Page
Visual Inspection / Cleaning
Meter
Data
Project
INSPECTION FORM
ANALOG METER
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Cell #:
Manufacturer:
Type:
Accuracy
ID:
Range
Cover Gasket:
Good
Acceptable
Poor
Cover Glass:
Good
Acceptable
Poor
Spiral Spring:
Good
Acceptable
Poor
Disc Clearance:
Good
Acceptable
Poor
Contacts:
Good
Acceptable
Poor
Case Shorting
Contacts:
Good
Acceptable
Poor
Rotating Disc Movement:
Good
Acceptable
Poor
General Condition:
Good
Acceptable
Poor
Cleanliness (as found)
Good
Acceptable
Poor
Unit Cleaned:
Yes
Connections (as found)
Good
Acceptable
Poor
Connections
Torqued:
Yes
Test Value
Reading
As Found
Reading
As Left
N/A
Units
0
Unit
Calibrated:
Final
Analysis
1 of 1
Yes
No
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-AM Rev.00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-AM.doc
Breaker Data
Project
INSPECTION FORM
AIR CIRCUIT BREAKER, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Switchgear:
Manufacturer:
Type:
Rated Voltage:
V
Momentary Fault
Closing Amps:
Visual Inspection / Cleaning
Breaker ID
Serial #:
A
Trip Unit Type:
Breaker Identification Tag Installed:
Interrupting Rating:
Control Voltage:
Yes
1 of 2
Cell #:
Current Rating:
A
Page
No
kA
V
BIL Rating:
Visual Signs of Overheating:
Cleanliness (As Found):
Good
Acceptable
Poor Support Insulators:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Arc Chutes:
Door Mechanical:
Good
Acceptable
Poor
Cell Fit and Alignment:
Good
Racking Mechanism:
Shutter:
Yes
Good
Electro/Mechanical
Interlock:
Acceptable
Poor
Good
Acceptable
Poor
Good
Acceptable
Poor
Contact Alignment and
Condition:
Good
Acceptable
Poor
Acceptable
Poor Operating Mechanism:
Good
Acceptable
Poor
Good
Acceptable
Poor Contact Fingers:
Good
Acceptable
Poor
Good
Acceptable
Poor Arcing Contacts:
Good
Acceptable
Poor
Good
Acceptable
Poor
Cables Supported Appropriately:
Yes
N/A
No
No Auxiliary Devices:
Unit Cleaned:
Yes
Photograph Taken:
Yes
Comments:
Test
Preparation
:
Insulation Resistance Test
Test
Voltage
Source:
Cable Dest. / Load:
Disconnected
Note: Approval of City’s Representative is required, prior to
Disconnected
leaving cables connected during the test.
Connected with
Connected with Load Isolated
Source Isolated
Insulation Resistance (MΩ)
Phase To GND (Breaker Closed)
A
B
Temperature:
o
C
C
2500 V
Test
Voltage
Insulation Resistance (MΩ)
Phase To Phase (Breaker Closed)
A–B
B–C
A-C
2500 V
Test
Voltage
Insulation Resistance (MΩ)
Line to Load (Breaker Open)
A
B
2500 V
Comments:
Form F-BKR-AIR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-AIR-4160V.doc
Test Summary
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Insulation Resistance
(Control Wiring)
INSPECTION FORM
AIR CIRCUIT BREAKER, 4160V
Wire Tag
Insulation
Resistance (MΩ)
Page
Breaker ID
Insulation
Resistance (MΩ)
Wire Tag
2 of 2
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Contact/Pole Measurements
A
B
C
Test Summary
Resistance (µΩ)
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Arcing Contact Gap (mm)
Arcing Contact Wipe (mm)
Main Contact Gap (mm)
Main Contact Wipe (mm)
High Potential Test
Comments:
Test
Preparation
:
Source:
Disconnected
Connected with
Source Isolated
Peak DC
Test Voltage
(1 minute
duration)
Note: Approval of City’s Representative is required, prior to leaving cables connected during
the test.
