Title Page
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Conducted on
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Prepared by
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Location
Store Info
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Store Number
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Store Name
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Store Address
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Store phone number
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Store Contact Name
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Store Contact Email
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Store contact phone number
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How many Floors
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Is there room in the store to store new equipment for 2 days?
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Lift available?
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Does the store have any accessibility solutions already installed (wheelchair ramps, stairlift etc). If yes please detail
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OCT solution - BOG or HB?
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How Many Telephone Lines Come Into The Building?
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How Many Wired PDQ's (Credit Card Machines)?
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Does the store have CCTV?
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Corporate WQB Wifi In Store?
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New / Additional Access Point Required?
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How Many Fax Machines does the store have?
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How Many Wireless PDQ's (Credit Card Machines)?
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Private Wifi In Store?
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If Yes, Survey Required?
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Back-up media - how many tapes?
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What IT issues is the store currently experiencing? (add prior to survey if available)
Survey Info
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Survey Date
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Surveyor Name
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Add location
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Time On site
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Time Off site
Devices
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Device list - Add all surveyed devices
Device
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Device Manufacturer
- Fujitsu
- ELO
- Star
- HP
- Brother
- Honeywell
- HandHelds
- Dell
- Samsung
- Draytek
- Netgear
- Cisco
- APC
- OKI
- Ricoh
- Apple
- WincorNixdorf
- Epson
- LG
- Newlink
- Edimax
- Xerox
- Verifone
- Ingenico
- Panasonic
- Nidek
- Intuit
- Micros
- Epysys
- iZettle
- NCR
- 5G
- Siemens
- Aten
- Belkin
- Other
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Device Type
- Desktop Client
- iPad
- Scanner
- Chip and PIN (PDQ)
- Till
- Monitor
- Printer
- UPS
- Server
- Docker1
- Doker2
- Router
- Switch
- Access Point
- KVM
- Telephony
- Fax Machine
- Copier
- Firewall
- Other
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IP Address
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MAC Address
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DHCP
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Hostname
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Monitor Make & Model
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Monitor mounting
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Video Connection
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OS Version
- RHEL0
- RHEL1
- RHEL2
- RHEL3
- RHEL4
- RHEL5
- RHEL6
- Windows XP
- Windows 7
- Windows 8
- Windows 10
- IOS
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OS Type
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Number of devices connected
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Fundus device
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Device Model
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Serial Number
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Used for
- Socrates
- Windows
- Till1
- Till2
- Till3
- Dispensing
- Scanning
- Printing
- Hearing Tests
- Socrates on Tablets
- Lab Tests
- Stock
- Fundus
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Location - Floor
- Basement
- Ground Floor
- 1st Floor
- 2nd Floor
- 3rd Floor
- 4th Floor
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Location - Room/Area
- FOH - Display Area
- Consult/Test 1
- Consult/Test 2
- Consult/Test 3
- Consult/Test 4
- Consul/Test 5
- Consul/Test 6
- Pretest
- Dispensing
- Collections
- Reception 1
- Reception 2
- Hearcare
- Managers Office
- Back Office
- Stock Room
- Lab
- Main comms Room
- Sub Comms Room
- Staff Room
- Waiting Area Downstairs
- Waiting Area Upstairs
- Landing
- Contact Lenses
- Contact Lenses Consult 1
- Contact Lenses Consult 2
- Call centre
- Office
- Consult/Test 7
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In Comms cabinet
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Which Comms cabinet
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U location
Cabinet
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How many Comms cabinets in store?
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Comms Cabinet details
Cabinet
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Cabinet(s) Location
- FOH - Display Area
- Consult/Test 1
- Consult/Test 2
- Consult/Test 3
- Consult/Test 4
- Consul/Test 5
- Consul/Test 6
- Pretest
- Dispensing
- Collections
- Reception 1
- Reception 2
- Hearcare
- Managers Office
- Back Office
- Stock Room
- Lab
- Main comms Room
- Sub Comms Room
- Staff Room
- Waiting Area Downstairs
- Waiting Area Upstairs
- Landing
- Contact Lenses
- Contact Lenses Consult 1
- Contact Lenses Consult 2
- Call centre
- Office
- Consult/Test 7
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How many Comms Cabinets are in the room?
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1st Cabinet Wall or Floor mounted?
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Cabinet Front
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At what height is the cabinet from the floor?
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Are ladders required to access the cabinet?
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Is the cabinet in good condition?
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Can it be worked on and opened?
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How many available and usable space is there for additional network equipment in U ?
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Is there room in the base of the cabinet for a new Fujitsu TX1330 Server? w177 x d560 x h455 mm
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How many free power sockets are there on the UPS PDU?
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How many free power ports are there on the UPS?
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What Size is the Cabinet? EG 9U
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Is the room with the cabinet well ventilated?
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Is there working air conditioning in the room?
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Are there any signs / indications of overheating (such as smell)?
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Are any cables / connectors damaged?
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Number of power sockets at cabinet
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2nd Cabinet Wall or Floor mounted?
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Cabinet Front
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At what height is the cabinet from the floor?
