Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Add location
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Store type
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Store number
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Select date
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Manager name
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Store phone number
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Did you explain purpose of visit/survey?
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Manager's office
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Mark location of manager's office in building
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Is fax machine currently functional?
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Can manager send and receive faxes?
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Take picture of fax machine. Make sure model number is visible.
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Are they having problems with wifi?
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Explain issues with wifi (if applicable)
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Mark location of existing WAPs on the MAP
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Multiple pictures of the clinic area
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Is there a cash register?
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Is there a phone?
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Photo of cash register/phone.
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Is this a shared network?
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Take multiple pictures of the back of the rack showing the terminal connections and RCA connection on all the amps.
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Take pictures of the paging rack.
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Take multiple photos of amplifier routing.
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Mark the paging equipment on map.
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Is there currently music playing in store?
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Are there external control knobs on outside of manager's office?
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Do you hear announcements over the speakers when an incoming call rings?
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Is the paging system a VALCOM?
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Take a close up picture of the connections on the VALCOM.
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What type of ceilings are in the store?
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Highest working height?
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Main store measurements from front to back.
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Main store measurements from side to side.
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Take a photo from the front of the store, showing the ceiling. Be sure to capture floor and ceiling.
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Back room measurements (front to back)
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Back room measurements (side to side)
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What size lift will be needed (if applicable)
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Will lift fit through front door?
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Take multiple pictures of the back room.
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Is all cables running into existing rack Cat5 or better?
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Take close up picture of the cable bundle with markings on the cable showing type.
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Take multiple close up and stand back pictures of the existing rack showing equipment and wiring.
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Stand back and take pictures of the existing rack location including the rack, PBX 66 blocks and all power outlets full and empty. Please make sure that all photos show as much detail as possible. Take as many photos as possible to get all data needed. Mark this location on the map as ERL
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If moving rack, take picture of new proposed rack location and the power outlet that will supply power. Mark on map as (NRL) new rack location.
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Is there an available 120V power outlet near proposed new rack location? If yes, how far away?
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Check voltage of the power outlet by either using a meter, or plug in power tester. Plug in device you can test power with. Take picture.
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What type of material is the wall made of that proposed rack is going to be hung on?
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Photo of material behind the backboard.
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Is there an existing grounding back bone in place to ground the rack?
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Grounding backbone
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Grounding termination point
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If grounding needs to be extended, how far?
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Novar/EMS photos
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Mark location of EMS on the MAP.
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Is there an existing MPOE/T1 circuit located in the back room near current equipment?
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Smart jack photo
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Smart jack circuit ID
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Does the manager know the location of the telecom room for the building?
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Location of the telecom room?
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Take photo of writing on the door
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What is the property management company name?
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Property manager name/phone number?
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Property management company contact number?
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Property management company e-mail?
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Were you able to gain access?
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Does the DMARC need to be extended?
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How far?
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What is the plan to extend it? (If applicable)
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Are there any obstacles in the way of your run?
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Obstruction details. (If applicable)
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Obstruction photo (if applicable)
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Time clock location?
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Time clock photo.
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Mark TC (time clock) location on map.
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Ask manager if there are any other locations or devices that may require network connection. Explain.
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Is this store retro or rewire?
- retro
- rewire
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Are you proposing new rack location?
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Will pre existing cable reach new rack location? (If applicable)
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What is the distance from new rack location to manager's office? (If applicable)
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How many registers are there?
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What is the distance from the rack location to the furthest register?
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Is there a customer service computer located in store?
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What is the distance from the new rack location to WAP1?
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What is the distance from the new rack location to WAP2
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What is the distance from the new rack location to WAP3?
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What is the distance from the new rack location to WAP4?
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Are there any other devices not covered in this survey? If so, how many, and explain devices.
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What is the distance from new rack location to these devices? (If applicable)
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Photo of completed site map.
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Have you been on site for more than 2 hours? If so, what was the delay?
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Any additional notes?
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Store Manager's signature
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End time
