Title Page
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Site Name
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Site Code
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Candidate ID
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Date
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Pole Coordinates
Attendees
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Project Manager PM
- Carl Westerman
- Wes Bonney
- Darren Stott
- Dawie Le Roux
- Lee Rapson
- Arvin Nakshan
- Craig Hunter
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RF Engineer RF
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State RF Engineer
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SAM
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State SAM
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Transmission Engineer TE
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State TE
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Civil Engineer CE
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Project Engineer PE
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RMA Planning Consultant PC
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Real Estate Consultant REC
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Landowners Representative LP
Site Specific Risk Assessment
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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.
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Control measures and Impact
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Control measures and Impact
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Animals/birds etc. Hazard created by animals, birds, insects, etc. both directly and from their waste products. Startling, stings, bites, faeces, viruses carried, etc.
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Control measures and Impact
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Control measures and Impact
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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.
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Control measures and Impact
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Control measures and Impact
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Criminal activity Malevolent damage to plant and equipment, such as tampering with a winch used to carry personnel, or attacks on staff. Vandalism etc
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Control measures and Impact
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Control measures and Impact
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Environmental conditions indoors Conditions within or on a building resulting from, for example, temperature variation, or poor lighting or ventilation, or "sick building syndrome".
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Control measures and Impact
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Control measures and Impact
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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.
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Control measures and Impact
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Control measures and Impact
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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.
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Control measures and Impact
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Control measures and Impact
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Noise Excessive level of acoustic noise which may damage the ears, or noise which obscures warning signals.
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Control measures and Impact
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Control measures and Impact
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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.
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Control measures and Impact
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Control measures and Impact
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Topographical factors Adverse characteristics of terrain, for example sleep slopes, deep water, bog, sudden changes of level.
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Control measures and Impact
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Control measures and Impact
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Weather, lightning The direct and indirect effects of lightning and electrical storms, particularly at a site with tall structures.
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Control measures and Impact
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Control measures and Impact
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Weather, other High winds, snow, rain, strong sunlight, very hot or cold conditions.
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Control measures and Impact
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Control measures and Impact
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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.
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Control measures and Impact
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Control measures and Impact
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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.
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Control measures and Impact
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Control measures and Impact
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M.S.D assessment required by RF for site?
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M.S.D assessment required for neighboring buildings?
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Does Vandalism Risk warrant a pole mounted Camera (note privacy issues)
Site Design Information
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Site Type (RF)
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Site Type (Structure)
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If co-locate, choose headframe type:
- Single Stack
- Double Stack
- Short Arm
- Spider Arm/Long Arm
- Carousel
- Other
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Specify
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Structure Type
- Roadside - Antenna above the light
- Roadside - Antenna below the light
- Roadside - Stand alone structure
- Monopole
- Guyed Mast
- Lattice Tower
- Wooden Pole
- Concrete Pole
- Rooftop
- In-Building
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Select option
- Replacement
- Stand Alone
- Existing (locate on exiting pole)
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Select option
- Replacement
- Stand Alone
- Existing (Locate on an existing pole)
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Select option
- Replacement
- Stand Alone
- Existing (Locate on an existing pole)
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BOUNDARY SURVEY REQUIRED
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Site Category
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Trans
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Site Objectives and Coverage Area-RF Engineer to fill in prior to Caravan
BTS & Antenna Requirements (4G)
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Low Band BTS required?
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BTS Type Initial Requirements
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BTS Future Upgrade Path
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Sector 1
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Required height of Antennas ( measured at the top of antenna )
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Antenna type
- 80010991
- 80010992
- 800372991
- RRZZHHTTS4-65B-R7
- KKZZV4-65D/B-R8
- Other
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State 'Other' type
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Antenna Azimuth req
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MHA/RRH/RRU
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Expected Tilts ( Electrical and Mechanical )
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Feeder or Fiber type and route
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DC Requirements
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Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)
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Sector 2
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Required height of Antennas ( measured at the top of antenna )
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Antenna type
- 80010991
- 80010992
- 800372991
- RRZZHHTTS4-65B-R7
- KKZZV4-65D/B-R8
- Other
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State 'Other' type
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Antenna Azimuth req
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MHA/RRH/RRU
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Expected Tilts ( Electrical and Mechanical )
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Feeder or Fiber type and route
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DC Requirements
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Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)
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Sector 3
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Required height of Antennas ( measured at the top of antenna )
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Antenna type
- 80010991
- 80010992
- 800372991
- RRZZHHTTS4-65B-R7
- KKZZV4-65D/B-R8
- Other
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State 'Other' type
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Antenna Azimuth req
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MHA/RRH/RRU
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Expected Tilts ( Electrical and Mechanical )
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Feeder or Fiber type and route
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DC Requirements
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Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)
BTS & Antenna Requirements (5G)
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High Band BTS required?
