DorBAG : Questionnaire

DIGITAL TERRESTRIAL TV RECEPTION PROBLEM REPORT

If you are experiencing problems with reception, and have not tried to resolve it using the DIGITAL UK help page, (http://www.digitaluk.co.uk) we recommend you do so. If that does not resolve your problem, you might consider calling in the supplier of your TV equipment and/or your aerial installer as some problems have been found to be down to faulty equipment, incorrect equipment set-up, or aerial quality or alignment.

If none of these avenues solve your problem, then please
FILL OUT THIS FORM SO WE CAN LOBBY THE AUTHORITIES ON YOUR BEHALF.
BUT EITHER WAY, WE HOPE YOU WILL COMPLETE THE SHORT TOP PART OF THE FORM REGARDING THE LOSS OF ITV 3 & 4 ON LOCAL RELAY TRANSMITTERS.

If you prefer to download the form to fill in later, please click here

The full form should take less than 2 minutes to complete. We appreciate your help
* (required fields)

Name *	Your name is required
House Number or House Name *	Required
Postcode *	Your postcode is requiredInvalid
Email Address *	Invalid FormatEmail required.
Please state whether you have a problem with the loss of ITV 3 & 4, problems with reception of other channels, or both	Loss of ITV3 & ITV4	TV Reception problems	Both


Information about your antenna and equipment
OS Grid Reference (if known)
Which BBC News programme do you receive ?
From where do you receive your TV signal ?
Transmitter (if known)
In which direction is your Aerial facing (appox)?
Make of TV or Set Top Box

Please choose one option from below:
a) Did the problem first occur on switchover ?
b) National retune - 30th September 2009 ?
c) Other (please state in the comments box below)

Last Question :	Yes	No
Are any of your neighbours similarly affected ?
Comments : Please use the box below for any other remarks, comments,etc

To help prevent spam, please insert the word tvform2 into the box below : Thank you for taking the time to complete this Report form.

If your form doesn't submit, please scroll to the top of the page and fix any highlighted errors

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Type of Loss			Time of Day			Duration
Picture freezes	Picture breaks up	Loss of audio	Morning	Afternoon	Evening	A few seconds	A few minutes	Longer	Always

Type of Loss			Time of Day			Duration
Picture freezes	Picture breaks up	Loss of audio	Morning	Afternoon	Evening	A few seconds	A few minutes	Longer	Always

Type of Loss			Time of Day			Duration
Picture freezes	Picture breaks up	Loss of audio	Morning	Afternoon	Evening	A few seconds	A few minutes	Longer	Always

Type of Loss			Time of Day			Duration
Picture freezes	Picture breaks up	Loss of audio	Morning	Afternoon	Evening	A few seconds	A few minutes	Longer	Always

Type of Loss			Time of Day			Duration
Picture freezes	Picture breaks up	Loss of audio	Morning	Afternoon	Evening	A few seconds	A few minutes	Longer	Always