Title Page
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Site ID
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Site Name
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Conducted on
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Prepared by
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Location
Minutes
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Jot Form Completed and Booked on with Lockdown?
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TM Cell ID:
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MBNL Site ID:
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Site Name:
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Site Type:
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Address:
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Postcode:
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Brief SOW:
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Date of PSM:
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Build Manager:
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Site Inspector
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Project Engineer:
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Project Manager:
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MBNL Build Manager:
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Detailed Design No:
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Revision:
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Revision date:
Surveyor Details
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Name
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Contact No
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Email
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Company
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Representing (Design, Build, Contractor etc.)
Additional Distribution
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Name
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Contact No
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Email
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Company
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Representing (Design, Build, Contractor etc.)
PROGRAM FORECAST DATES
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MS8 Month:
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F/C Start Date:
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F/C Completion Date:
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F/C Civils Date:
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F/C Electrical Date:
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F/C Rigging Date:
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F/C Crane Date:
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F/C H3G DICI Date:
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NSA permits required
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SA permit required
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OLO Outage dates required:
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Additional Comments:
SITE ACCESS DETAILS
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Site Provider Name:
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Site Provider Contact Details:
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Agreed access route:
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Parking arrangements:
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Delivery arrangements:
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Storage arrangements:
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Scaffolding required for access?
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Notice Period for Cranes:
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Letter Drops / Notifications to councils etc Required:
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Supervision, climbing or special access permits required:
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Working Hours:
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Working Days:
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Any OOH work required:
SITE SETUP & WELFARE
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Local Welfare facility identified:
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Welfare cabin required:
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Delivery & Storage area identified:
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Admin area identified:
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First Aid location identified:
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Emergency muster point identified:
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Emergency escape route identified:
BUILD PRE-REQUISITES
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RDS
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Description
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EE RDS Received:
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H3G RDS Received:
STRUCTURAL
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STATs received - Date received?
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Structural Analysis / GDC Completed:
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Geotech Stage 1 (trial hole) – Completed:
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Geotech Stage 2 (borehole) – Completed:
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Piling design completed:
ROAD AND PEDESTRIAN MANAGEMENT
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Road Closure Required:
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Pedestrian Management Required:
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ETON Notice Required:
SITE PROVIDER WARRENTIES
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Site Provider warranties identified for all roof and cladding materials which will be affected by the build. Confirm existing weatherproofing material:
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Who will be responsible for making good to any warranted works (SP’s roofer etc):
TEMPORARY BUILDING FABRIC PROTECTION
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Temporary Protection Required to protect SP building fabric i.e. carpets, lifts, doors, gates etc:
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Dilapidation photographs taken for Crane Location:
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Dilapidation photographs taken for Access Track / Route to Roof:
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Dilapidation photographs of current site and proposed locations taken:
Extra Dilapidation photographs
CRANEAGE / CHERRY PICKERS
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Size of crane / CP:
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Location agreed:
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Access suitable:
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Safe level platform identified:
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Trackway Required incl length:
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Removal of gates / bollards required and agreed with the SP:
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Network rail approval required:
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Additional Remarks:
HEALTH AND SAFETY
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Asbestos identified and is Register available?
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Are the works impacted by any known Asbestos?
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Is there safe Operative access to all areas of work?
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Any edge protection required?
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Any roof lights to protect?
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Flues and Vents Identified as safe?
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Is there Bird Mess to remove?
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Will work have any effect on public?
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Barriers or Herras fencing required?
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Drop Zones and barriers required?
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Addtional Remarks
ENVIRONMENTAL ISSUES
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How will waste be stored and removed:
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Wildlife affected during the build:
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Waterways (silt traps required):
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Noise:
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Protected Area’s:
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Nesting Birds:
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Dust:
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Additional Remarks
SCOPE OF WORKS
Power, Electrical & Mechanical
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Description
Existing Main AC Power Supply:
Proposed Main AC Power Supply:
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New meter cabinet required:
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New AC Distribution board required:
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Additional Remarks
Existing DC Power supply:
Proposed DC Power supply EE:
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Proposed DC Power supply H3G:
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Proposed TX rack DC supply:
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Any temp power works required:
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New submains & Isolators required:
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LP works required:
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Cable tray / gantry works required:
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Additional Roxtec frames required:
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Additional comments:
Civils Works
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Tower base required:
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Piling required:
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Cabinet bases or plinths required:
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RT Plinths and weatherproofing:
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Site clearance required:
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Lightning Protection pits or earth mats required:
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Ducting or trenching required:
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Rigging
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Tower build required and any space issues:
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Antenna headframe swap:
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RRU headframe required:
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Tower strengthening required:
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Lift n Shift of existing antennas required:
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Existing feeders being reused:
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Cable routes confirmed:
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Antenna & AAU locations confirmed:
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RRU & BoB locations confirmed:
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MHA & Active router locations confirmed:
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Triplexer / Quadplexer locations confirmed:
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Existing RRU’s to be relocated:
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Roxtec requirement identified:
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BoM completed at PSM:
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Transmission
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TX rack ok with adequate space:
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New TX rack or cabinet required:
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Existing Dish ML numbers:
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TX IDU relocation required:
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Dish relocations required:
New Dish steelwork required:
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VM or BT Fibre on site:
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Fibre relocation required:
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New CAT5 required for any cabinet relocations:
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Additional Remarks
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RT Steelwork
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Bespoke antenna frames or Quadpods:
Other steelwork:
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Perm handrail required:
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Stepovers required:
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Steel stubs required:
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Resin Anchors being installed:
Decommissioning
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Cabinets to be removed:
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Steelwork to be removed:
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Cable and cable trays to be removed:
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Any base removals required:
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Other
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Third Party or OLO Equipment Relocations required:
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General photos must be taken of the site and saved within the site file on the server within the PSM folder
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Site access and dilapidation photos to be inserted and labelled below
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Site Access & Dilapidation Photographs (photos must be labelled)
Extra Site Access & Dilapidation Photographs (photos must be labelled
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Photo Sheet
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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General site photos
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