Topline Site Survey V1.1

• Site ID

• Site Address

• Date

  Date

• Surveyor

• Location
  Address

• System Type

  Select SCS IRS 5 Wire IRS 9 Wire IRS 13 Wire V4 V5 V9

  • SCS
  • IRS 5 Wire
  • IRS 9 Wire
  • IRS 13 Wire
  • V4
  • V5
  • V9

• Client Details

Building Information

• Blocks Or Cores?

  Blocks

  Cores

• No. Of Blocks/Cores (FOR MULTIPLES PLEASE SELECT ALL RELEVANT TO NUMBER ON SITE. I.E. IF THERE ARE 6 BLOCKS, SELECT 1,2,3,4,5,6)

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Block/Core 1

• How Many Units?

• Number Of Floors?

• Block/Core 2

• How Many Units?

• Number Of Floors?

• Block/Core 3

• How Many Units?

• Number Of Floors?

• Block/Core 4

• How Many Units?

• Number Of Floors?

• Block/Core 5

• How Many Units?

• Number Of Floors?

• Block/Core 6

• How Many Units?

• Number Of Floors?

• Block/Core 7

• How Many Units?

• Number Of Floors?

• Block/Core 8

• How Many Units?

• Number Of Floors?

• Block/Core 9

• How Many Units?

• Number Of Floors?

• Block/Core 10

• How Many Units?

• Number Of Floors?

• Total Units Overall

• Parking

  Yes

  Limited - Add description

  No

• Take a picture of the building overall and parking

  Media

Dish Location

• Where Is a The Dish Located?

  Select Gable End Wall Chimney Front Facing Wall Rear Facing Wall Lift Motor Room Wall NPGM Thru The Roof Other

  • Gable End Wall
  • Chimney
  • Front Facing Wall
  • Rear Facing Wall
  • Lift Motor Room Wall
  • NPGM
  • Thru The Roof
  • Other

• Description

• Take A Picture

  Media

• Sky Dishes Present

  Yes

  No

• How Many?

• Other Dishes Present

  Yes

  No

• How Many?

Main Head End Location

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• Approx Distance From Rig/Dish to HeadEnd?

• Are There Any Modulators?

  Yes

  No

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

Data Log

• Data Log Available?

  Yes

  No

• Please Take A Screenshot Of The Data Log From Your iPad And Add Here

  Media

• Free Ports On Switches For Data Logs?

  Yes

  No

• Please Take A Screenshot Of The Data Log From Your iPad And Add Here

  Media

• Faceplates Available To Data Log?

  Yes

  No

• Please Take A Screenshot Of The Data Log From Your iPad And Add Here

  Media

Sub Head End Location(s)

• No. Of Subs (FOR MULTIPLES PLEASE SELECT ALL RELEVANT TO NUMBER ON SITE. I.E. IF THERE ARE 6 SUBS, SELECT 1,2,3,4,5,6)

  Select Sub 1 Sub 2 Sub 3 Sub 4 Sub 5 Sub 6 Sub 7 Sub 8 Sub 9 Sub 10

  • Sub 1
  • Sub 2
  • Sub 3
  • Sub 4
  • Sub 5
  • Sub 6
  • Sub 7
  • Sub 8
  • Sub 9
  • Sub 10

• Sub Head End 1

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 2

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 3

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 4

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 5

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 6

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 7

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 8

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 9

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

• Sub Head End 10

• Location

  Select Internal External

  • Internal
  • External

• Externally Contained Within?

  Select Cabinet Remote Building Other

  • Cabinet
  • Remote Building
  • Other

• Internally Contained Within?

  Select Loft Space Riser Lift Motor Room Cabinet Cupboard

  • Loft Space
  • Riser
  • Lift Motor Room
  • Cabinet
  • Cupboard

• HeadEnd Type

  Select Launch Split Cascade Tap Switch

  • Launch
  • Split
  • Cascade
  • Tap
  • Switch

• What Is The Tap Loss?

• Description

• Take a picture

  Media

• 240v Socket Available?

  Yes

  No

• Earthing Point Available?

  Yes

  No

• How Many Units Fed From Head End?

