ACCEPTANCE TEST PROCEDURE

For

PT. EKA MAS REPUBLIK

Subfeeder Name : Panggung Kidul RW 01

Document Prepared by ZTE and Approved by EMR

ZTE Representation : ;

EMR Representation : ;

PT. ZTE INDONESIA

2022
 Acceptance Test Procedure
Checklist for Fiber Access Terminal (FAT)

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To : FAT
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01

No. Item Requirements Comment

Check the position of FAT is installed according to the Design plan □passed □fail □N/A
Check the stability of FAT and or pedestal fixed on
1 Position □passed □fail □N/A
pole/pedestal/wall as per the Design plan
Check the pedestal foundation according to the standard design
□passed □fail □N/A
plan
Ensure the Pedestal and or FAT body is not damage □passed □fail □N/A

Ensure the FAT adapters are not damage □passed □fail □N/A

2 Condition Ensure the FAT pigtails not damage □passed □fail □N/A

Ensure the FAT adapters & connectors are using SC/APC □passed □fail □N/A

Ensure the FAT and or pedestal can be open and locked properly □passed □fail □N/A

Ensure the connectors are plugged properly □passed □fail □N/A

3 Connection
Ensure no pigtail pinched or bending □passed □fail □N/A

Check the FAT label and numbering according MR numbering plan □passed □fail □N/A
4 Label FAT
Check the cable label and pigtail label □passed □fail □N/A
Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik

Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Checklist for Fiber Distribution Terminal (FDT)

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To : FDT
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01

No. Item Requirements Comment

Check the position of FDT is installed according to the Design plan □passed □fail □N/A
Check the stability of FDT fixed on the concrete foundation as per
1 Position □passed □fail □N/A
Design plan
Check the FDT foundation according to the standard Design plan □passed □fail □N/A

Ensure the FDT body is not damage □passed □fail □N/A

Ensure the FDT adapters are not damage □passed □fail □N/A

Ensure the FDT pigtails not damage □passed □fail □N/A

2 Condition
Ensure the Splitters installed properly □passed □fail □N/A

Ensure the FDT splitters, adapters & connectors are using SC/APC □passed □fail □N/A

Ensure the FDT door can be open and locked properly □passed □fail □N/A

Ensure the connectors are plugged properly □passed □fail □N/A

3 Connection Ensure no pigtail pinched or bending □passed □fail □N/A

Ensure cable route are installed neat & properly □passed □fail □N/A

Check the FDT label and numbering according MR numbering plan □passed □fail □N/A
4 Label FDT
Check the cable label and pigtail label □passed □fail □N/A
Comments :

SMG 100-0201

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik

Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Checklist for Civil work- Trench & HDPE laying

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01

No. Item Requirements Comment

1 Trenching The depth of the trench complies the standard □passed □fail □N/A
Ensure the duct is not damaged and ends are always covered □passed □fail □N/A
HDPE duct
2 No damage during placement □passed □fail □N/A
laying
Correct method of duct coupling □passed □fail □N/A
Backfilling & Compaction with same soft soil excavated from the
3 Backfilling □passed □fail □N/A
trench
Installation of the warning tape comply standard □passed □fail □N/A
4 Warning tape
The logo on the tape is clear □passed □fail □N/A
Asphalt road reinstatement comply with the standard □passed □fail □N/A
Reinstatement of pavement comply with standard □passed □fail □N/A
6 Reinstatement
Concrete reinstatement done comply with sandard □passed □fail □N/A
Reinstatement of grass comply with standard □passed □fail □N/A
Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik

Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Checklist for Road and Railway Crossing

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01

No. Item Requirements Comment

Base on local department standard, the boring depth is 1.5~2m
□passed □fail □N/A
from surface
1 Railway Boring Laying HDPE 40/34mm
□passed □fail □N/A

Pit backfilled and Reinstatement □passed □fail □N/A

The boring depth is 1.5~2m from surface □passed □fail □N/A

2 Road Boring Laying HDPE 40/34mm □passed □fail □N/A

Pit backfilled and Reinstatement □passed □fail □N/A

Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik

Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Check List for Bridges Crossing

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01

Inspection Item Criteria Comment

Specified size □passed □fail □N/A
Self Support ( SS ) Firmly □passed □fail □N/A
Fixed / connected □passed □fail □N/A
Specified size □passed □fail □N/A
Attachment (ATB) Firmly □passed □fail □N/A
Fixed / connected □passed □fail □N/A
Specified size □passed □fail □N/A
Single Pole Suspension Firmly □passed □fail □N/A
Fixed / connected □passed □fail □N/A
Specified size □passed □fail □N/A
Double Pole Suspension Firmly □passed □fail □N/A
Fixed / connected □passed □fail □N/A
Structure Conform to drawing □passed □fail □N/A
Concrete encasement No cracks □passed □fail □N/A
Fixing Hardware Sufficient □passed □fail □N/A
Cable Tag Installed as spec □passed □fail □N/A
Levelling of foundation Level □passed □fail □N/A
Reinstatement Performed □passed □fail □N/A
Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik
Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Check List for Precast Handhole/Precast Handhole Pit
(Visual Checking)

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01
HH Number : HH GPS :

Size Measurement
Inner : Outer :
L
W
D

Note : All measurement in cm

Inspection Item Criteria Comment
Placement Base and Design and actual condition □passed □fail □N/A
Dimensions According Spec. □passed □fail □N/A
Comments : Smooth □passed □fail □N/A
Frame □passed □fail □N/A
No Crack □passed □fail □N/A
Smooth □passed □fail □N/A
HH Wall/Roof Frame Bar □passed □fail □N/A
No Crack □passed □fail □N/A
Reinstatement (Surface Type) Performed □passed □fail □N/A
Name Plate Provided □passed □fail □N/A
Levelling □passed □fail □N/A
HH Cover (HH -2 covers,HH Pit 1 Frame □passed □fail □N/A
cover) Handle □passed □fail □N/A
Identity (MyRepublic) □passed □fail □N/A
HH & Handhole Pit Accessories Cable Bracket □passed □fail □N/A
Cable Bracket,label Handhole ID, Drainase
Label HH & Cable □passed □fail □N/A
hole etc.
Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik
Name : Name :
ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Check List for Handhole/Handhole Pit
(Visual Checking)

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01
HH Number : HH GPS :

Size Measurement
Inner : Outer :
L
W
D

Note : All measurement in cm

Inspection Item Criteria Comment
Placement Base and Design and actual condition □passed □fail □N/A
Dimensions According Spec. □passed □fail □N/A
Comments : Smooth □passed □fail □N/A
Frame □passed □fail □N/A
No Crack □passed □fail □N/A
Smooth □passed □fail □N/A
HH Wall/Roof Frame Bar □passed □fail □N/A
No Crack □passed □fail □N/A
Reinstatement (Surface Type) Performed □passed □fail □N/A
Name Plate Provided □passed □fail □N/A
Levelling □passed □fail □N/A
HH Cover (HH -2 covers,HH Pit 1 Frame □passed □fail □N/A
cover) Handle □passed □fail □N/A
Identity (MyRepublic) □passed □fail □N/A
HH & Handhole Pit Accessories Cable Bracket □passed □fail □N/A
Cable Bracket,label Handhole ID, Drainase
Label HH & Cable □passed □fail □N/A
hole etc.
Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik
Name : Name :
ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Checklist for Boring Rojok Manual (BRM)

Region : Semarang Inner Subfeeder : Panggung kidul RW 01

Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung kidul RW 01

No. Item Requirements Comment

The boring depth is 1.5 m from surface in feeder part □passed □fail □N/A
The boring depth is 0.3 m from surface in cluster part □passed □fail □N/A
Lay HDPE 40/34mm □passed □fail □N/A
Boring Rojok
1
Manual Backfilled pit □passed □fail □N/A
Surface Reinstatement □passed □fail □N/A

Site Cleaness □passed □fail □N/A

Boring Rojok manaual is similar meaning with Manual Boring

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik

Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Check List for Building Cable Access
Panggung kidul RW 01
Region : Semarang Inner Subfeeder :

Link From : OLT Gajahmungkur To :

Panggung kidul RW 01
Address : Kecamatan Semarang Utara Address :

Inspection Item Criteria Comment

Sealing at Entry Pipe Conform □passed □fail □N/A
Cable Installation Conform □passed □fail □N/A
Wall Fixing at Entry Pipe Conform □passed □fail □N/A
Cable Labelling Provided & Correct □passed □fail □N/A
Spare Cable Installation Conform □passed □fail □N/A
Comments :

N/A

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik

Name : Name :
ID:
ID :
Signature : Signature :

Date : Date :
 Acceptance Test Procedure
Check List for Pole Erection with Accessories
Region : Semarang Inner Subfeeder/Route : Panggung Kidul RW 01
Link From : OLT Gajahmungkur To :
Address : Kecamatan Semarang Utara Address : Panggung Kidul RW 01

Inspection Item
Pole to Pole Span Height of Pole installed Pole Depth Solution Pole Labelling Pole Accessories Installation Area Clean ATP Result
Pole height (7Mtr/9Mtr) If hole depth can't reach to the
and hole depth comply standard requirement
Pole Accessories
with standard Pole have label Pole Foundation and near
Cut pole to like - Hanger, Pole Wise ATP Output
DESCRIPTION => (1.4m/1.8m), Move to another pole ID & EMR by area should be neat
keep same Clamps & Etc should result
differentiation veticality proposed name labeling and clean
clearance with follow the Specs.
pole note more than 2 location
Degree other pole
Pole 001 □pass □fail □Need Repair
Pole 002 □pass □fail □Need Repair
Pole 003 □pass □fail □Need Repair
Pole 004 □pass □fail □Need Repair
Pole 005 □pass □fail □Need Repair
Pole 006 □pass □fail □Need Repair
Pole 007 □pass □fail □Need Repair
Pole 008 □pass □fail □Need Repair
Pole 009 □pass □fail □Need Repair
Pole 010 □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Pole ... □pass □fail □Need Repair
Comments :

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik
Name : Name :
ID : ID :
Signature : Signature :

Date: Date:
 Acceptance Test Procedure
Checklist for Cable Installation in HH,HH Pit and OTB
(Visual Inspection)

Region : Semarang Inner Subfeeder : Panggung Kidul RW 01

Link From : OLT Gajahmungkur To :

Address : Kecamatan Semarang Utara Address : Panggung Kidul RW 01

No. Item Requirements Comment

Cable Arrangement and coil in 10m slack on bracket □passed □fail □N/A
1 Handhole Joint closure and excess cable on the bracket properly □passed □fail □N/A
Cleaness of handhole after cable pulled □passed □fail □N/A
Cable Arrangement and coil in 10m side slack □passed □fail □N/A
2 HH Pit Cable Place on the bracket properly □passed □fail □N/A
Cleaness of handhole after cable pulled □passed □fail □N/A
Cable enter to the OTB properly □passed □fail □N/A
Cable protected by corrugated HDPE (exposed) □passed □fail □N/A
3 OTB Cable arrangement enter to the cabinet properly □passed □fail □N/A
Label OTB and Port (PTB must be labeling and description
□passed □fail □N/A
of the port arrangement)
The cable ground clearance conform to required height □passed □fail □N/A
The slack cable is coiled in the coiling holder at >20 times
□passed □fail □N/A
the cable diameter (15-20 meter)
The cable is properly tensioned /clamped / wrapped □passed □fail □N/A
4 Aerial Cable Cable is properly secured at the pole □passed □fail □N/A
Bending radius 20 times of cable diameter at turning point □passed □fail □N/A
Cable damage □passed □fail □N/A
Cable labelling □passed □fail □N/A
Remark :

Signatures :
PT. ZTE Indonesia PT. Eka Mas Republik 7
Name : Name :

ID : ID :
Signature : Signature :

Date : Date :
 RECORD OF PUNCH LIST
CW ATP
Project Name : EMR-ZTE FTTH TURNKEY PROJECT
Subfeeder Name : Panggung Kidul RW 01
Subfeeder ID : SF29-99-064
ATP Date :

Sign
No Defect Item Target Date Repaired Date
(customer)

Signatures :

PT. ZTE Indonesia PT. Eka Mas Republik PT. ZTE Indonesia PT. Eka Mas Republik
Name : Name : Name : Name :
ID : ID : ID : ID :
Signature : Signature : Signature : Signature :

Date : Date : Date : Date :

 RECORD OF PUNCH LIST
RECTIFICATION
Project Name : EMR-ZTE FTTH TURNKEY PROJECT
Subfeeder Name : Panggung Kidul RW 01
Subfeeder ID : SF29-99-064
ATP Date :

FDT No. No. Defect Item Defect Description Punchpoint Result Date Of Clearence

Signatures :

PT. ZTE Indonesia PT. Eka Mas Republik PT. ZTE Indonesia PT. Eka Mas Republik
Name : Name : Name : Name :
ID : ID : ID : ID :
Signature : Signature : Signature : Signature :

Date : Date : Date : Date :

 BERITA ACARA RECTIFIKASI PUNCH LIST

Pada hari ini, tanggal , bulan , tahun , kami yang bertanda tangan di bawah ini :

Nama :

Perusahaan : PT. ZTE Indonesia

Nama :

Perusahaan : PT. Eka Mas Republik

Telah melaksanakan pengecekan ulang untuk hasil rektifikasi punch list Civil Work seperti dibawah ini dengan hasil
BAIK dan DITERIMA.

Cluster Name Panggung Kidul RW 01

Cluster ID : SF29-99-064

ATP Date :

FDT No Defect Item Defect Description Punch Point Type Result Date of Clearence

PT. Eka Mas Republik PT. ZTE Indonesia

Nama : Nama :
 Site Photo
For

PT. EKA MAS REPUBLIK

SUBFEEDER NAME : Panggung Kidul RW 01

Document Prepared by ZTE and Approved by EMR

ZTE Representation : ;

EMR Representation : ;

PT. ZTE INDONESIA

2022
 No. Category Photo profile Qty
front view with door closed 1
back view with door closed 1
1 FDT 576 front view with door open 1
back view with door open 1
left or right view 1
front view with door closed 1
2 FDT 288/144 front view with door open 1
left or right view 1
corner pole/per cluster 5
3 pole
middle pole/per cluster 5
in the front of FAT, door closed 10% of total
4 FAT
in the front of FAT, door open 10% of total
cover view each cluster 1
5 HH
inner view each cluster 1
6 OPM one photo the longest FAT of each line 1

Note : All photo show with labeling by paper/white board

 Region : Semarang Inner
PHOTO OLT Name : Gajahmungkur
Implementasi SF Name : Panggung Kidul RW 01
EMR FTTH TURNKEY PROJECT SF ID : SF29-99-64

Description: Digging Pole Description: Installation Pole

Description: Pulling Cable Description: kemiringan tiang

Description: Splicing Description: Kedalaman tiang

Description: Install Aksesoris Description: Pondasi tiang

 Region : Semarang Inner
OLT Name : Gajahmungkur
PHOTO FDT
SF Name : Panggung Kidul RW 01
EMR FTTH TURNKEY PROJECT SF ID : SF29-99-64

Description: FDT Close Description: FDT Open

Description: FDT Pole Description: FDT Pole Pondasi

Description: FDT Acc Description: FDT Label Pole