Fixed Solution Site Assessment Survey

Name

Phone number:

School / Business Phone Number

Name of person undertaking survey

School / Business name

School / Business Address

Room name / Number

Preferred installation Date

Preferred installation Time

Is the site heritage listed?

Is the site a construction site?

Is the room on the ground floor, accessible via a ramp or elevator?

Are there any steps on the way to the room that the equipment will be installed in?

If "Yes" how many stairs (approximately)

Staircase photo

Is there any asbestos present in the buildings?

Asbestos report
(If you selected yes above, please provide a copy of the relevant pages of the asbestos report for the room/s we are installing into (4Mb Limit))

What is the position on the wall that you would like the screen to be mounted?

Floor to ceiling height? (m) Where the projector/screen will be installed

Do you require the screen to be mounted on an existing black / white board?

Estimate of angle?

Do you require speakers?

What is the wall made from?

Wall – If you selected "Other" above, please specify

Do you require a Power Point to be installed? (VIC only)
(A power point is required within 1m of the installed equipment eg. screen, projector )

Approximate distance to existing power? (in m)

Do you require existing equipment to be uninstalled?

Special requests regarding this installation / additional information?

Photos from a distance showing mounting of screen (4Mb Limit)

Addition Image / Scan (4Mb Limit) – Optional

Are there any special access / parking instructions?

If "Yes" please detail

Confirmation

I have read the above and I would like to continue

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