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SHVIA* WAIVER FIELD TESTING FORM
For Arbitration by ARRL
A
- REFERRING ORGANIZATION/COMPANY
(Fill out whichever is applicable.)
Broadcaster Information
Broadcast station company name:
Broadcast station call letters:
Contact:
Address:
City, State, Zip:
Telephone: Email:
Satellite Provider Information
Satellite service provider:
Satellite service company name/dealer:
Address:
City, State, Zip:
Telephone:
Email:
ARRL shall be held harmless by all parties, including the proposed tester, from any costs, liabilities, assessments, damages, and causes of action occasioned by any determination made, and for any statements made concerning the proposed tester's qualifications.
___________________________________________________ (Signature)
*Satellite Home Viewer Improvement Act
B - TESTING COMPANY
1. Company Identification
Company name:
Owner/manager/contact name:
Address:
City, State, Zip:
Telephone: Fax:
Email: Web:
Does company have any financial interest in
the sale of satellite equipment or broadcast antennas? If yes, describe:
2. Test Company Experience And Training:
Description of company experience in field testing of TV signals:
Description of experience and training of person who will be doing testing:
Does company have NVLAP or other equivalent certification? If other, describe:
3. Test Equipment To Be Used:
What make/model/serial number of measurement equipment will be used?:
What make/model/serial number of antenna used?:
What is the gain of this antenna at each channel being tested?:
When was this equipment last calibrated by the factory or an independent calibration lab? :
What is the name, address and telephone number of the calibration lab?:
What type of feed line will be used to connect the antenna to the measurement equipment?:
What is the loss of the antenna feed line, if any?
4. Measurements To Be Performed:
What TV station/channel(s) will be measured?
What is the Grade B level signal for each channel?
How many points at each measurement site will be taken?
By what distance will those points be separated?
What is the measurement uncertainty of the tests on each channel being measured?
By what method was this measurement uncertainty calculated?
5. Additional Information:
Please provide any additional information you feel best represents your company's test capabilities:
Please provide a written description of the test methods you use. As an alternative, this can be sent by FAX or mail to ARRL.
Information on this form will be shared with the parties involved including the FCC.
This form can be returned to ARRL by postal mail, FAX or email at the contact information below. If by email, it can be as plain text, a Word document, a .pdf or as html.
|
ARRL |
Tel: 860-594-0200 |
Date:________________________
I, ______________________________________________, serving as:
(job title)_______________________
for: ____________________________________________ (test company name)
________________________________________________ (street address)
________________________________________________ (city, state, ZIP)
certify that I am familiar with the requirements and test procedures outlined in the Satellite Home Viewer Improvement Act and that my company has the technical ability and equipment to perform such testing to a reasonable accuracy. I also certify that my company is able to perform the test without bias to the end results and that those results will be presented accurately without favor to any party.
In addition, ARRL shall be held harmless by all parties, including the proposed tester, from any costs, liabilities, assessments, damages, and causes of action occasioned by any determination made, and for any statements made concerning the proposed tester's qualifications.
___________________________________________________ (Signature)
Information on this form will be shared with the parties involved including the FCC.
Please return this entire form by email or FAX to ARRL, followed by an original copy sent by mail or carrier.
ARRL
225 Main St
Newington, CT 06111
FAX: 860-594-0259 - Attn: Ed Hare
