Name of the BTS :

Item Site ID Name

FORMAT FOR CERTIFICATION OF BTS FOR COMPLIANCE OF THE EMF EXPOSURE LEVELS (BROADBAND MEASUREMENT) C-I : SITE DATA & TECHNICAL PARAMETERS SYSTEM TYPE:
Units VODAFONE RELIANCE AIRCEL

Date of Commissioning

Address

SITE DATA

Lat / Long RTT / GBT Building Height AGL Antenna Height AGL Make and model of Antenna System Type (GSM/CDMA/UMTS) Base Channel Frequencies Carriers / Sector BTS Power (dBm) (MHz) (m) (m)

Building 0 (B0) Measured value of Power Density(W/Sqm) & Electric Field Strength(V/m) at adjacent buildings/ conspicuous locations within 20 meters radius.
Lat /Long

C-II : BROADBAND MEASUREMENT OF POWER DENSITY (W/Sqm) Own Building Top Corners and other points on the periphery of exclusion zone Remarks

Dis. From Tower Base (m) ICNIRP Power Density Limit(W/Sqm)* Permisible Limit under BB Measurement Method@10% Measured Power DensityValue(W/Sqm) Power Density Ratio (Measured/ICNIRP ) COMPLIANT (YES/ NO)

Building 1 (B1)
Azimuth Lat Distance from BTS(m)

Measurement at various floors of the adjacent building I II III IV Remarks

Long ICNIRP Power Density Limit(W/Sqm)* Permisible Limit under BB Measurement Method@10% Measured Power DensityValue(W/Sqm) Power Density Ratio (Measured/ICNIRP ) COMPLIANT (YES/ NO)

Building 2 (B2)
Azimuth Lat Distance from BTS

Measurement at various floors of the adjacent building I II III IV Remarks

RESULT

Long ICNIRP Power Density Limit(W/Sqm)* Permisible Limit under BB Measurement Method@10% Measured Power DensityValue(W/Sqm) Power Density Ratio (Measured/ICNIRP ) COMPLIANT (YES/ NO) SPOT LANDMARK ENTRY POINT Lat Long Azimuth Distance from BTS(m) ICNIRP Power Density Limit(W/Sqm)* Permisible Limit under BB Measurement Method@10% Measured Power DensityValue(W/Sqm) Power Density Ratio (Measured/ICNIRP ) COMPLIANT (YES/ NO)

OTHER CONSPICUOUS LOCATIONS ON THE GROUND

Spot 2

Spot 3

Spot 4

Remarks

Govt. of lndia Ministry of Communications & lT Department of Telecommunications O/o Deputy Director General, TERM Delhi Performa for EMR Compliance Result Ref. No. .. 1 2 3 4 5 6 7 Name of Telecom Sevice Provider Name of LSA Date Of EMR Measurement Done by TERM cell Name/Identity & address of BTS (As per TSP) Longitude & Latitude of BTS (Measured by equipment provided by TSP) Compliance Method adopted by TSP Result indicated by TSP

Measurement Value by Term Cell

Type of exposure Average Value Peak Value

9 10

Signage status Site Compliant/Non Compliant with Reasons

TO

Note: This site was tested in accordance with DoT letter No:800-15/2010-

a ations & lT munications neral, TERM Annexure I

liance Result

Freq. Range

Electric field Strength(V/M)

Power Density(W/m2)

Signature Designation

Date

letter No:800-15/2010-VAS dated 8th April 2010