GE PowerVac GEK-86132F Instruction Manual page 38

Check all appropriate blocks and provide information indicated. For major trouble provide additional information requested on back of
page supplemented with additional pages if necessary.
EQUIPMENT:
Equipment Nameplate
Information
Breaker Background: Shipped________, Installed________, Maintained_________, Modernized_______, Date _____________
Operational Counter Reading _________________________________________________________________________________


Location: Indoor


Interrupter: Air Blast,
ENVIRONMENT:


General:
Industrial,
Other________________________________________________________________________________________


Weather Conditions:


Temp. Trend 


Wind 
External Mechanical Stresses Involved:
Other___________________________________________________________________________________________________
Nominal System voltage__________________________
TROUBLE:


When Discovered: Installation,
Breaker Mode at Time of Trouble:
Breaker Response at Time of Trouble:
Subsystem in Trouble:



Isolating Contact,


Resistor Sw or Aux. Int.,



Wiring, Operating Mechanism,
________________________________________________________________________________________________________
State Specifically What Failed (With Instr. Book Ref.):____________________________________________________________
________________________________________________________________________________________________________
Has it occurred before on this type of breaker?
State How Problem was Corrected
________________________________________________________________________________________________________


POSSIBLE CAUSE: Design/Manufacture,


Wear/Aging,
Comments and Suggestions: _______________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
EFFECT:


Breaker Down Time:
No Interruption,


Repair Time: Less than 30 Min.,
Breaker Outage Status:
User Person
Completing Report ______________________________________________________Date__________________________________
User Approval Name_____________________________________________________Date _________________________________
User Contact Name____________________________________________Telephone Number________________________________
User Company_______________________________________________
FAILURE REPORTING FORM FOR POWER CIRCUIT BREAKERS
Mfgr._______________________________Type_______________ Serial #_____________________
kV_______Inter Amps/MVA___________________Continuous Amps__________ BIL______________
(Mo/Yr)


Outdoor



Air Magnetic,



Urban, Suburban,



Dry, Rain, Lightning in Area,



Rising, Falling, Steady,



Calm, Light, Strong-Steady,


Normal,



In Service,


De-energized,


Fault Interruption,


Not Called Upon to Operate,


Failed to Operate


External Insulation to Ground,



Bushing, Interrupter,


Voltage Grading Device,


Mechanical Linkage,


No,
:
___________________________________________________________________________


Shipping,


Animal/Birds,


30 Min. or Less,



1 Hr, 2 Hr,


Immediate Forced Outage,


Repair Deferred Until Regular Maintenance,
Station____________________________ of Breaker___________________
(Mo/Yr) (Mo/Yr)


Enclosure: Non-metal Clad,



Oil, SF , Vacuum, Other____________________________________
6



Rural, Sea Coast,



Snow, Fog,


Extreme Cold, Temperature_____° F,


Strong-Gusty




Earthquake, Wind,


Maintenance, Test, Other _____________________________________




Closed, Open, Tripping,



Load Switching, Line Switching


Performed at Intended,


Internal Insulation to Ground,


Seals-Gaskets, Air System,



Line Terminals, Compressor,


Other _______________________________________________


Yes, How many times______________________________________



Storage, Installation,



Other, Not Obvious




1 Hr, 2 Hr,




6 Hr, 1 Day, 2 Days,


Outage Within 20 Min.,


No Outage for Repair
USER REPORT NO.
User Ident
(Mo/Day/Yr)



Metalclad, GIS



Above 3300', High Contamination,



Freezing Rain, Frost,
Abnormal Terminal Loading,



Closing, Reclosing,


Unsatisfactory Operation,


Insulating Medium,



SF System, C.T.,
6


Heater, Electrical Controls,



Instructions, Maintenance,



6 Hr, 12 Hr, 24 Hr, Other ______________



3 Days, 1 Week, Other ______________


Required Subsequent Outage,
Trouble


Condensation,