Network Connectivity Questionnaire (Response Required) - Stryker Operating Room Information System Preinstallation Manual

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Network Connectivity Questionnaire (Response Required)

Note This form is intended for use only when installing Stryker equipment on a customer's network.
Instructions: Customer IT department must complete this form with assistance from Stryker Project Manager and Engi-
neers (Stryker personnel must enter number of static IP addresses required for ORIS install and for local CODECs before
providing this form to the customer, at a minimum). Accurate completion of this form is required for installation. Do not
use this form for ConnectSuite.
FACILITY _____________________________________________________________________
CUSTOMER PROJECT MGR._____________________________________________________
TELEPHONE: ____________________________EXTENSION: __________________________
HOURS: ________________________TARGET INSTALL TIME FRAME: _________________
E-MAIL _______________________________________________________________________
ORIS
At peak usage, what percentage of total internal bandwidth is used? _________________________________
Primary manufacturer of network switches: ___________________________ Other: __________________
Number of Static IP addresses required for ORIS install: _________________
Subnet Mask: ____________________
Videoconferencing (fill in this section if installing a Polycom)
Is there a Videoconferencing (VC) network subnet separate from the primary network?__________________
How much total bandwidth is available on your separate VC network? _______________________________
What percentage of your VC network bandwidth do you currently use? ______________________________
Do CODECs associate with an H.323 Gatekeeper (aka Session Border Controller)? _____________________
If this institution works with a bridging service, please provide the information below:
Company name: ____________
Number of IP Addresses required for local CODECs (Polycom): _________________________________
Range of IP Addresses Reserved for local CODECs: ___________________ to ______________________
Subnet Mask: ____________________ Default Gateway: ___________________________
If E.164 IDs are not auto-assigned by an H.323 Gatekeeper, please provide reserved E.164 IDs: (for each
Polycom)
___________________
I acknowledge the above information submitted us accurate to the best of my knowledge.
Institution Representative Printed Name
Institution Representative Signature
46
POC name: _____________
___________________
Default Gateway: ____________________
POC phone/email: ______________
___________________
Title
Title
___________________
___________________