Title Page

  • Site Name

  • Site Code

  • Candidate ID

  • Date

  • Pole Coordinates

Attendees

  • Project Manager PM

  • RF Engineer RF

  • State RF Engineer

  • SAM

  • State SAM

  • Transmission Engineer TE

  • State TE

  • Civil Engineer CE

  • Project Engineer PE

  • RMA Planning Consultant PC

  • Real Estate Consultant REC

  • Landowners Representative LP

Site Specific Risk Assessment

  • Airborne pollution The presence of gas, vapour, or particles in the air, both created by the activity and pre-existing. It may be a hazard through inhalation, by affect on the eyes, etc.

  • Control measures and Impact

  • Control measures and Impact

  • Animals/birds etc. Hazard created by animals, birds, insects, etc. both directly and from their waste products. Startling, stings, bites, faeces, viruses carried, etc.

  • Control measures and Impact

  • Control measures and Impact

  • Contractors Persons employed by outside companies working on VFNZ premises. They may be unfamiliar with our safety requirements and their actions may constitute a hazard.

  • Control measures and Impact

  • Control measures and Impact

  • Criminal activity Malevolent damage to plant and equipment, such as tampering with a winch used to carry personnel, or attacks on staff. Vandalism etc

  • Control measures and Impact

  • Control measures and Impact

  • Environmental conditions indoors Conditions within or on a building resulting from, for example, temperature variation, or poor lighting or ventilation, or "sick building syndrome".

  • Control measures and Impact

  • Control measures and Impact

  • Moving vehicles Road accidents, either as vehicle occupant or other road user or bystander. Includes low speed accidents, for example being hit by a reversing lorry.

  • Control measures and Impact

  • Control measures and Impact

  • Obstacles/obstructions Objects such as steps, low doors, abrupt changes of gradient, congested equipment cabinets, protruding pipes, etc. which could cause one to trip, stumble, or bang into something.

  • Control measures and Impact

  • Control measures and Impact

  • Noise Excessive level of acoustic noise which may damage the ears, or noise which obscures warning signals.

  • Control measures and Impact

  • Control measures and Impact

  • Slippery/uneven surfaces Any rough, wet, polished, etc. surface on which one might have to walk or work or move objects, which might cause one to slip or trip.

  • Control measures and Impact

  • Control measures and Impact

  • Topographical factors Adverse characteristics of terrain, for example sleep slopes, deep water, bog, sudden changes of level.

  • Control measures and Impact

  • Control measures and Impact

  • Weather, lightning The direct and indirect effects of lightning and electrical storms, particularly at a site with tall structures.

  • Control measures and Impact

  • Control measures and Impact

  • Weather, other High winds, snow, rain, strong sunlight, very hot or cold conditions.

  • Control measures and Impact

  • Control measures and Impact

  • Contamination Contamination of land, groundwater and/or waterways. That can lead to the destruction of the land leading to loss of vegetation and unable to support wildlife. In turn leading to risk of enforcement action.

  • Control measures and Impact

  • Control measures and Impact

  • Public Presence of non-participants. i.e. factors concerning the risk to others who are not directly involved in the activity, such as members of the public, visitors to site. Assume Non-participants are present unless this is clearly not the case.

  • Control measures and Impact

  • Control measures and Impact

  • M.S.D assessment required by RF for site?

  • M.S.D assessment required for neighboring buildings?

  • Does Vandalism Risk warrant a pole mounted Camera (note privacy issues)

Site Design Information

  • Site Type (RF)

  • Site Type (Structure)

  • If co-locate, choose headframe type:

  • Specify

  • Structure Type

  • Select option

  • Select option

  • Select option

  • BOUNDARY SURVEY REQUIRED

  • Site Category

  • Trans

  • Site Objectives and Coverage Area-RF Engineer to fill in prior to Caravan

BTS & Antenna Requirements (4G)

  • Low Band BTS required?

  • BTS Type Initial Requirements

  • BTS Future Upgrade Path

  • Sector 1

  • Required height of Antennas ( measured at the top of antenna )

  • Antenna type

  • State 'Other' type

  • Antenna Azimuth req

  • MHA/RRH/RRU

  • Expected Tilts ( Electrical and Mechanical )

  • Feeder or Fiber type and route

  • DC Requirements

  • Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)

  • Sector 2

  • Required height of Antennas ( measured at the top of antenna )

  • Antenna type

  • State 'Other' type

  • Antenna Azimuth req

  • MHA/RRH/RRU

  • Expected Tilts ( Electrical and Mechanical )

  • Feeder or Fiber type and route

  • DC Requirements

  • Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)

  • Sector 3

  • Required height of Antennas ( measured at the top of antenna )

  • Antenna type

  • State 'Other' type

  • Antenna Azimuth req

  • MHA/RRH/RRU

  • Expected Tilts ( Electrical and Mechanical )

  • Feeder or Fiber type and route

  • DC Requirements

  • Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)

BTS & Antenna Requirements (5G)

  • High Band BTS required?