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Are ladders required to access the cabinet?
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Is the cabinet in good condition?
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Can it be worked on and opened?
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How many available and usable space is there for additional network equipment in U ?
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Is there room in the base of the cabinet for a new Fujitsu TX1330 Server? w177 x d560 x h455 mm
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How many free power sockets are there on the UPS PDU?
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How many free power ports are there on the UPS?
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What Size is the Cabinet? EG 9U
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Is the room with the cabinet well ventilated?
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Is there working air conditioning in the room?
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Are there any signs / indications of overheating (such as smell)?
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Are any cables / connectors damaged?
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Number of power sockets at cabinet
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Are ladders required to access the cabinet?
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Is the cabinet in good condition?
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Can it be worked on and opened?
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How many available and usable space is there for additional network equipment in U ?
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Is there room in the base of the cabinet for a new Fujitsu TX1330 Server? w177 x d560 x h455 mm
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How many free power sockets are there on the UPS PDU?
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How many free power ports are there on the UPS?
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What Size is the Cabinet? EG 9U
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Is the room with the cabinet well ventilated?
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Is there working air conditioning in the room?
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Are there any signs / indications of overheating (such as smell)?
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Are any cables / connectors damaged?
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Number of power sockets at cabinet
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Type of sockets at cabinet
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Number of sockets in use
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Has the cabinet been recently installed?
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Patch cable standard
Wi-Fi
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Wi-Fi Tests
Location
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Location/Room
- FOH - Display Area
- Consult/Test 1
- Consult/Test 2
- Consult/Test 3
- Consult/Test 4
- Consul/Test 5
- Consul/Test 6
- Pretest
- Dispensing
- Collections
- Reception 1
- Reception 2
- Hearcare
- Managers Office
- Back Office
- Stock Room
- Lab
- Main comms Room
- Sub Comms Room
- Staff Room
- Waiting Area Downstairs
- Waiting Area Upstairs
- Landing
- Contact Lenses
- Contact Lenses Consult 1
- Contact Lenses Consult 2
- Call centre
- Office
- Consult/Test 7
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Signal Strength
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Speed Test
Wide Area Network (WAN)
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Location of Network Termination Point
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Picture of NTE/NTP points
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Mark up the location of NTE/NTP or the DP in relation to the main Comms cabinet location
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Are there 3 power sockets available at NTP?
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Distribution Point location and markings
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Picture of DP
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Anything blocking access to DP?
Power Sockets
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Power socket count
Location
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Location/Room
- FOH - Display Area
- Consult/Test 1
- Consult/Test 2
- Consult/Test 3
- Consult/Test 4
- Consul/Test 5
- Consul/Test 6
- Pretest
- Dispensing
- Collections
- Reception 1
- Reception 2
- Hearcare
- Managers Office
- Back Office
- Stock Room
- Lab
- Main comms Room
- Sub Comms Room
- Staff Room
- Waiting Area Downstairs
- Waiting Area Upstairs
- Landing
- Contact Lenses
- Contact Lenses Consult 1
- Contact Lenses Consult 2
- Call centre
- Office
- Consult/Test 7
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Number of Sockets
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Sockets in use
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Daisy Chained?
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Condition
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Describe the condition of the socket and whether deemed unsafe
Switch Capacity
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Port Tests
Switch
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Switch make and model
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Ports
Port
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Patched?
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Used?
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Corporate or Fundus
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Network?
Structured Cabling
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Cabling Tests
Patch panel
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Ports
Port
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Wall port ID (1,2,3 or 101,102,103 etc)
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Are patch panel and wall socket labels the same?
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Data outlet location
- FOH - Display Area
- Consult/Test 1
- Consult/Test 2
- Consult/Test 3
- Consult/Test 4
- Consul/Test 5
- Consul/Test 6
- Pretest
- Dispensing
- Collections
- Reception 1
- Reception 2
- Hearcare
- Managers Office
- Back Office
- Stock Room
- Lab
- Main comms Room
- Sub Comms Room
- Staff Room
- Waiting Area Downstairs
- Waiting Area Upstairs
- Landing
- Contact Lenses
- Contact Lenses Consult 1
- Contact Lenses Consult 2
- Call centre
- Office
- Consult/Test 7
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Test Results
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Type of Cabling
IT MOT Report
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Wi-Fi Status
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Recommended Action
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Items (list all required kit)
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Cost
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WAN upgrade
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Recommended Action
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Items (list all required kit)
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Cost
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Desktop Client Upgrade RHEL 6.5 Gold Build
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Recommended Action
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Items (list all required kit)
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Cost
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iPad/iOS
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Recommended Action
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Items (list all required kit)
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Cost
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Comms Cabinet
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Recommended Action
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Items (list all required kit)
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Cost
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Ports and Power
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Recommended Action
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Items (list all required kit)
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Cost
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Cabling
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Recommended Action
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Items (list all required kit)
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Cost
Summary and Sign off
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Did Power and Structured Cabling tests Pass overall
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Cab layout recommendations and a Quick summary of major issues
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Name and signature of inspector