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REPORT NO.
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
Amps_______BIL_________
Recl Background:
Date__________
(Mo/Day/Yr)
Operational Counter Reading
__________________________________________________________________________
! Indoor
Location:
! Air Blast, ! Air Magnetic, ! Oil, ! SF 6 , ! Vacuum,
Interrupter:
Other_________________________________
ENVIRONMENT:
! Industrial, ! Urban, o Suburban,
General:
Contamination,
Other_________________________________________________________________________________
W eather Conditions: o Dry, o R a i n , o L i g h t n i n g i n A r e a ,
Condensation,
Temp. Trend —
Wind —
External Mechanical Stresses Involved:
Other_____________________________________________________________________________________________
Nominal System voltage__________________________
TROUBLE:
When Discovered:
Other__________________________________
Recloser Mode at Time of Trouble: o De-energized, o Closed, o Open, o Tr i p p i n g , o C l o s i n g , o
Reclosing,
Recloser Response at Time of Trouble: o Not Called to Operate, o Performed as Intended, o Unsatisfactory
Operation,
Subsystem in Trouble:
o I s o l a t i n g C o n t a c t , o Bushing, o I n t e r r u p t e r, o Seals-Gaskets, o Air System, o SF 6 System, o C.T. ,
o Resistor Sw or Aux. Int., o Voltage Grading Dev, o Line Terminals, o Compressor, o Heater, o E l e c t r i -
cal Controls,
o W i r i n g , o Operating Mechanism, o Mechanical Linkage, o
Other__________________________________________
______________________________________________________________________________________________________
State Specifically What Failed (Wi t h I n s t r. Book
Ref.):________________________________________________________
_______________________________________________________________________________________________________
Has it occurred before on this type of recloser? o N o , o Yes, How many
times__________________________________
State How Problem was Cor-
rected:_____________________________________________________________________
________________________________________________________________________________________________________
POSSIBLE CAUSE: o Design/Manufacture, o Shipping, o Storage, o I n s t a l l a t i o n , o I n s t r u c t i o n s , o Mainte-
nance,
o Wear/Aging, o Animal/Birds, o Other, o Not Obvious
Comments and Suggestions:
Courtesy of NationalSwitchgear.com
FAILURE REPORTING FORM
Mfgr._______________________________Type_______________ Serial
KV_________ Inter Amps/MVA___________________ Continuous
Shipped______, Installed______, Maintained______, Modernized____________,
(Mo/Yr)
! Outdoor
o R i s i n g ,
o F a l l i n g ,
o Steady, o Extreme Cold, Temperature_____° F,
o C a l m ,
o L i g h t , o Strong-Steady, o Strong-Gusty
o Normal, o Earthquake, o Wi n d , o Abnormal Terminal Loading,
o I n s t a l l a t i o n , o I n S e r v i c e , o Maintenance,
o F a u l t I n t e r r u p t i o n , o Load Switching, o Line Switching
o Failed to Operate
o External Insulation to Grnd, o Internal Insulation to Grnd, o Insulating Medium,
Station__________________________ of Recloser
(Mo/Yr)
(Mo/Yr)
Enclosure: ! Non-metal Clad, ! Metalclad, ! GIS
o R u r a l ,
o Sea Coast,
o Snow, o F o g , o Freezing Rain,
o Te s t ,
66
USER
User Ident
Trouble
(Mo/Yr)
o Above 3300',
o High
o F r o s t , o
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