• Site Name

  • Site Code

  • Conducted on

  • Prepared by

Site Details

  • Site Name

  • Select Site Type

  • Date undertaken

  • Region

Site Details

  • Site physical address

  • Name of VC contact

  • VC contact email address

VC Endpoint Details

  • VC Endpoint Name, IP or E.164 Number

  • VC Endpoint Location (AMS Number preferable)

  • Please be aware that this survey is to assist with Polycom VC Endpoint replacement scheduling and suitability. This replacement program has been designed to update ageing technology within the VC network with more modern equipment. This will support the improvement of functionality with the new infrastructure that is now in use.

    To make sure there is minimal disruption to business and to avoid delay in the replacement process for your site. It is requested that you be as accurate as possible with the information requested for each Polycom VC Endpoint.

    All Polycom VSX Video Conferencing Endpoints that aren't replaced will be retired at a later date.

    Contact about the actual replacement may come months after the survey is completed depending on where it falls in the replacement schedule.

    Requested photos need to include (1) close up and (1) wide angle photo with a minimum of 1.2 megapixels resolution (image max. size 75k) not blurred.

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Survey Questions

  • Please confirm you have power and data ports available at the location for the replacement

  • What is the status of the VC Endpoint and does it need replacing?

  • IF faulty - what is the problem?

Camera Information

  • How many existing cameras are attached to the VC Endpoint?

  • Cable length from codec to each camera?

Microphone Information

  • How many existing microphones are attached to the VC Endpoint?

  • Type of microphones?

  • IF other - describe

  • Cable length from codec to each microphone

Display Information

  • How many existing displays are attached to the VC Endpoint?

  • Type of displays

  • If other - describe

  • If you have a CRT, do you have funds within your budget to replace it?

  • Cable lengths from codec to each display

  • What are the connection capabilities Display 1? Please capture all available connection ports in pictures.

  • Add photos here

  • What are the connection capability of Display 2? Please capture available connection ports in pictures.

  • Add photos here

  • What is the function of VC Endpoint display 1?

  • What is the function of VC Endpoint display 2?

Room Controller

  • Is there a room controller?.

  • Type of room controller?

  • If you have a room controller, do you require Multimedia and Conferencing Services to organize an Integrated Services Technician to configure?

  • If so, please provide any configuration documents you have with this survey form

  • Please take a picture of the back of the VC Endpoint and room controller (if you are using one)

  • Please adds any additional information here:

  • Please scan the completed survey to a PDF format and attached with the pictures to an email to: with the SUBJECT using the following format " - Polycom VC Survey Results"
    Eg. 0916 - Polycom Replacement Survey Results

    Thank you for completing this survey for your Polycom VC Endpoint. The information provided will assist with the replacement program and with future endeavors to help improve functionality. If you have any further questions please don't hesitate to call 9468 0830 to get additional information.

  • Signature

  • Date

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.