Trouble Reporting Form - GE PowerVac Instructions Manual

FAILURE REPORTING FORM FOR POWER CIRCUIT BREAKERS
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 _________________________________________________________________________________
! Indoor
Location:
! Air Blast, ! Air Magnetic, ! Oil, ! SF
Interrupter:
ENVIRONMENT:
! Industrial, ! Urban, ! Suburban, ! Rural, ! Sea Coast, ! Above 3300', ! High Contamination,
General:
Other________________________________________________________________________________________
Weather Conditions: ! Dry, ! Rain, ! Lightning in Area, ! Snow, ! Fog, ! Freezing Rain, ! Frost, ! Condensation,
Temp. Trend 
! Rising, ! Falling, ! Steady, ! Extreme Cold, Temperature_____° F,
Wind 
! Calm, ! Light, ! Strong-Steady, ! Strong-Gusty
External Mechanical Stresses Involved: ! Normal, ! Earthquake, ! Wind, ! Abnormal Terminal Loading,
Other___________________________________________________________________________________________________
Nominal System voltage__________________________
TROUBLE:
When Discovered: ! Installation, ! In Service, ! Maintenance, ! Test, Other _____________________________________
Breaker Mode at Time of Trouble: ! De-energized, ! Closed, ! Open, ! Tripping, ! Closing, ! Reclosing,
Breaker Response at Time of Trouble: ! Not Called Upon to Operate, ! Performed at Intended, ! Unsatisfactory Operation,
Subsystem in Trouble:
! Isolating Contact, ! Bushing, ! Interrupter, ! Seals-Gaskets, ! Air System, ! SF
! Resistor Sw or Aux. Int., ! Voltage Grading Device, ! Line Terminals, ! Compressor, ! Heater, ! Electrical Controls,
! Wiring, ! Operating Mechanism, ! Mechanical Linkage, ! Other _______________________________________________
________________________________________________________________________________________________________
State Specifically What Failed (With Instr. Book Ref.):____________________________________________________________
________________________________________________________________________________________________________
Has it occurred before on this type of breaker? ! No, ! Yes, How many times______________________________________
State How Problem was Corrected
________________________________________________________________________________________________________
POSSIBLE CAUSE: ! Design/Manufacture, ! Shipping, ! Storage, ! Installation, ! Instructions, ! Maintenance,
! Wear/Aging, ! Animal/Birds, ! Other, ! Not Obvious
Comments and Suggestions: _______________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
EFFECT:
Breaker Down Time: ! No Interruption, ! 30 Min. or Less, ! 1 Hr, ! 2 Hr, ! 6 Hr, ! 12 Hr, ! 24 Hr, Other ______________
Repair Time: ! Less than 30 Min., ! 1 Hr, ! 2 Hr, ! 6 Hr, ! 1 Day, ! 2 Days, ! 3 Days, ! 1 Week, Other ______________
Breaker Outage Status: ! Immediate Forced Outage, ! Outage Within 20 Min., ! Required Subsequent Outage,
User Person
Completing Report ______________________________________________________Date__________________________________
User Approval Name_____________________________________________________Date _________________________________
User Contact Name____________________________________________Telephone Number________________________________
User Company_______________________________________________
Mfgr._______________________________Type_______________ Serial #_____________________
kV_______Inter Amps/MVA___________________Continuous Amps__________ BIL______________
(Mo/Yr)
! Outdoor
! Fault Interruption, ! Load Switching, ! Line Switching
! Failed to Operate
! External Insulation to Ground, ! Internal Insulation to Ground, ! Insulating Medium,
:
___________________________________________________________________________
! Repair Deferred Until Regular Maintenance, ! No Outage for Repair
Station____________________________ of Breaker___________________
(Mo/Yr) (Mo/Yr)
Enclosure: ! Non-metal Clad, ! Metalclad, ! GIS
, ! Vacuum, Other____________________________________
6
USER REPORT NO.
User Ident
Trouble
(Mo/Day/Yr)
System, ! C.T.,
6