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| AC ground supplied to outlet |
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| The power outlet located under
2m/6ft |
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| Select the type of power
outlet |
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| Refer to "International
Plug Pattern" |
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| Specify the power AC Volt: |
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Amp : |
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Cycle HZ: |
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| Is a twist lock connector
required |
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| 2 power circuit & breaker provided |
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| The breaker must be
accessible all times |
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| Dedicated circuit breaker
number # |
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| Breaker clearly marked |
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| Is there any history of poor
power |
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| regulation prior to this
installation ? |
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| Explain the nature of the problems |
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| Will the equipment be
connected to a UPS |
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| What type of ground connector
is required |
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| All Power Supply must be
Surge protected |
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| Telco / Line be Surge protected |
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| Signal Ground and Power GND
separated |
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| Secondary Power Considerations |
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| Is there a backup UPS or
battery? |
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| Capacity rating in AMP hours |
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| What type of battery is used
(lead, gel ) |
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| Is the battery trickle
charged or on STB cct |
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| Cabling Characteristics |
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| How
are the cables being run |
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| Who does inside wiring |
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Contact's Name : |
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| What are the demarcation
points |
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| Other (
Describe): |
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| What type of IDF/MDF are
installed ? |
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| Other (
Describe): |
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| How the router should be
installed ? |
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| Remaining space on wall, rack
- Dimension |
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| Are there any special
protections |
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| Other (
Describe): |
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| Environmental Considerations |
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| Proper A/C Climate control |
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| A/C works 24/24 hrs, 7/7
day's |
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| Equipment place in clean, dry
room |
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| electromagnetic radiation at
10'/3,1m |
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