Record form No:

IDABB PSSS Inspection and test record

1WATPSF0-017
Description: Order No.: Sheet:
LV Circuit Breaker 1
Drawing no.: Cont:
–
Customer: Customer ref.:

Erection Site: Ref.:

A. General
Location:       Manufacturer      
:
Type:       Serial No:      
Mode of spring operation: Hand - operated:
Motor - operated:

B. Test and inspection Checked Not applicable

Checked to be as specified:
Checked to be clean and without damage:
“Drawn-out” function operates correcly:
Undervoltage trip checked:
In “Test” Position:
Local operation checked:
Remote operation checked:
In “Connected” Position:
Local operation checked:
Remote operation checked:
Automatic trip before insertion to connected position checked:
Automatic trip before withdrawal from connected position checked:
Alarms signals checked:
Indication signals checked:

Remarks:      
     

References to used instruments

Type:       Identity:      
Type:       Identity:      
Type:       Identity:      
Type:       Identity:      

Test carried out: Customers approval:

Date, Sign: Date , Sign: