Name of Consultant:	aaaaa

Telephone Number: 	xxxx xxxx

Fax Number:	xxxx xxxx

Email:	aaaaa@aaaaa.com



Project Title:	aaaaa

Date:	xx/xx/xxxx		Time:	xx:xx



Coordinate System used:	aaaaa

Year of Traffic Flow used:	xxxx



Options for Corrections:

Multiple Screening Effect:	Yes/No

Opposite Façade Effect:	Yes/No

Cut-off Angle:	x.x deg.

Cut-off Distance:	xxxx.x m

Cut-off Distance for Reflection from Barrier:	xx.x m



Road Link(s):



Link No.:	xxxx

Link ID:	aaaaa

Category:	(1)New/(2)Existing/(3)Other

Flow:		xxxxx veh/hr

Speed:	xxx.x km/h	Speed Corrected for Gradient: Yes/No

%Heavy Vehicle:	xxx.x

Flow Direction:	One Way/Two Way

Dual Carriageway:	Yes/No

Width of Central Divider: xx.x	Vertical Separation: xx.x

Elevated Road:	Yes/No

Surface Type:	Concrete/Bituminous/Pervious/Surface Corr.

Texture Depth:	xx.x mm

Seg From                          To                            Width  Ground Type

No. X        Y        Z     H     X        Y        Z     H            Left   Right

1   xxxxxx.x xxxxxx.x xxx.x xxx.x xxxxxx.x xxxxxx.x xxx.x xxx.x xxx.x  xxx.x  xxx.x

2   xxxxxx.x xxxxxx.x xxx.x xxx.x xxxxxx.x xxxxxx.x xxx.x xxx.x xxx.x  xxx.x  xxx.x

.

.



Barrier Link(s):



Link No.:	xxxx

Link ID:	aaaaa

Type:		Absorptive/Reflective

Level:	Grade/Elevated





Seg From                          To                            Inclined  Mean    Mean    FOA  Width

No. X        Y        Z     H     X        Y        Z     H       angle   Length  Opening

1   xxxxxx.x xxxxxx.x xxx.x xxx.x xxxxxx.x xxxxxx.x xxx.x xxx.x   xx.x    xxx.x   xx.x    x.x   xx.x

2   xxxxxx.x xxxxxx.x xxx.x xxx.x xxxxxx.x xxxxxx.x xxx.x xxx.x   xx.x    xxx.x   xx.x    x.x   xx.x



.

.



[blank row]

Receiver(s):



No.  NSR ID               X        Y        Z     H        View Angle Bearing    Facade

                                                             Left    Right    Correction

1    aaaaa                xxxxxx.x xxxxxx.x xxx.x xxx.x      xxx.x   xxx.x       Yes/No

2    aaaaa                xxxxxx.x xxxxxx.x xxx.x xxx.x      xxx.x   xxx.x       Yes/No