Fiber Solutions

Structured Cabling Site Survey

Your Name*
First Last
Your Email*
Date
MM slash DD slash YYYY
Client Name
Contact Name
First Last
Contact Phone
Address where work will be performed
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Who, if anyone, will walk the job with technician?
Estimated client budget
Please provide a detailed scope of work to be performed:
Cabling/Fiber distances and/or limitations?
Does the site have open or closing times, or special after-hours needs?
- Yes
- No
If so, what are they?
How high is the ceiling?
What type of ceiling?
- Open
- Drop
- Hard Coat
- Other
Fiber environment
- Plenum
- Riser
- Outdoor
What type of pathway is there?
- J-hook
- EMT
- PVC
- No existing pathway
- Other
Is it new construction or retro fit?
- New
- Retro fit
Describe existing infrastructure (if any) in detail:
Jacks/Faceplates brand and color
Brand Color
Describe patch panels/wire management requirements:
What types of walls are there?
- Drywall
- Block
- Tilt wall
- Other
Are there existing penetrations or are we bringing/installing them?
- Existing
- We are bringing/installing
New or existing MDF/IDF?
- New
- Existing
Will a lift be required for installation?
- Yes
- No
Please provide any additional relevant details:
Please upload any site photographs or prints.
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Brand	Color