Confidential Property of EMR
Passive Network Planning
TSSR
TECHNICAL SITE SURVEY REPORT
Complex/Cluster/Building Name OPEN AREA JL.NGEBONG TAMAN
Site Address Jl. Ngebong
Hub Plan Name MADIUN
OLT / Sub Hub Plan Name MADIUN KOTA
Survey Date 12 Juni 2024
Survey Company FiberHome
PT. EKA MAS REPUBLIK
MyRepublic Plaza 1st Floor
Green Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
I. REQUESTOR & SURVEYOR INFORMATION
1. Requestor Name :
2. EMR Department :
3. Contact Phone Number :
II. SURVEYOR INFORMATION
1. Survey Date : 12 Juni 2024
2. Surveyor Name : Sandi
3. Survey Company : FiberHome
4. Contact Phone Number : +62822 1025 8381
III. SITE INFORMATION
1. Site Location Name
:
Open Area Jl. Ngebong Taman
2. Site Location Address : Jl. Ngebong
3. Site Coordinates : -7.536768,111.681537
: 1.
4. Site Location PIC/Phone Number
: 2.
5. PKS Status : Done Not Done
6. Survey Map : Hardcopy Softcopy
7. Home Pass and Occupation :
9. Network Topology : FTTH / FTTB / HFC* *(Delete as applicable)
10. Service Type Delivered : TV / Internet / Voice / Triple Play* *(Delete as applicable)
*(Delete as
11. Construction Type : SEWER * | AE / UG* applicable)
12. Existing Provider Network : Yes / No* | FTTH / FTTB / HFC*| SEWER / UG* *(Delete as
applicable)
13. Existing Provider Name : Telkom,RT/RW Net
14. Survey Result & Note :
Survey Result & Note :
Hasil survey pada tanggal 12 Juni :
. Pengambilan sampling rumah bagus, rumah jelek, ruas jalan.
. Existing Provider ; Telkom,RT/RW Net
Note : Site information shall refer to IMI Request For Survey Form released.
PT. EKA MAS REPUBLIK
MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
IV. GUIDANCE MAP / GOOGLE EARTH
SATELLITEPHOTO OF LOCATION
PT. EKA MAS REPUBLIK
MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
V. PHOTOS OF SITE ACTUAL CONDITION (Note : Photo size shall not exceed more than 500 kB)
MAINT GATE TO SITE LOCATION ACTUAL SITE LOCATION
PT. EKA MAS REPUBLIK
MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
VI.PHOTOS OF SITE ACTUAL CONDITION (Note : Photo size shall not exceed more than 500 kB)
ACTUAL SITE LOCATION ACTUAL SITE LOCATION
PT. EKA MAS REPUBLIK
MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
I. SIGN & CHECK MATRIX
SURVEY COMPANY PIC – EMR SURVEYOR / DEVELOPER /COMMUNITY
Name : Ahmad Alfian Name : INDRA BAYU W
Date : 12 Juni 2024 Date : 12 Juni 2024
