Form CEM-5819C "Link Loss Budget Worksheet" - California

What Is Form CEM-5819C?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-5819C by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LINK LOSS BUDGET WORKSHEET
Page 1 of 3
CEM-5819C (NEW 09/2018)
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CERTIFIED FIBER OPTIC TECHNICIAN
CONTRACTOR NAME
Certificate Number
Date Issued
Expiration Date
CERTIFIED FIBER OPTIC TECHNICIAN (Print Name)
SIGNATURE
DATE
AFTER SPLICING AND TERMINATION
LOCATION OF LINK ENDS
Route
Post Mile
Location Description
END 1
END 2
LINK NUMBER
Buffer Tube
Fiber
Wavelength
MEASURED OTDR TEST RESULTS
1310nm
1550nm
Forward Link Loss
dB
dB
1A
Reverse Link Loss
dB
dB
1B
Average Link Loss (1A + 1B) / 2
dB
dB
1C
Link Length (From OTDR)
km
km
1D
MEASURED POWER METER AND LIGHT SOURCE TEST RESULTS
Forward Link Loss
dB
dB
2A
Reverse Link Loss
dB
dB
2B
Average Link Loss (2A + 2B) / 2
dB
dB
2C
CALCULATED LINK FIBER LOSS
Fiber Loss Allowed
dB/km
dB/km
3A
-0.40
-0.30
Total Link Fiber Loss (1D X 3A)
dB
dB
3B
CALCULATED LINK SPLICE LOSS
Splice Loss Allowed
dB
dB
4A
-0.30
-0.30
Number of Splices
4B
Total Link Splice Loss (4A X 4B)
dB
dB
4C
CALCULATED LINK CONNECTOR LOSS
Connector Loss Allowed
dB
dB
5A
-0.40
-0.40
Number of Connectors
5B
Total Link Connector Loss (5A X 5B)
dB
dB
5C
CALCULATED TOTAL LINK LOSS
(3B + 4C + 5C)
dB
dB
6A
LINK VERIFICATION
Compare 1C with 2C and enter the larger value
dB
dB
7A
Difference Between Measured and Calculated Loss (7A - 6A)
dB
dB
7B
LINK TEST RESULTS
If the value of 7B is greater than zero, the link failed the test
Pass
Fail
Pass
Fail
Add Page
Remove Page
RESIDENT ENGINEER REVIEW
RESIDENT ENGINEER (Print Name)
SIGNATURE
DATE
COPY TO TRAFFIC OPERATIONS (Print Name)
SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LINK LOSS BUDGET WORKSHEET
Page 1 of 3
CEM-5819C (NEW 09/2018)
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CERTIFIED FIBER OPTIC TECHNICIAN
CONTRACTOR NAME
Certificate Number
Date Issued
Expiration Date
CERTIFIED FIBER OPTIC TECHNICIAN (Print Name)
SIGNATURE
DATE
AFTER SPLICING AND TERMINATION
LOCATION OF LINK ENDS
Route
Post Mile
Location Description
END 1
END 2
LINK NUMBER
Buffer Tube
Fiber
Wavelength
MEASURED OTDR TEST RESULTS
1310nm
1550nm
Forward Link Loss
dB
dB
1A
Reverse Link Loss
dB
dB
1B
Average Link Loss (1A + 1B) / 2
dB
dB
1C
Link Length (From OTDR)
km
km
1D
MEASURED POWER METER AND LIGHT SOURCE TEST RESULTS
Forward Link Loss
dB
dB
2A
Reverse Link Loss
dB
dB
2B
Average Link Loss (2A + 2B) / 2
dB
dB
2C
CALCULATED LINK FIBER LOSS
Fiber Loss Allowed
dB/km
dB/km
3A
-0.40
-0.30
Total Link Fiber Loss (1D X 3A)
dB
dB
3B
CALCULATED LINK SPLICE LOSS
Splice Loss Allowed
dB
dB
4A
-0.30
-0.30
Number of Splices
4B
Total Link Splice Loss (4A X 4B)
dB
dB
4C
CALCULATED LINK CONNECTOR LOSS
Connector Loss Allowed
dB
dB
5A
-0.40
-0.40
Number of Connectors
5B
Total Link Connector Loss (5A X 5B)
dB
dB
5C
CALCULATED TOTAL LINK LOSS
(3B + 4C + 5C)
dB
dB
6A
LINK VERIFICATION
Compare 1C with 2C and enter the larger value
dB
dB
7A
Difference Between Measured and Calculated Loss (7A - 6A)
dB
dB
7B
LINK TEST RESULTS
If the value of 7B is greater than zero, the link failed the test
Pass
Fail
Pass
Fail
Add Page
Remove Page
RESIDENT ENGINEER REVIEW
RESIDENT ENGINEER (Print Name)
SIGNATURE
DATE
COPY TO TRAFFIC OPERATIONS (Print Name)
SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LINK LOSS BUDGET WORKSHEET
Page 2 of 3
CEM-5819C (NEW 09/2018)
GENERAL INFORMATION
This form is to provide documentation that individual fibers in each fiber optic link are in compliance with the specifications after splicing and
terminating the fibers. A fiber optic link is defined as part of a system that provides a data connection between a transmitter and receiver. A
link may include splices and couplers. For example, a video data link may be from the video fiber optic transmitter to video fiber optic
receiver.
