Site Survey Form – Copy as necessary

Jobsite Information

Name
Street Address
City
State/Province
Country
Zip/Postal Code

Contact Name
Contact Title
Contact Telephone
Contact E-Mail

Site Surveyor

Name
Title
Company Name
Street Address
City
State/Province
Country
Zip/Postal Code
Contact Telephone
Contact E-Mail

Available here in Microsoft Word

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Use this form to document information gathered from site surveys. If the site
is a K-12 school, then refer to our K-12 system questionnaire and design
guide.

When performing a site survey, you will need:

a) A long tape measure, laser based measuring device or equivalent

b) A sound level meter

c) A calculator

d) A Stop Watch

e) Floor plans

f) An air horn

g) Copies of this form

h) A Digital Camera to photograph each area for future reference and to

document the environment on which your quote is based.
What is the purpose of the system?

a) General announcements

b) Emergency Notification

c) 2-way Intercom

d) Door answering

e) Emergency messaging/Code Blue

f) Offsite notification (e-mail, Facebook™, Twitter™, app, etc.)

g) Class change tones/Shift change tones

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Other:

How many buildings?

Describe available existing infrastructure between buildings.

If integrating to the site’s telephone system:

a) System type/model number

b) How many FXO/Loop Start Trunk ports are available
c) How many page ports are available
d) How many analog station ports are available?
e) Does the phone system support Session Initiation Protocol (SIP)?

Other system access? Microphone Dedicated paging telephone

System wide features:

a) Feedback Elimination
b) Automatic Volume Adjustment
c) Scheduled announcements/tones

How many users will need to make announcements simultaneously? _____

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Area Specific Requirements

(Complete one for each separate area)

Area name: _________________________________________________

Environment:
Expert Tip - Capturing video recordings and photographs
a) Retail during the site survey can save you time and effort!
b) Office
c) Warehouse
d) Manufacturing
a. Describe any protective garments or hearing protection
required.
e) Exterior
a. Protected from precipitation? Yes No
f) Other:

If the area is potentially reverberant, sound an air horn for ½ a second and
record how long it takes for the sound to completely diminish. ___seconds

Area Dimensions (provide drawing if necessary):

Length: ___________

Width: ____________

Ceiling speaker mounting height: ___________ (may be lower than ceiling height)

Note the locations of support columns, tall shelving, dividing walls and any
sound blocking obstacles on the floorplans.
Area Ceiling Type _______________________________

Is the area behind the ceiling accessible? Yes No

a) If ceiling tile, provide tile dimensions

4’ x 2’ 2’ x 2’ 600mm x 600mm Other:

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Maximum area sound level in dBspl (A-weighted)

<45 50 55 60 65 70 75 80 85 90 95 100+

Will this area receive area specific announcements? Yes No

Clock Type and Quantity _______________________________________

LED Sign Type and Quantity ____________________________________

Features for this area:

1) Background music
a) Unique to this area
b) System wide BGM
2) Feedback elimination (will local live announcements be initiated from
this area?)
3) Local paging microphone(s)
4) Local paging telephone(s) (independent of the telephone system)
5) Automatic volume control (will noise levels fluctuate from loud to quiet?)
6) Manual volume control knob
Other Features:
7) Night ring
8) Talkback (2-way intercom)
9) Emergency panic buttons
10) Visual paging
11) Emergency call stations
12) Explosion-Proof required
13) Cleanroom rated required

Identify/photograph local equipment closet locations. Make note of all

available ac power and network connections within these closets.
Once you’ve completed the site survey; refer to our General Public Address
and Intercom System Design Guidelines for equipment selection.

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Assumptions can be costly

Site surveys can provide crucial details that RFPs alone cannot. RFPs don’t
typically advise of costly accessibility challenges like asbestos laden ceilings,
heavy room furnishings that must be moved to complete work, requiring a
rented scissor lift to mount horns, or concrete walls through which
infrastructure must be routed.

1) Are prescribed equipment mounting locations appropriately sized?

2) Are dedicated power receptacles of adequate capacity located in all
equipment mounting locations?
3) Will any existing equipment require removal or relocation?
4) Does the prevailing building/fire/electrical code require:
a. that abandoned cabling be removed or that new cable be in
conduit?
b. fire/plenum ratings on backboxes, cable or other equipment?
c. that backboxes or other equipment to be tethered to the facility’s
structure (i.e. seismic strapping)?
5) If existing equipment will be reused, is the equipment in working
condition?
a. Does the equipment offer suitable inputs and outputs for the
required integration?
b. If existing cabling will be reused, is it in good condition, of the
correct type/gauge/conductor count for use with the new
system? Are cables easily identifiable?
c. If existing speakers will be reused, are they the correct type, in
good working order and properly located?
d. Are existing clocks keeping accurate time and compatible with
the new system?
e. Are existing amplifiers providing clear adequate sound?
f. Is existing rack space of the correct type, adequately sized and
in a suitable location?
g. Will existing data networks and data jack locations support new
IP based equipment?
6) Is the environment slated for the new equipment environmentally
controlled and protected from water leaks, building debris and
tampering (as required)?
7) Are all work areas easily accessible?

Advise the owner of any observations and concerns in your proposal

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Describe all expected integration(s) to any non-Valcom equipment not

previously addressed in this form and the anticipated results in detail: (Attach
additional sheets if required)
Device Manufacturer/Type
Model Number
Desired Integration:

Device Manufacturer/Type
Model Number
Desired Integration:

Device Manufacturer/Type
Model Number
Desired Integration:

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

Model Numbers and Quantities

Area Name/ID
Speaker Clock LED Sign Call Button Notes/Feature by Number
Example Area 52 x VE4020A 3 x VIP-A12A 2 x VL-540 1 x V-2972PK 1b, 6 (feature #(s) from previous page feature list)

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates
 Site Survey Form – Copy as necessary

© 2016 - 2018 Valcom, Inc. Roanoke, Va. U.S.A. 1-540-563-2000 Rev 2018-1.03 Updates