  • BTS Type Initial Requirements

  • BTS Future Upgrade Path

  • Sector 1

  • Required height of Antennas ( measured at the top of antenna )

  • Antenna type

  • State 'Other' type

  • Antenna Azimuth req

  • MHA/RRH/RRU

  • Expected Tilts ( Electrical and Mechanical )

  • Feeder or Fiber type and route

  • DC Requirements

  • Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)

  • Sector 2

  • Required height of Antennas ( measured at the top of antenna )

  • Antenna type

  • State 'Other' type

  • Antenna Azimuth req

  • MHA/RRH/RRU

  • Expected Tilts ( Electrical and Mechanical )

  • Feeder or Fiber type and route

  • DC Requirements

  • Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)

  • Sector 3

  • Required height of Antennas ( measured at the top of antenna )

  • Antenna type

  • State 'Other' type

  • Antenna Azimuth req

  • MHA/RRH/RRU

  • Expected Tilts ( Electrical and Mechanical )

  • Feeder or Fiber type and route

  • DC Requirements

  • Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)

Equipment Housing Type

  • Indoor

  • Room or Other description

  • Room size and Condition

  • Cooling and access notes

  • Outdoor

  • Greenfield- Note approx lease area

  • Rooftop – Note Area available

  • Other- Note area size, colour and conditions

  • Note if co-located, requires Air-conditioning, access and any other requirements to make space suitable for Equipment. What is the structure, and any special requirements, colour etc...

DC System Requirements (PE)

  • System

  • Radio Battery Back up (Hours)

  • Trans Battery Back up (Hours)

  • Comments

Transmission Requirements

  • Microwave Transmission?

  • Far end

  • Dish size

  • Height

  • Azimuth

  • Comments (far end caravan required, tree trimming, LOS needed, etc..)

  • Fiber Transmission?

  • On-Net or Off-Net

  • Supplier

  • Nearest fiber location

  • Comments

Access & Conditions

  • Staff Access Restrictions

  • Other Ristrictions

  • Staff Access Comments

  • Vehicle Access - Note Cherry Picker Access (if non-climbable)

  • Vehicle Access Comments

  • Landowner Conditions or Requirements (LR,SA)

  • RMA Conditions or Requirements (PC,SA)

  • Additional info

  • o Base line pole and existing telco cabinet survey required - Note further comments

  • Baseline pole survey required on pole within 100m of site location – RMA planner on site can provide direction on which pole can be used as the baseline pole. Also telco cabinet survey required

  • Rooftop Conditions (CE)

  • Condition of Rooftop

  • Walkways

  • Rooftop Access

  • Penetrations required

  • Existing Antenna works

  • Shrouds, Painting or camouflage required

  • Other Comments

Civil Requirements (CE) - Note any requirements or issues relating to the below items

  • Fencing/Retaining walls

  • Security, Bollards, Stock

  • Environmental issues

  • Salt, Sulphur etc

  • planting / Landscaping

  • Noise conditions (Acoustic fencing?)

  • Geotech

  • Earthwork Management plan required

  • Visual impact of Site - Ensure visual impact is minimised

  • Lightning Risk and Requirements

  • Overhead cables

  • Traffic Management

  • Tree trimming

  • Parking

  • Site security

  • Existing Services

  • Separate Boundary Survey required? (Note - If a roadside pole, or lease area within 3m of boundary, then a survey is needed)

  • Separate Topo survey required?

  • Wind Zone

  • Lease Plan Area (If landscaping is required, include in lease area)

  • Lease & RMA Drawing Required

  • Other Comments

AC Power Requirements (CE) - Note most likely solution

  • On Grid or Off Grid?

  • Nearest Likely AC Source

  • Line Company

  • Transformer req

  • Main Meter or Check Meter

  • Overhead cable available

  • Space for generator

  • Length of power run

  • Easements required

  • Existing power availability

  • AC Power comments

  • Sketch of Electrical design- AC supply route and connection points

Antenna Support Solution (CE)

  • Greenfield Structure Type and Height

  • Building

  • Street pole Type and Height

  • Other

  • Basic Sketch of Site design- Equipment and Antenna Support (CE)

  • Photo of Solution Design

Caravan Sign off

  • Site Caravan sign off (PM)

  • Date

  • Note Issues or info missing

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.