Client
Date
Location :
Order No :
Page 1 of 2
Micrologic Type
Breaker Family
Rated Current
Breaker Type
Breaker Sr.#
I.
Sr.#
SETTING
Ir
tr
Injected
Current
Trip Time
II.
Remarks
Sr.#
Description
4.
Breaker Terminals
III.
Remarks
Electrical Checks:
Sr.#
1
2
3
4
COMPANY
NAME
SIGNATURE
DATE
Description
Insulating Parts Check
Check Indications of CB Open/Close
Check continuity on Closed position
Check resistance on Open position
Schneider Electric
Remarks
Client
Date
Location :
Order No :
Page 2 of 2
Test Device:
Digital Multi-meter
Serial Number:
Make & Model:
2.
COMPANY
NAME
SIGNATURE
DATE
Test Device:
Insulation-Continuity Tester
Serial Number:
W8107210
KYORITSU 3007A
Schneider Electric