SAFETY
FOR LIFE
Form 5 Control Default Test Sheet
Date:
2.
Battery Circuitry
3.
Phase
Minimum Trip
4.
Ground
Minimum Trip
5.
Phase Timing
Volts
MA
Volts
Normal Profile
Phase A Amps
Profile #1
Phase A Amps
Profile #2
Phase A Amps
Profile #3
Phase A Amps
Normal
Ground Amps
Profile #1
Ground Amps
Profile #2
Ground Amps
Profile #3
Ground Amps
Trip to Lockout Sequence
Normal
Phase A 2X
Phase B 5X
Phase C 10X
Profile #1
Phase A 2X
Phase B 5X
Phase C 10X
Profile #2
Phase A 2X
Phase B 5X
Phase C 10X
Profile #3
Phase A 2X
Phase B 5X
Phase C 10X
Serial No:
2.6 Volts
2.6 MA
2.6 volts
Phase B Amps
Phase B Amps
Phase B Amps
Phase B Amps
1st
S280-79-10
Phase C Amps
Phase C Amps
Phase C Amps
Phase C Amps
2nd
3rd
4th
53