Submitted in accordance with clause 4(4) of the Resource Management (National Environmental Standards for Telecommunication Facilities) Regulations 2008.
Notice of new telecommunication facility generating radiofrequency fields
Location of telecommunication facility
| Address: | |
| Facility on road reserve? |  Yes No |
| Grid reference: | |
| Physical structure consent requirements |
|
| Estimated date of starting operation: |
Network operator details
| Operator name: | |||
| Contact person: | |||
| Address: | |||
| Phone/fax: | Email: | ||
Compliance checklist
| Yes | No | |
| Design and operation | ||
| Facility planned and operated in accordance with NZS 2772.1: 1999, including compliance with clause 10(d)? [cl 4(3) of NES] | ||
| Predicted exposure levels report | ||
| Is report on predicted exposure levels attached? [cl 4(4)(b) of NES] | ||
| Report prepared in accordance with NZS 6609.2. 1990? [cl 4(4)(b)(i) of NES] | ||
| Other transmitters nearby taken into account? [cl 4(4)(b)(ii) of NES] | ||
| Exposures in publicly accessible areas exceed 25% of public limits (post-installation measurements required)? [cl 4(5)5 of NES] | ||
| Will exposures in publicly accessible areas exceed public limits specified in NZS 2772.1. 1999?8 (If yes, then facility will be non-complying) |
Supporting documentation attached (tick all applicable)
| Location plan: | |
| Site plan: | |
| Elevation drawing: | |
| Technical specifications: | |
| Others: |
Other information
(Note: if a certificate of compliance is required, check the specific information requirements of the relevant local authority.)
| Name of person responsible for this report: | |
| Qualification/experience: | |
| Signature of person responsible for this report: |
8. If the answer is YES, then resource consent will be required before the facility can be installed.
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Appendix C: Radiofrequency Reporting Template
November 2009
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