• Flat Number of Longest Run

• Length of Longest Run

Cable Routes

• Description

• Take a picture

  Media

• Number of Pre Wires

• Reason for Pre Wires

Additional Information

• Additional Requirements

  Select 2 Man Team Special Heights Loft Work Ladder Size MEWP Abseilors Scaffold Traffic Management

  • 2 Man Team
  • Special Heights
  • Loft Work
  • Ladder Size
  • MEWP
  • Abseilors
  • Scaffold
  • Traffic Management

• Days MEWP/ Abseilors/ Scaffold/ Traffic Management Required?

• Ladder Size Information

  Select 12's 14's 18's 22's CAT

  • 12's
  • 14's
  • 18's
  • 22's
  • CAT

• Loft Information

  Select Loft Lit Loft Boarded

  • Loft Lit
  • Loft Boarded

Additional Information

• Description

Additional Items

• What additional's are required?

  Select 5 Lines Amplifier 4x SAT 1x TERR PSU UK Version of 9933 5 Lines 2 Way Splitter 4x SAT 1x TERR 5 Lines 1 Way Tap -10dB 4x SAT 1x TERR Smart Splitter MDF Backboard Cabinet 460x350x120 Cabinet 400x600x200 Cabinet 400x600x300 Cabinet 700x600x300 4 Way Switch 8 Way Switch 16 Way Switch 4 Way Trailing Socket

  • 5 Lines Amplifier 4x SAT 1x TERR
  • PSU UK Version of 9933
  • 5 Lines 2 Way Splitter 4x SAT 1x TERR
  • 5 Lines 1 Way Tap -10dB 4x SAT 1x TERR
  • Smart Splitter
  • MDF Backboard
  • Cabinet 460x350x120
  • Cabinet 400x600x200
  • Cabinet 400x600x300
  • Cabinet 700x600x300
  • 4 Way Switch
  • 8 Way Switch
  • 16 Way Switch
  • 4 Way Trailing Socket

Additional Photos

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Risk Assessment

• This risk assessment has been carried out at survey stage.
  At any point a further site specific risk assessment may be required due to building changes, change of system design or additional hazards.

Identify Hazards

• Select Fall From Height Access Issues Adverse Weather 3rd Parties Traffic Hazardous Existing Equipment Property Hazards Garden Hazards Ground Hazards Asbestos Any Other Hazards Slip/Trips

  • Fall From Height
  • Access Issues
  • Adverse Weather
  • 3rd Parties
  • Traffic
  • Hazardous Existing Equipment
  • Property Hazards
  • Garden Hazards
  • Ground Hazards
  • Asbestos
  • Any Other Hazards
  • Slip/Trips

Who might be harmed and how?

• Select Engineer Customer Public 3rd Party Workers Pets/Wildlife

  • Engineer
  • Customer
  • Public
  • 3rd Party Workers
  • Pets/Wildlife

Evaluate the risk, decide on precautions, and record findings

• Likelihood

  Very Likely

  Likely

  Moderate

  Unlikely

  Very Unlikely

• Severity

  Fatalaties

  Major

  Serious

  Minor

  Negligible

• Can the hazards be removed?

  Yes

  No

  N/A

• Please describe what has been removed and how

• Control Measures

  Select P.P.E Full Fall Arrest Laddermate Microlite Cones Barriers Additional Rope Additional Ratchet Strap Signage

  • P.P.E
  • Full Fall Arrest
  • Laddermate
  • Microlite
  • Cones
  • Barriers
  • Additional Rope
  • Additional Ratchet Strap
  • Signage

• With the control measures in place please review the risk assessment

• Likelihood

  Very Likely

  Likely

  Moderate

  Unlikely

  Very Unlikely

• Severity

  Fatalaties

  Major

  Serious

  Minor

  Negligible

• Has the risk been lessened with control measures?

  Yes

  No

  N/A

• Please escalate install

Review assessment & update

• At any point a further site specific risk assessment may be required due to building changes, change of system design or additional hazards.
  This means a copy of this form must be filled out again and emailed to update records.

Safe Systems of Work

• All ladder work will be carried out as per content of H&S information folder. A copy of which is kept available and accessible on every vehicle.
  
  As standard when working with:
  
  Single, double or triple section ladders.
  CATS
  
  Full P.P.E
  Full Fall Arrest
  Laddermate
  Microlite
  

• All planning should be made so that no deviations are required from standard working practice.
  Where deviations are required, full safe systems of work are required below and this should be highlighted in the risk assessment.

• Please state deviation from standard ladder or roof working practice

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