Title Page

Document identification

  • Document Classification

  • RAV Project number

  • DSMS Reference Number

Location

  • Facility

  • Room Name/Number

  • Exact Address
  • Conducted by: (RAV contact)

  • Phone: (RAV contact

  • Conducted on

Contact Details

Unisys Point of Contact

  • Name:

  • Phone Number:

Delivery Point of Contact

  • Name:

  • Phone Number:

Alternate Point of Contact

  • Name:

  • Phone Number:

Faulty Equipment

  • Add items and fill in descriptive information below:

  • Item
  • Manufacturer

  • Serial number

  • Model Number

  • Description

Faults/Issues Adressed

    Insert Faults below
  • Description

(Option 1) Replacement Equipment

  • Add items and fill in descriptive information below:

  • Item
  • Manufacturer

  • Model Number

  • Description

(Option 2) Recommended System Upgrade (If Required)

  • Add Item

  • Item
  • Quantity

  • Description

Justification Brief (Engineering Only)

  • Description

  • Take image of Illustration of issue or:

  • Sketch Illustration of Issue

  • Before and/or After images of Room

Checklist

Room Details

  • Wall Type

  • Ceiling Type

  • Ceiling Access

  • Detail

  • Cable Access

  • Detail

Equipment Details

  • PROJECTOR

  • Throw Distance detail

  • Screen Size Detail

  • FLAT SCREEN DISPLAY

  • Detail

  • VIDEO CONFERENCING

  • Detail

  • AUDIO

  • Detail

  • SPEAKERS

  • Detail

  • LIGHTING

  • Detail

Source Requirements

  • ROOM PC

  • Detail

  • LAPTOP

  • Detail

  • VIDEO

  • Detail

  • DVD

  • Detail

  • TV

  • Detail

  • VIDEO CONFERENCING

  • Detail

Control Equipment

  • AMX/CRESTRON

  • Detail

  • TOUCH SCREEN

  • Detail

  • Location

  • Site Notes

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.