Site Survey

Consultants Name

Company Name

Email Address

Phone Number

General Scope of Work

Primary Use
 Conference / Boardroom Training Room Digital Signage Lecture/ Performance Hall Other

Divisible Room(s)?
Are there any non permanent walls?
 Yes No

Room Dimensions
Length x Width x Height

Name / Number of Room (i.e. 10th Floor Conference Room, Room 200, South Conference Room)
It is suggested that you fill out one form per room.


Display Device Count
How many displays are in the room?

List Display Sources

Matrix Outputs?
Does every display source need to be switched independently and receive all inputs?
 Yes No

Display Mount Configuration
Please describe how each display device is to be mounted, including ceiling type.

Wall Backing Required
Select No if performed by other trades
 Yes No

Audio / Video Conferencing and Control

Audio System Configuration
General description of speaker count and configuration and any special inputs or outputs required.

Microphone Type
Choose one or several of the following options:
 Wired Wireless Podium Ceiling Tabletop Floor Stands

Control System Configuration
Describe configuration and scope of control system. Be sure to include a list of devices to be controlled and requirements for the touch panel.

Control Interface Type
Pick all that apply
 Table Top Touch Panel Wall Mount Touch Panel Wireless iPad / Android Tablet Button Panel PC based (Crestron XPanel)

Video Conferencing System
General description of video conferencing system and configuration.

Video Conferencing Type
 H.232 / SIP Web Bridge of both above

Camera Type
 Fixed Pan Tilt Zoom (PTZ)

Multi-Point License Required
 Yes No

Content Sharing Required?
 Yes No

Is Phone/Voice Integration Required
 Yes No

What Type of Phone System
 POTS / PSTN / Analog VOIP Digital USB / Web (Skype, Google Hangout, etc.) Other Unknown

Room Attributes

Furniture Integration
Describe any special requirements for furniture integration or cable management.

Floor Core?
 Yes No

Plenum Rated Cabling Required?
 Yes No Unknown

Rack Requirements
Describe any special requirements for rack, including rack size and form factor.

Free Standing or In Cabinet Rack?
Describe any special requirements for rack, including rack size and form factor.
 Free Standing In Cabinet Rack

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