Customer Survey Worksheet - PDF

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Customer Survey Worksheet - PDF Powered By Docstoc
					                                                         PRESITE SURVEY WORKSHEET
         Customer Info
Customer Name:                                                              Physical Address:
Own / Rent (circle)             Phone 1:                                                Email:                                                     Date:
    Programming Info
Number of rooms receiving independent programming:                                 Upgrade? Y / N, If Y then number of receivers swapped:

           Dish Info
Dish Mounting Type: ROOF / WALL / POLE / TRIPOD / NON-PEN                          Ground Source: SERVICE MAST / METER BOX / GROUND ROD / PIPE / FRAME
          Receiver Location #1                       Receiver Location #2                          Receiver Location #3                        Receiver Location #4
Room:                                       Room:                                         Room:                                       Room:
Model:               DVR / Non-DVR (circle) Model:               DVR / Non-DVR (circle)   Model:               DVR / Non-DVR (circle) Model:               DVR / Non-DVR (circle)
Type: SD / HD / Single / Dual               Type: SD / HD / Single / Dual                 Type: SD / HD / Single / Dual               Type: SD / HD / Single / Dual
Outlet Tested Correctly?            Y/N     Outlet Tested Correctly?            Y/N       Outlet Tested Correctly?            Y/N     Outlet Tested Correctly?            Y/N
Existing Cable / New Run                    Existing Cable / New Run                      Existing Cable / New Run                    Existing Cable / New Run
Ext.Wall Pen / Int. Wall Pen / Attic Drop   Ext.Wall Pen / Int. Wall Pen / Attic Drop     Ext.Wall Pen / Int. Wall Pen / Attic Drop   Ext.Wall Pen / Int. Wall Pen / Attic Drop
Phone / Ethernet / DishCOMM                 Phone / Ethernet / DishCOMM                   Phone / Ethernet / DishCOMM                 Phone / Ethernet / DishCOMM
Existing Services:                          Existing Services:                            Existing Services:                          Existing Services:
Existing Components:                        Existing Components:                          Existing Components:                        Existing Components:

                                SERVICE AGREEMENT (to be completed by the customer)
* This section must be completed by someone with the authority to make decisions regarding satellite installation. Please carefully read and provide
the following information. It is very important that you understand the details of the service being provided. Changes to this installation cannot be made once
the installation has begun.
The technician went over the channels in my programming package.                    Y/N
The technician went over the mounting options of the dish with me.                  Y/N
The technician went over the routing of all exterior cables with me.                Y/N
The technician went over the routing of the cables in each room.                    Y/N
The technician went over the grounding location with me.                            Y/N
The technician went over the receiver locations in my home.                         Y/N
The technician verified the correct programming package ordered.                    Y/N                Customer will have ground rod installed _________ (initials)
The technician verified the correct equipment (receivers) to be installed.          Y/N
The technician asked permission to move any furniture.                              Y/N

I understand the details involved with this installation. I authorized the technician to complete the installation of my Dish Network system as outlined
above. I understand that any modifications to this installation after installation has begun are not permitted.
Customer Name:_______________________________________                       Customer Signature:____________________________________ Date:__________________
                                                           PRESITE SURVEY WORKSHEET
   Technician Checklist                                                        System Diagram
Tour of interior rooms with customer:                                     * Indicate all rooms to be installed and receiver location for each room. Note whether
__ Confirm placement of receiver                                          TV1 or TV2 for dual tuners.
__ Confirm cable outlet positions – note whether existing or new; if
   new, note wall pen, floor pen, or wall drop
__ Confirm existing customer components to connect to Dish system
   - note if they are working; note existing damage
__ Check electrical outlets
__ Confirm phone/Ethernet/DishCOMM connection available
__ Confirm receiver location is accessible; ask permission to move
   furniture; note existing damage to furniture before moving;
   move furniture with customer present
__ Note existing cable/internet services to be left connected

Tour of exterior with customer:
__ Confirm LOS for all orbital locations – note existing foliage, trees
__ Confirm ground source – note whether service mast, meter box,
   ground rod, cold water pipe, or trailer frame
__ Confirm dish placement – note mounting type:
   roof, wall, pole, tri-pod, non-pen
__ Confirm cable routing – note existing cable to be used, new cable
   installed, cable route, attachment used (screw clip, nail clip)
__ Draw install diagram indicating all rooms to be installed and
   receiver location for each room; note TV1 or TV2 for dual tuners
__ Review diagram
__ Estimate total time to complete work order
__ Confirm that no one else needs to be informed of decisions made
__ Emphasize install details cannot be changed after install begins
__ Give copy of Quick Reference Guide to customer for pre-study
__ Get signature of customer authorizing install details
Technician Notes:

				
DOCUMENT INFO
Description: Customer Survey Worksheet document sample