Test Summary
(µA)
A
Test Summary
B
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C
12 kV
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-BKR-AIR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-AIR-4160V.doc
Breaker Data
Project
INSPECTION FORM
AIR CIRCUIT BREAKER, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Switchgear:
Manufacturer:
Type:
Rated Voltage:
V
Momentary Fault
Closing Amps:
Visual Inspection / Cleaning
Interrupting Rating:
Trip Unit Type:
Yes
Breaker ID:
Serial #:
A
Breaker Identification Tag Installed:
1 of 3
Cell #:
Frame Size:
A
Page
kA
Control Voltage:
No
V
Visual Signs of Overheating:
Cleanliness (As Found):
Good
Acceptable
Poor Support Insulators:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Arc Chutes:
Door Mechanical:
Good
Acceptable
Poor
Cell Fit and Alignment:
Good
Racking Mechanism:
Shutter:
Yes
Good
Electro/Mechanical
Interlock:
Acceptable
Poor
Good
Acceptable
Poor
Good
Acceptable
Poor
Contact Alignment and
Condition:
Good
Acceptable
Poor
Acceptable
Poor Operating Mechanism:
Good
Acceptable
Poor
Good
Acceptable
Poor Contact Fingers:
Good
Acceptable
Poor
Good
Acceptable
Poor Arcing Contacts:
Good
Acceptable
Poor
Good
Acceptable
Poor
Cables Supported Appropriately:
Yes
N/A
No
No Auxiliary Devices:
Unit Cleaned:
Yes
Photograph Taken:
Yes
Comments:
Test Preparation:
Insulation Resistance Test
Test
Voltage
Source:
Cable Dest. / Load:
Disconnected
Note: Approval of City’s Representative is required,
Disconnected
prior to leaving cables connected during the test.
Connected with
Connected with Load Isolated
Source Isolated
Insulation Resistance (MΩ)
Phase To GND (Breaker Closed)
A
B
Temperature:
o
C
C
1000 V
Test
Voltage
Insulation Resistance (MΩ)
Phase To Phase (Breaker Closed)
A–B
B–C
A-C
1000 V
Test
Voltage
Insulation Resistance (MΩ)
Line to Load (Breaker Open)
A
B
1000 V
Comments:
Form F-BKR-AIR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-AIR-600V.doc
Test Summary
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Insulation Resistance
(Control Wiring)
INSPECTION FORM
AIR CIRCUIT BREAKER, 600V
Wire Tag
Insulation
Resistance (MΩ)
Page
Breaker ID:
Test Summary
Insulation
Resistance (MΩ)
Wire Tag
2 of 3
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Contact/Pole Measurements
A
B
C
Test Summary
Resistance (µΩ)
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Arcing Contact Gap (mm)
Arcing Contact Wipe (mm)
Main Contact Gap (mm)
Main Contact Wipe (mm)
Comments:
Breaker Settings
Plug Rating:
A
Sensor Tap
Relay Setting (As Left)
Ground Fault
Setpoint
3W
4W
Delay
I2T
Enabled
Long Time
X
A =
A
sec
Yes
No
On
Off
Short Time
X
A =
A
sec
Yes
No
On
Off
Instantaneous
X
A =
A
Yes
No
Yes
No
On
Off
Ground Fault
N/A
A
sec
TCC NO:
Time Band
Breaker Test
Test
Test Current
Long Time
A
Short Time
A
Instantaneous
A
Ground Fault
A
Min.
(sec)
Max.
(sec)
Form F-BKR-AIR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-AIR-600V.doc
A
As-Found
(sec)
B
As-Left
(sec)
As-Found
(sec)
C
As-Left
(sec)
As-Found
(sec)
As-Left
(sec)
Final
Analysis
INSPECTION FORM
AIR CIRCUIT BREAKER, 600V
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Page
3 of 3
Breaker ID:
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-BKR-AIR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-AIR-600V.doc
Breaker Data
Project
INSPECTION FORM
MOLDED CASE CIRCUIT BREAKER, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Panelboard/MCC:
Manufacturer:
Type:
Rated Voltage:
V
Interrupting
Rating:
kA
1 of 1
ID:
Cell #:
Serial #:
Frame Size:
A
Trip Unit:
Comments:
Breaker Identification Tag Installed:
Visual Inspection /
Cleaning
Page
Yes
No
Visual Signs of Overheating:
Cleanliness (As Found):
Good
Acceptable
Poor Cables Supported Appropriately:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Exercise Circuit Breaker:
Door Mechanical:
Good
Acceptable
Poor Other:
Electro/Mechanical
Interlock:
N/A
Good
Yes
No
Yes
No
Acceptable
Poor
Yes
Contact
Measurements
Comments:
A
Breaker Settings
Test Summary
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Resistance (mΩ)
Comments:
Trip Unit Rating:
Final
Analysis
B
A
Trip Unit Type:
Breaker Setting (As Left)
None
Thermal Magnetic
Range
Electronic
Setpoint
LI
LSI
Delay
LSIG
I2T
Long Time
Fixed
Adj.
