ACCEPTANCE TEST REPORT

FIBER OPTIC ACCESS PROJECT

Contractor : PT.Mitra Karsa Utama

Purchase Order No. :
Date : 8-Jul-19
Site ID :
Site Name :
Tenant :
 ACCEPTANCE TEST REPORT
FIBER OPTIC ACCESS PROJECT

1 Document Checklist
2 Acceptance Test Report
3 Inspection & Acceptance Test for OTB
4 Inspection & Acceptance Test for FO Distribution Pole (Aerial Cable)
5 OTDR Splice Loss Measurement
6 As Plan Drawing
7 As Built Drawing
8 Pending Item / Punch List
9 Daily Progress Report (Photo)

Contractor : PT.Mitra Karsa Utama

Purchase Order No. :
Date : 8-Jul-19
Site ID :
Site Name :
Tenant : 0
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ACCEPTANCE TEST REPORT

Today, Date Month Year , an

acceptance test was done for:
Site ID :
Site Name :

with summary as follows:

Item Qty Status Remarks
Inventory
FO Distribution Pole S / SR / F
Accessories S / SR / F
FO Cable Slack S / SR / F
New JC 24 Core S / SR / F
New OTB 24 Core 1 S / SR / F
OTB 96 Core S / SR / F
Subduct HDPE S / SR / F
Handhole S / SR / F
Pigtail S / SR / F
Bridge (Galvanist Steel Pipe) S / SR / F
Pvc S / SR / F
(Additional items, e.g. Cassette, Patchcord, etc.) S / SR / F
Services
Optical Time-Domain Reflectometer (OTDR) test S / SR / F
FO Aerial Cable 24 core (in m) S / SR / F
Galian Tanah S / SR / F
FO Duct Buried Cable (in m) S / SR / F
FO Core Jointing S / SR / F
FO Termination 24 S / SR / F

Note: S : Successful Attachments: 1. Visual test sheet

S : Successful with remarks 2. OTDR test sheet
F : Failed 3. As Built Drawing
 4. Punch List
5. Daily Progress Report
PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
CCEPTANCE TEST REPORT
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Inspection & Acceptance for OTB

(Visual Checking)

Site ID : 0 Date : 8-Jul-19

Site Name : 0

Inspection Item Criteria OK NOK Remarks

Cable position Conformed
Fixing cable on OTB Firmly fixed/connected
Grounding Provided
Bounded to bar
Firmly fixed
Cable tray Provided
Labeling Conformed Please write/attach OTB labels
Termination Conformed 1
Flexible pipe Provided
Place Conformed
Tightening of bolt frame Tightened
Pigtail Conformed
Miscellaneous

Note:

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
tion & Acceptance for OTB
(Visual Checking)

Please write/attach OTB labels

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Inspection & Acceptance Test for FO Distribution Poles (Aerial Cable)

(Visual Checking)

Site ID : 702521 Date : 8-Jul-19

Site Name : Tegal Alur 021 # Pole : units

Inspection item Criteria OK NOK Remarks

Pole placing Specified place (40m distance) Coordinate attached
Specified Size
Pole structure Conform to drawing
No damage
Painting / finishing Painted black galvanized
No rust or corrotion
Concrete foundation Conform to specification
No crack
Pole erection Performed
Verticality
Pole accessories installation Conform to specification
No missing accessories
Cable installation Performed
Cable span
Cable storage system installation Performed
Joint Closure Conform to specification
Installed position
Miscellaneous

Note:

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
rial Cable)

ate attached
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R

Inspection & Acceptance Test for FO Distribution Poles (Aerial Cable)

(Visual Checking)

Site ID : Date :
Site Name : # Pole :

No Pole ID / Barcode Longitude Latitude Position FO Pole (Photo) Accessories (Photo)

8
PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
ble)

ssories (Photo)
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R

Inspection & Acceptance Test for FO Distribution Poles (Jointing)

(Visual Checking)

: Date :
Site Name : # Pole : Unit

No Pole ID / Barcod Longitude Latitude Position FO Joint (Photo) Total Joint

1 8 Core

2 16 Core

3 8 Core

4 8 Core

5 8 Core
PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
g)

Total Joint

8 Core

16 Core

8 Core

8 Core

8 Core
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OTDR Splice Loss Measurement

(OTDR Results)

Site ID : 0 Site Name : 0

No Site ID Date Length Average Loss

1
2
3
4
5
6
7
8

Note:

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
R Splice Loss Measurement
(OTDR Results)
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OTDR Splice Loss Measurement

(OTDR Results)

Site ID : 0 Date :
Site Name : 0

Test Equipment : Cable Length :

Wavelength : 1310 / 1550 nm Total Joints :
FO Joint No: FO Joint No: FO Joint No: FO
Core Loss_db Ave Core Loss_db Ave Core Loss_db Ave Core
1 A-B 9 A-B 17 A-B 25 A-B
B-A B-A B-A B-A
2 A-B 10 A-B 18 A-B 26 A-B
B-A B-A B-A B-A
3 A-B 11 A-B 19 A-B 27 A-B
B-A B-A B-A B-A
4 A-B 12 A-B 20 A-B 28 A-B
B-A B-A B-A B-A
5 A-B 13 A-B 21 A-B 29 A-B
B-A B-A B-A B-A
6 A-B 14 A-B 22 A-B 30 A-B
B-A B-A B-A B-A
7 A-B 15 A-B 23 A-B 31 A-B
B-A B-A B-A B-A
8 A-B 16 A-B 24 A-B 32 A-B
B-A B-A B-A B-A

Note:
- OTDR printout report attached

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
lice Loss Measurement
(OTDR Results)

meter

Loss-db Ave
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As Plan Drawing
(Map / Drawing)

Site ID : 0 Date :
Site Name : 0 Length : meter

As Plan Drawing

Note:
- As Built Drawing attached

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
As Plan Drawing
(Map / Drawing)

As Plan Drawing
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As Built Drawing
(Map / Drawing)

Site ID : 0 Date :
Site Name : 0 Length : meter

As Built Drawing

Note: Tikor : New JC 24 C :

OTB Existing :

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
As Built Drawing
(Map / Drawing)

As Built Drawing
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Pending Item / Punch List

Site ID : 0 Date :
Site Name : 0

No Item Issue Remarks

Note:

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
ding Item / Punch List
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Daily Progress Report

(Photos)

Site ID : Date :
Site Name :

Photo Documentation

Proses Penarikan FO Proses Penarikan FO

Proses Penarikan FO Proses Penarikan FO

Proses Penarikan FO Proses Penarikan FO

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

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Daily Progress Report

(Photos)

Site ID : 0 Date :
Site Name : 0

Photo Documentation

Proses Penarikan FO Proses Penarikan FO

Proses Penarikan FO Proses Penarikan FO

Proses Penarikan FO Proses Penarikan FO

PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

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Photo OTB

Site ID : Date :
Site Name :

Photo Documentation
PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto
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Photo Jointing

Site ID : Date :
Site Name :

Photo Documentation
PT.Mitra Karsa Utama PT. Bali Towerindo Sentra, Tbk.

Purwanto