CO Initial Site Survey

• Central Office Name

• Application ID

• SL job#

• Conducted on

  Date
• Location
  Address

• Prepared by

OSPE Contact

• Name

• Phone Number(s)

Relay Rack or Proposed Relay Rack Location

• Rack #

• Picture of Existing Rack or Proposed Location of Rack

  Media

Pre-Term Cable 1

• Count:

• Length:

Pre-Term Cable 2

• Count:

• Length:

Vault

• Picture:

  Media

Route 1 MMP

• Scope of Work:

• Collector Shot of Route 1

  Media

• AT&T MH to SL HH

  Media

Route 2 MMP

• Scope of Work:

• Collector Shot of Route 2

  Media

• AT&T MH to SL HH

  Media

Sign Off

• Operator's signature

  Sign

• OSPE's signature

  Sign