Room/Suite:
Floor:
Room/Suite:
Rack:
HE:
Distance: ………………………………………………ft/meters
Existing internal wiring: YES/NO
Type of internal wiring: …………………
Wiring can be used: YES/NO
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Onsite Survey Form
10 If the internal wiring as mentioned in question 9 does
not exist or cannot be used, describe who we should
contact to discuss this missing internal wiring (e.g.
who will install it, etc.)
11 If the internal wiring as mentioned in question 9 does
not exist or cannot be used, describe who is allowed
to install the required ‘internal wiring’
12 Is there enough space (= 10cm / 4 inch or more) in
the ‘(End Customer) data room’ (see 7) to install the
service related equipment (e.g. modem, router and
or switch)?
13 Are there enough AC power sockets (at least 2)
available in the ‘(End Customer) data room’ (see 7)
within 1.5 m (5 ft) of the service related equipment?
Company: ……………………………………………………………….
Contact Name: ………………………………………………………..
Contact Email: …………………………………………………………
Contact Phone: ……………………………………………………….
 (User name) is allowed to do it.
 Any 3rd party is allowed to do it.
 Only the following company is allowed to do it:
Company: ……………………………………………………………….
Contact Name: ………………………………………………………..
Contact Email: …………………………………………………………
Contact Phone: ……………………………………………………….
 Don’t know.
YES/NO
YES/NO
……..

SITE PICTURES

Make pictures of:

1. The ‘carrier demarcation room’ in the building (the room/location where the copper/fiber infrastructure
enters the building);
2. The ‘(End Customer) data room’ i.e. the room/location where the Internet service related terminating
equipment is installed (typically a modem, switch or router) ;
3. The place in the ‘(End Customer) data room’ where the Internet service related terminating equipment needs
to be installed;
4. Any other relevant room, cabinet, or item.

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Onsite Survey Form

ADDITIONAL COMMENTS/FINDINGS

*** END OF ONSITE SURVEY ***

After completion of this onsite survey,

please email the completed form and the pictures to provisioning@expereo.com.

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Onsite Survey Form

Annex A – Site Diagram

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