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Name and address of customer

Name* :
Last Name* :
Address :
Zip code :
City :
Tel.* :
Fax :
Email* :
 

Name and address of the structure to be protected

Name :
Address :
Zip code :
City :

Definition of the structure

Building usage :
Type of products stored/manufactured in the building :
Presence of antennae on the roof ? oui non
Presence of metallic structures on the roof ? oui non
Presence of external gas pipes ? oui non
Presence of electrical cables on the facade ? oui non
Is a specific electrical equipments surge protection survey required ? oui non
Nature of the ground for installation of the LPS earthing system ?
Presence of asphalt or concrete (at the location of the future earthing system) ?
Presence of other earthing pits ?
Presence of underground earth loop around the building ? oui non
Presence of earth rods ? oui non
Telecom lines ? oui non
Data lines ? oui non

Location of the structure

Structure located in a place where there are other strucures or trees of identical or greater height.
Structure surrounded by lower structures
Isolated structure, no other structures closer than a distance of 3H.
Isolated structure at the top of a hill.

Occupation of the building

Unoccupied
Commonly occupied
Difficult evacuation (risk of panic)

Structure contents

No value - No fire risk
Common value - Low fire risk
High value - Increased fire risk
Exceptional value - Very great risk of fire - Explosives

Consequences of a lightning strike

Interruptible services - No environmental consequences
Non interruptible services - No environmental consequences
Environmental consequences

Remarks

Attachements

Attachements and send :
ILPA
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