Information
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This Sheet is to be Completed prior to Any Quoting and or works commencing.
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Simpro Lead/Quote/Job Number
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Village Name
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Location
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Contact Information
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Manager Contact Name:
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Contact Phone Number:
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Contact Email:
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Conducted on
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Inspector Sign
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Induction Requirements: (Please specify)
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Other Information
Village Unit Information
Village Details
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Number of Units
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Type of Unit:
- Brick
- Tile roof
- Tin Roof
- Timber
- Single Storey
- Double Storey
- Flat Roof
- PitchRoof
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Ceiling Access?
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How Many Village Stages Are Built?
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On site or Off site monitoring?
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On Site/Off Site Details: (ie Smartwatch paging system, Tunstall monitoring)
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Type of Medical Alarm System:(Make and Model)
Trigger Details
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Dialer 1
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Type of Device
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Location:
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Trigger 2
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Type of Device
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Location
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Trigger 3
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Type of Device
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Location
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Trigger 4
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Type of Device
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Location
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Trigger 5
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Type of Device
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Location
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Trigger 6
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Type of Device
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Location
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Trigger 7
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Type of Device
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Location
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Trigger 8
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Type of Device
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Location
Smoke Detectors
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Smoke Detectors Installed?
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Type of Device
- Hard Wired 240 Volt
- Wireless 9 Volt
- Wirless PSA Interface
- Isolation Relay with TX
- Hard Wired to Dialer
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Location
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QTY:
Inputs and Outputs
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Are there any Hard Wired Inputs
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Number of inputs:
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Type of Input
- Call Point
- Pendant
- Smoke detector
- PIR
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is there any Hard Wired Outputs
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Type of Output
- Yes
- No
- N/A
Power Supply Locations.
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Please explain location of Power Supply
Phone Number Programing
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Phone Number 1:
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Phone Number 2:
Phone Line
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Type of Phone Line
- PSTN
- ISDN
- PBX
- NBN
- VOIP
- Mobile
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Is there mode 3?
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Number of Phone Outputs
Community Centre Details
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Number of Community centre:
Centre Details
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Type of Building
- Brick
- Tile roof
- Tin Roof
- Timber
- Single Storey
- Double Storey
- Flat Roof
- PitchRoof
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On Site/Off Site Monitoring
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On Site System/Off site Monitoring Details:
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Type of Medical Device:
Device Details
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Dialler 1
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Location of Dialler:
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Location of Power Supply
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Trigger 1 Type
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Location:
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Trigger 3 Type
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Location:
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Trigger 2 Type
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Location:
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Trigger 4 Type
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Location:
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Trigger 5 Type
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Location:
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Trigger 6 Type
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Location:
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Trigger 7 Type
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Location:
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Dialler 2
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Location of Dialler:
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Location of Power Supply
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Trigger 1 Type
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Location:
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Trigger 3 Type
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Location:
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Trigger 2 Type
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Location:
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Trigger 4 Type
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Location:
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Trigger 5 Type
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Location:
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Trigger 6 Type
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Location:
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Trigger 7 Type
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Location:
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Dialler 3
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Location of Dialler:
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Location of Power Supply
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Trigger 1 Type
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Location:
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Trigger 3 Type
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Location:
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Trigger 2 Type
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Location:
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Trigger 4 Type
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Location:
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Trigger 5 Type
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Location:
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Trigger 6 Type
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Location:
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Trigger 7 Type
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Location:
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Dialler 4
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Location of Dialler:
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Location of Power Supply
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Trigger 1 Type
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Location:
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Trigger 3 Type
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Location:
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Trigger 2 Type
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Location:
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Trigger 4 Type
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Location:
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Trigger 5 Type
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Location:
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Trigger 6 Type
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Location:
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Trigger 7 Type
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Location:
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Dialler 5
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Location of Dialler:
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Location of Power Supply
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Trigger 1 Type
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Location:
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Trigger 3 Type
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Location:
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Trigger 2 Type
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Location:
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Trigger 4 Type
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Location:
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Trigger 5 Type
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Location:
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Trigger 6 Type
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Location:
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Trigger 7 Type
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Location:
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Dialler 6
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Location of Dialler:
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Location of Power Supply
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Trigger 1 Type
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Location:
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Trigger 3 Type
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Location:
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Trigger 2 Type
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Location:
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Trigger 4 Type
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Location:
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Trigger 5 Type
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Location:
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Trigger 6 Type
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Location:
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Trigger 7 Type
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Location:
