SCADA Site Survey Form

SCADA Site Survey Form
Use this form to share the information needed to plan and conduct a SCADA site survey.
Site and Contact Information
Site Name
Site Address or Location Description
Primary Contact Name
Primary Contact Job Title / Role
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method
Site Overview and Operational Context
Site type
Other
Brief site description
Number of operating locations/areas involved in this survey
Current operational schedule or hours
Existing SCADA / PLC Environment
Is SCADA currently installed?
Current SCADA vendor/platform
PLC/RTU present?
PLC/RTU manufacturers or models
Estimated number of controlled assets or remote sites
Main equipment categories
Rows Equipment Type Quantity Condition/Status
SCADA Server
HMI/Operator Workstation
PLC
RTU
Network Switch/Router
IO Modules
Telemetry Radio
Other
Communications and Network Details
Communication Methods in Use
Other
Network Topology Description
Available Internet/WAN Connectivity
Remote Access Method (if any)
Cybersecurity or Segmentation Concerns Noted
Power, Environment, and Physical Conditions
Available power sources for control equipment
Other
UPS or generator backup present
Environmental conditions impacting equipment
Other
Equipment room or cabinet locations
Known space or mounting constraints
Access, Safety, and Survey Scope
Site access restrictions
Required safety training or site check-in procedures
Preferred survey date and time window
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Survey objectives
Other
Priority areas to inspect
Special instructions for the survey team
Should be Empty:

Select theme:

Rows	Equipment Type	Quantity	Condition/Status
SCADA Server
HMI/Operator Workstation
PLC
RTU
Network Switch/Router
IO Modules
Telemetry Radio
Other

SCADA Site Survey Form

Site and Contact Information

Site Overview and Operational Context

Existing SCADA / PLC Environment

Communications and Network Details

Power, Environment, and Physical Conditions

Access, Safety, and Survey Scope