-
X
A =
A
sec
On
Off
Short Time
Fixed
Adj.
-
X
A =
A
sec
On
Off
Instantaneous
Fixed
Adj.
-
X
A =
A
Ground Fault
Fixed
Adj.
-
On
Off
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
A
N/A
sec
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-BKR-MC-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-MC-600V.doc
Breaker Data
Project
INSPECTION FORM
VACUUM CIRCUIT BREAKER, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Switchgear:
Manufacturer:
Type:
Rated Voltage:
V
Momentary Fault
Closing Amps:
Visual Inspection / Cleaning
Breaker ID
Serial #:
A
Trip Unit Type:
Breaker Identification Tag Installed:
Interrupting Rating:
Control Voltage:
Yes
1 of 2
Cell #:
Current Rating:
A
Page
No
A
V
BIL Rating:
Visual Signs of Overheating:
Cleanliness (As Found):
Good
Acceptable
Poor Support Insulators:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Door Mechanical:
Good
Cell Fit and Alignment:
Yes
Good
Electro/Mechanical
Interlock:
Acceptable
Poor
Good
Acceptable
Poor
Poor Contact Fingers:
Good
Acceptable
Poor
Acceptable
Poor Vacuum Bottle
Good
Acceptable
Poor
Good
Acceptable
Poor Contact Erosion Indicator
Good
Acceptable
Poor
Racking Mechanism:
Good
Acceptable
Poor Operating Mechanism:
Good
Acceptable
Poor
Shutter:
Good
Acceptable
Poor Arcing Contacts:
Good
Acceptable
Poor
Auxiliary Devices:
Good
Acceptable
Poor
Cables Supported Appropriately:
Counter Reading:
As-Found
Yes
No Unit Cleaned:
N/A
No
Yes
Photograph Taken:
Yes
As-Left
Comments:
Test Preparation:
Insulation Resistance Test
Test
Voltage
Source:
Cable Dest. / Load:
Disconnected
Note: Approval of City’s Representative is required,
Disconnected
Connected with
prior to leaving cables connected during the test.
Connected with Load Isolated
Source Isolated
Insulation Resistance (MΩ)
Phase To GND (Breaker Closed)
A
B
Temperature:
o
C
C
2500 V
Test
Voltage
Insulation Resistance (MΩ)
Phase To Phase (Breaker Closed)
A–B
B–C
A-C
2500 V
Test
Voltage
Insulation Resistance (MΩ)
Line to Load (Breaker Open)
A
B
2500 V
Comments:
Form F-BKR-VAC-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-VAC-4160V.doc
Test Summary
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Insulation Resistance
(Control Wiring)
INSPECTION FORM
VACUUM CIRCUIT BREAKER, 4160V
Wire Tag
Insulation
Resistance (MΩ)
Wire Tag
Insulation
Resistance (MΩ)
Page
2 of 2
Breaker ID
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Contact/Pole
Measurements
A
B
C
Test Summary
Pole Resistance (µΩ)
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Contact Resistance (µΩ)
Contact Travel (mm)
High Potential Test
Comments:
Test Preparation:
Peak DC
Test Voltage
(1 min.
duration)
Source:
Disconnected
Connected with
Source Isolated
Note: Approval of City’s Representative is required, prior to leaving cables
connected during the test.
