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Date: __________________
Name / Location: __________________
Contact: __________________

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1. Physical Setup

1. Where is the router placed? (Near window / center of building / enclosed space / other)
2. Any large obstructions nearby? (Metal shelves, concrete walls, appliances) ☐ Yes ☐ No
3. Antennas: ☐ Internal ☐ External – If external, are they aimed toward the nearest tower? ☐ Yes ☐ No
4. Router ventilation: ☐ Adequate ☐ Limited (overheating possible)

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2. 5G Cellular Connection

1. Carrier: __________________
2. Signal Strength (check router admin page/app):
   • RSRP: _______ dBm
   • RSRQ: _______ dB
   • SINR: _______ dB
3. Current Connection: ☐ 5G mmWave ☐ 5G Mid-Band ☐ 5G Low-Band ☐ LTE/4G
4. Is carrier aggregation active? ☐ Yes ☐ No ☐ Not Sure
5. SIM card seated correctly? ☐ Yes ☐ No
6. Any data caps or throttling from carrier? ☐ Yes ☐ No

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3. Wi-Fi Network Details

1. Active Bands: ☐ 2.4 GHz ☐ 5 GHz ☐ 6 GHz (Wi-Fi 6E)
2. Separate SSIDs for each band? ☐ Yes ☐ No
3. Security Mode: ☐ WPA3 ☐ WPA2 ☐ Other __________
4. Approximate distance from device to router: _______ feet/meters
5. Channel setting: ☐ Auto ☐ Manual – Channel #: _______
6. Guest network enabled? ☐ Yes ☐ No

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4. Device Load & Usage

1. Total connected devices: _______
2. Critical devices: ___________________________________________
3. Any devices streaming or downloading heavily during slowdowns? ☐ Yes ☐ No
4. Is QoS (Quality of Service) enabled? ☐ Yes ☐ No ☐ Not Sure

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5. Performance Measurements (Fill in from tests)

Test Type	Result	Notes
Idle Ping (ms)	____________
Download Ping (ms)	____________
Upload Ping (ms)	____________
Download Speed	____________	Mbps
Upload Speed	____________	Mbps
Packet Loss (%)	____________
Jitter (ms)	____________

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6. Interference & Environment

1. Other nearby Wi-Fi networks on same channel? ☐ Yes ☐ No
2. Nearby devices that could cause interference? (Microwave, cordless phones, etc.) ☐ Yes ☐ No
3. Weather conditions affecting signal? ☐ Yes ☐ No
4. Seasonal foliage or construction nearby? ☐ Yes ☐ No

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7. Software & Firmware

1. Router firmware up to date? ☐ Yes ☐ No
2. Last firmware update date: __________________
3. Have you restarted the router recently? ☐ Yes ☐ No
4. Have you factory reset the router? ☐ Yes ☐ No – Date: ____________

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8. Third-Party & Carrier Factors

1. Carrier outage reported in area? ☐ Yes ☐ No
2. Slowdowns only at certain times of day? ☐ Yes ☐ No – If yes, when: ____________
3. Using VPN? ☐ Yes ☐ No – If yes, speed tested without it? ☐ Yes ☐ No

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