Circuit Upgrade Site Readiness Assessment Form

Please fill out the following form after performing a site readiness assessment. Be as complete and detailed as necessary.

Agency Information
Agency *
Contact information
EXCEL Representative *
EXCEL Representative
EXCEL Phone Number *
EXCEL Phone Number
AT&T Representative *
AT&T Representative
AT&T Phone Number *
AT&T Phone Number
Interview Date *
Interview Date
Site Address
Address *
Address
Point of Entry
Backboard Information
Demarc *
Is Demarc extension required?
Busbar *
Is a grounding busbar required?