FORM
Complete the form for each fiber optic link after splicing and terminating the fibers, but before connecting the active components. Ensure
individual fiber links comply with the specifications. This is a multiple page form, complete a page for every fiber link that has been spliced
and terminated. Provide a copy of the completed form to the engineer.
CONTRACT NUMBER/CO/RTE/PM: For local agency encroachment permit projects, write the encroachment permit number in the
CONTRACT NUMBER field.
PROJECT IDENTIFICATION NUMBER: For local agency encroachment permit projects, write N/A in the field.
CONTRACTOR NAME: Write the name of the contractor or subcontractor installing the fiber optic cables.
CERTIFIED FIBER OPTIC TECHNICIAN: Enter the certification information for the employee performing the fiber optic tests.
Certificate Number: Enter the certificate number.
Date Issued: Write the date issued.
Expiration Date: Write the certificate expiration date.
LOCATION OF LINK ENDS: Enter the location information for both ends of the link.
Route
Post Mile
Location Description: Enter additional information to further define the location of the link end (type of system, cabinet, direction, etc.)
LINK NUMBER: Enter the link number obtained from the engineer or create a unique number to identify the link.
MEASURE OTDR TEST RESULTS:
Forward Link Loss: Enter the attenuation measured by the OTDR at one end of the link.
Reverse Link Loss: Enter the attenuation measured by the OTDR at the opposite end of the link.
Average Link Loss: The forward link loss (1A) and reverse link loss (1B) are added together and divided by 2.
Link Length: Enter the length (km) of the link measure by the OTDR.
MEASURE POWER METER AND LIGHT SOURCE TEST RESULTS:
Forward Link Loss: Enter the attenuation measured by the power meter at one end of the link.
Reverse Link Loss: Enter the attenuation measured by the power meter at the opposite end of the link.
Average Link Loss: The forward link loss (2A) and reverse link loss (2B) are added together and divided by 2.
CALCULATED LINK FIBER LOSS:
Fiber Loss Allowed: Attenuation per kilometer allowed by the specifications.
Total Link Fiber Loss: The fiber loss allowed (3A) is multiplied by the link length (1D).
CALCULATED LINK SPLICE LOSS:
Splice Loss Allowed: Attenuation per splice allowed by the specifications.
Number of Splices: Enter the number of splices within the link.
Total Link Splice Loss: The splice loss allowed (4A) is multiplied by the number of splices (4B).
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LINK LOSS BUDGET WORKSHEET
Page 3 of 3
CEM-5819C (NEW 09/2018)
CALCULATED LINK CONNECTOR LOSS:
Connector Loss Allowed: Attenuation per connector allowed by the specifications.
Number of Connectors: Enter the n umber of connectors within the link.
Total Link Connector Loss: The connector loss allowed (5A) is multiplied by the number of splices (5B).
CALCULATED TOTAL LINK LOSS:
Average Link Loss: The sum of total link fiber loss (3B), total link splice loss (4C) and total link connector loss (5C).
LINK VERIFICATION:
Compare the average link loss (1C) measured by the OTDR to the average link loss (2C) measured by the power meter and
enter the largest value.
The calculated total link loss (6A) is subtracted from the largest of the measured link loss values (7A).
LINK TEST RESULTS:
If the value of 7B is greater than zero select "fail" to indicate the fiber link does not meet the attenuation requirements.
Otherwise, select "pass" to indicate the fiber link meets the attenuation requirements.
ADD PAGE: Use the "Add Page" button to add pages for additional fiber links as needed.
REMOVE PAGE: Use the "Remove Page" button to remove pages not needed.
ATTENUATION COMPLIANCE
The engineer inspecting the fiber optic installation must:
Review the completed form and verify the fiber optic cable complies with the attenuation requirements before authorizing installation of
the active components.
Reject the fiber optic cable, if at least one of the fibers in the link does not comply with the attenuation requirements. The non-compliant
segment must be replaced.
Inform the contractor of the requirements to test the replacement segment.
Get a representative from the District Traffic Operations office to complete the name, signature, and date.
Provide a copy of the signed form to the District Traffic Operations representative and file a copy in Category 58.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Page of 3