Site Survey

Consultants Name

Company Name

Email Address

Phone Number

General Scope of Work

Primary Use
Conference / BoardroomTraining RoomDigital SignageLecture/ Performance HallOther

Divisible Room(s)?
Are there any non permanent walls?
YesNo

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.

Displays

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?
YesNo

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
YesNo

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:
WiredWirelessPodiumCeilingTabletopFloor 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 PanelWall Mount Touch PanelWirelessiPad / Android TabletButton PanelPC based (Crestron XPanel)

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

Video Conferencing Type
H.232 / SIPWebBridge of both above

Camera Type
FixedPan Tilt Zoom (PTZ)

Multi-Point License Required
YesNo

Content Sharing Required?
YesNo

Is Phone/Voice Integration Required
YesNo

What Type of Phone System
POTS / PSTN / AnalogVOIPDigitalUSB / Web (Skype, Google Hangout, etc.)OtherUnknown

Room Attributes

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

Floor Core?
YesNo

Plenum Rated Cabling Required?
YesNoUnknown

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 StandingIn Cabinet Rack

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