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BTS Type Initial Requirements
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BTS Future Upgrade Path
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Sector 1
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Required height of Antennas ( measured at the top of antenna )
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Antenna type
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State 'Other' type
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Antenna Azimuth req
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MHA/RRH/RRU
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Expected Tilts ( Electrical and Mechanical )
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Feeder or Fiber type and route
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DC Requirements
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Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)
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Sector 2
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Required height of Antennas ( measured at the top of antenna )
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Antenna type
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State 'Other' type
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Antenna Azimuth req
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MHA/RRH/RRU
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Expected Tilts ( Electrical and Mechanical )
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Feeder or Fiber type and route
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DC Requirements
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Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)
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Sector 3
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Required height of Antennas ( measured at the top of antenna )
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Antenna type
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State 'Other' type
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Antenna Azimuth req
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MHA/RRH/RRU
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Expected Tilts ( Electrical and Mechanical )
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Feeder or Fiber type and route
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DC Requirements
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Comments (Feeder tray capacity, Glands, Shroud, painted, etc...)
Equipment Housing Type
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Indoor
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Room or Other description
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Room size and Condition
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Cooling and access notes
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Outdoor
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Greenfield- Note approx lease area
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Rooftop – Note Area available
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Other- Note area size, colour and conditions
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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)
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System
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Radio Battery Back up (Hours)
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Trans Battery Back up (Hours)
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Comments
Transmission Requirements
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Microwave Transmission?
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Far end
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Dish size
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Height
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Azimuth
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Comments (far end caravan required, tree trimming, LOS needed, etc..)
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Fiber Transmission?
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On-Net or Off-Net
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Supplier
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Nearest fiber location
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Comments
Access & Conditions
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Staff Access Restrictions
- None
- Business Hours Only - Mon-Fri
- Other Restrictions (Specify in comments
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Other Ristrictions
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Staff Access Comments
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Vehicle Access - Note Cherry Picker Access (if non-climbable)
- Frequent - Asphalt surface or sealed road
- Regular - Urban: Sealed road surface or frequently maintained unsealed road surface
- Regular - Rural: Frequently maintained unsealed road surface
- Periodic Access - Unsealed road surface
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Vehicle Access Comments
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Landowner Conditions or Requirements (LR,SA)
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RMA Conditions or Requirements (PC,SA)
- NESTF Compliant Replacement Pole
- NESTF Compliant New Standalone Pole
- Permitted
- Controlled
- Discretionary
- RC
- Other or comments
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Additional info
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o Base line pole and existing telco cabinet survey required - Note further comments
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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
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Rooftop Conditions (CE)
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Condition of Rooftop
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Walkways
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Rooftop Access
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Penetrations required
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Existing Antenna works
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Shrouds, Painting or camouflage required
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Other Comments
Civil Requirements (CE) - Note any requirements or issues relating to the below items
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Fencing/Retaining walls
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Security, Bollards, Stock
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Environmental issues
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Salt, Sulphur etc
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planting / Landscaping
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Noise conditions (Acoustic fencing?)
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Geotech
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Earthwork Management plan required
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Visual impact of Site - Ensure visual impact is minimised
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Lightning Risk and Requirements
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Overhead cables
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Traffic Management
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Tree trimming
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Parking
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Site security
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Existing Services
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Separate Boundary Survey required? (Note - If a roadside pole, or lease area within 3m of boundary, then a survey is needed)
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Separate Topo survey required?
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Wind Zone
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Lease Plan Area (If landscaping is required, include in lease area)
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Lease & RMA Drawing Required
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Other Comments
AC Power Requirements (CE) - Note most likely solution
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On Grid or Off Grid?
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Nearest Likely AC Source
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Line Company
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Transformer req
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Main Meter or Check Meter
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Overhead cable available
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Space for generator
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Length of power run
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Easements required
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Existing power availability
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AC Power comments
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Sketch of Electrical design- AC supply route and connection points
Antenna Support Solution (CE)
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Greenfield Structure Type and Height
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Building
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Street pole Type and Height
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Other
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Basic Sketch of Site design- Equipment and Antenna Support (CE)
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Photo of Solution Design
Caravan Sign off
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Site Caravan sign off (PM)
- Carl Westerman
- Wes Bonney
- Darren Stott
- Dawie Le Roux
- Lee Rapson
- Arvin Nakshan
- Craig Hunter
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Date
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Note Issues or info missing