Title Page

  • Site ID

  • Site Name

  • Conducted on

  • Prepared by

  • Location

Minutes

  • Jot Form Completed and Booked on with Lockdown?

  • TM Cell ID:

  • MBNL Site ID:

  • Site Name:

  • Site Type:

  • Address:
  • Postcode:

  • Brief SOW:

  • Date of PSM:

  • Build Manager:

  • Site Inspector

  • Project Engineer:

  • Project Manager:

  • MBNL Build Manager:

  • Detailed Design No:

  • Revision:

  • Revision date:

Surveyor Details

  • Name

  • Contact No

  • Email

  • Company

  • Representing (Design, Build, Contractor etc.)

  • Additional Distribution
  • Name

  • Contact No

  • Email

  • Company

  • Representing (Design, Build, Contractor etc.)

PROGRAM FORECAST DATES

  • MS8 Month:

  • F/C Start Date:

  • F/C Completion Date:

  • F/C Civils Date:

  • F/C Electrical Date:

  • F/C Rigging Date:

  • F/C Crane Date:

  • F/C H3G DICI Date:

  • NSA permits required

  • SA permit required

  • OLO Outage dates required:

  • Additional Comments:

SITE ACCESS DETAILS

  • Site Provider Name:

  • Site Provider Contact Details:

  • Agreed access route:

  • Parking arrangements:

  • Delivery arrangements:

  • Storage arrangements:

  • Scaffolding required for access?

  • Notice Period for Cranes:

  • Letter Drops / Notifications to councils etc Required:

  • Supervision, climbing or special access permits required:

  • Working Hours:

  • Working Days:

  • Any OOH work required:

SITE SETUP & WELFARE

  • Local Welfare facility identified:

  • Welfare cabin required:

  • Delivery & Storage area identified:

  • Admin area identified:

  • First Aid location identified:

  • Emergency muster point identified:

  • Emergency escape route identified:

BUILD PRE-REQUISITES

  • RDS

  • Description

  • EE RDS Received:

  • H3G RDS Received:

STRUCTURAL

  • STATs received - Date received?

  • Structural Analysis / GDC Completed:

  • Geotech Stage 1 (trial hole) – Completed:

  • Geotech Stage 2 (borehole) – Completed:

  • Piling design completed:

ROAD AND PEDESTRIAN MANAGEMENT

  • Road Closure Required:

  • Pedestrian Management Required:

  • ETON Notice Required:

SITE PROVIDER WARRENTIES

  • Site Provider warranties identified for all roof and cladding materials which will be affected by the build. Confirm existing weatherproofing material:

  • Who will be responsible for making good to any warranted works (SP’s roofer etc):

TEMPORARY BUILDING FABRIC PROTECTION

  • Temporary Protection Required to protect SP building fabric i.e. carpets, lifts, doors, gates etc:

  • Dilapidation photographs taken for Crane Location:

  • Dilapidation photographs taken for Access Track / Route to Roof:

  • Dilapidation photographs of current site and proposed locations taken:

  • Extra Dilapidation photographs

CRANEAGE / CHERRY PICKERS

  • Size of crane / CP:

  • Location agreed:

  • Access suitable:

  • Safe level platform identified:

  • Trackway Required incl length:

  • Removal of gates / bollards required and agreed with the SP:

  • Network rail approval required:

  • Additional Remarks:

HEALTH AND SAFETY

  • Asbestos identified and is Register available?

  • Are the works impacted by any known Asbestos?

  • Is there safe Operative access to all areas of work?

  • Any edge protection required?

  • Any roof lights to protect?

  • Flues and Vents Identified as safe?

  • Is there Bird Mess to remove?

  • Will work have any effect on public?

  • Barriers or Herras fencing required?

  • Drop Zones and barriers required?

  • Addtional Remarks

ENVIRONMENTAL ISSUES

  • How will waste be stored and removed:

  • Wildlife affected during the build:

  • Waterways (silt traps required):

  • Noise:

  • Protected Area’s:

  • Nesting Birds:

  • Dust:

  • Additional Remarks

SCOPE OF WORKS

Power, Electrical & Mechanical

  • Description

Existing Main AC Power Supply:

Proposed Main AC Power Supply:

  • New meter cabinet required:

  • New AC Distribution board required:

  • Additional Remarks

Existing DC Power supply:

Proposed DC Power supply EE:

  • Proposed DC Power supply H3G:

  • Proposed TX rack DC supply:

  • Any temp power works required:

  • New submains & Isolators required:

  • LP works required:

  • Cable tray / gantry works required:

  • Additional Roxtec frames required:

  • Additional comments:

Civils Works

  • Tower base required:

  • Piling required:

  • Cabinet bases or plinths required:

  • RT Plinths and weatherproofing:

  • Site clearance required:

  • Lightning Protection pits or earth mats required:

  • Ducting or trenching required:

  • Rigging

  • Tower build required and any space issues:

  • Antenna headframe swap:

  • RRU headframe required:

  • Tower strengthening required:

  • Lift n Shift of existing antennas required:

  • Existing feeders being reused:

  • Cable routes confirmed:

  • Antenna & AAU locations confirmed:

  • RRU & BoB locations confirmed:

  • MHA & Active router locations confirmed:

  • Triplexer / Quadplexer locations confirmed:

  • Existing RRU’s to be relocated:

  • Roxtec requirement identified:

  • BoM completed at PSM:

  • Transmission

  • TX rack ok with adequate space:

  • New TX rack or cabinet required:

  • Existing Dish ML numbers:

  • TX IDU relocation required:

  • Dish relocations required:

New Dish steelwork required:

  • VM or BT Fibre on site:

  • Fibre relocation required:

  • New CAT5 required for any cabinet relocations:

  • Additional Remarks

  • RT Steelwork

  • Bespoke antenna frames or Quadpods:

Other steelwork:

  • Perm handrail required:

  • Stepovers required:

  • Steel stubs required:

  • Resin Anchors being installed:

Decommissioning

  • Cabinets to be removed:

  • Steelwork to be removed:

  • Cable and cable trays to be removed:

  • Any base removals required:

  • Other

  • Third Party or OLO Equipment Relocations required:

  • General photos must be taken of the site and saved within the site file on the server within the PSM folder

  • Site access and dilapidation photos to be inserted and labelled below

  • Site Access & Dilapidation Photographs (photos must be labelled)

  • Extra Site Access & Dilapidation Photographs (photos must be labelled

Photo Sheet

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

  • General site photos

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