Test Summary
(µA)
A
Test Summary
B
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C
12 kV
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-BK-VAC-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-BKR-VAC-4160V.doc
Capacitor Bank
Data
Project
INSPECTION FORM
CAPACITOR BANK, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Switchgear/MCC:
Manufacturer:
Model:
Size:
VAR
Configuration:
Rated Voltage:
Delta
Visual
Inspection/
Cleaning
Insulation Resistance Test
1 of 1
ID:
Cell #:
Serial #:
V
Wye-Ungrounded
Capacitor Identification Tag Installed:
Page
Capacitance:
µF
Wye-Grounded
Yes
No
Cables Supported Appropriately:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Anchorage, alignment:
Good
Acceptable
Poor
Connections:
Good
Acceptable
Poor Required Clearances:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Unit Cleaned:
Source Cables:
Disconnected
Connected with Source Isolated
Test Preparation:
A (A-B)
B (B-C)
Photograph Taken:
Yes
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance (MΩ)
Phase To GND
Test
Voltage
Yes
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C (C-A)
1000 V
Comments:
Capacitance
Capacitance (µF)
A (A-B)
B (B-C)
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C (C-A)
Comments:
Discharge
Resistance
Resistance (Ω)
A (A-B)
Test Summary
B (B-C)
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C (C-A)
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-CAP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CAP-600V.doc
Project
INSPECTION FORM
CAPACITOR BANK, MEDIUM VOLTAGE
Facility:
Project Name:
Area :
Bid Opportunity:
Capacitor Bank
Data
Cell #:
Manufacturer:
Model:
Size:
VAR
Configuration:
Visual
Inspection/
Cleaning
1 of 1
ID:
Location:
Rated Voltage:
Delta
Serial #:
V
Wye-Ungrounded
Capacitor Identification Tag Installed:
Insulation Resistance Test
Page
Capacitance:
µF
Wye-Grounded
Yes
No
Cables Supported Appropriately:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Anchorage, alignment:
Good
Acceptable
Poor
Connections:
Good
Acceptable
Poor Required Clearances:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Unit Cleaned:
Source Cables:
Disconnected
Connected with Source Isolated
Test Preparation:
A (A-B)
Photograph Taken:
Yes
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance (MΩ)
Phase To GND
Test
Voltage
Yes
B (B-C)
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C (C-A)
2500 V
Comments:
Capacitance
Capacitance (µF)
A (A-B)
Test Summary
B (B-C)
C (C-A)
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Discharge
Resistance
Resistance (Ω)
A (A-B)
Test Summary
B (B-C)
C (C-A)
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-CAP-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CAP-MV.doc
Project
INSPECTION FORM
POWER CABLE, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
Source:
Cable Data
Cable ID:
Type:
No. of
Conductors:
V
Conductor:
AWG
MCM
Size:
Rated Voltage:
Installation:
Visual
Inspection
1 of 3
Dest. / Load:
Manufacturer:
Operating
Voltage:
Cable Tray
Strapped
Length:
V
m
Copper
Measured
Jacket Markings
Aluminum
Previous Data
TDR
Date Installed:
EMT
Steel Conduit
Alum. Conduit
PVC Conduit
Direct Buried
Underground Duct
Other:
Physical Damage on Exposed Ends:
Yes
No
Cable Identification Tag Installed:
Yes
No
Visual Signs of Overheating/Corona:
Yes
No
Cable Supported Appropriately:
Yes
No
Damage to Splices/Terminations:
Yes
No
Shield Grounded:
Yes
No
Bend Radius Acceptable:
Yes
No
Comments:
Test
Preparation:
Insulation Resistance Test
Page
Cable Dest. / Load:
Source:
Disconnected
Disconnected
Connected with Source Isolated
Connected with Load Isolated
Cable Temperature:
o
C
Ground all conductors not under test for
each reading.
Temperature Correction Factor for 20oC:
Insulation Resistance (MΩ)
Test
Voltage
A-GND
Reading
2500V
Corrected to 20oC
Comments:
Form CBL-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CBL-4160V.doc
B-GND
Note: Approval of City’s Representative
is required, prior to leaving cables
connected during the test.
Test Summary
C-GND
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
INSPECTION FORM
4160V POWER CABLE
Source:
Disconnected
Connected with
Source
Isolated
High Potential
Very Low Frequency (VLF) Test
Test Preparation:
Frequency:
0.1 Hz
Test
Voltage
(RMS)
Elapsed
Time
(min)
7000V
0
7000V
1
7000V
2
7000V
3
7000V
4
7000V
5
7000V
6
7000V
7
7000V
8
7000V
9
7000V
10
7000V
11
7000V
12
7000V
13
7000V
14
7000V
15
Page
2 of 3
Cable ID:
Cable Dest. / Load:
Disconnected
Note: Approval of City’s Representative is required, prior to
Connected with leaving cables connected during the test.
Load Isolated
Waveform: sinusoidal
Ground all conductors not under test for each reading.
Peak Leakage Current (uA)
A-GND
Comments:
Form CBL-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CBL-4160V.doc
B-GND
Test Summary
C-GND
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
INSPECTION FORM
4160V POWER CABLE
Frequency:
Dissipation Factor
(Tangent Delta) Test
A
Tan
Delta
3 of 3
Cable ID:
Waveform: sinusoidal
0.1 Hz
Test Voltage
(RMS)
Page
B
Capacitance
(nF)
Current
(µA)
Tan
Delta
C
Capacitance
(nF)
Current
(µA)
Tan
Delta
Capacitance
(nF)
Current
(µA)
2400V
4800V
Difference
Test Summary
Comments:
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
Termination
Connection Resistance (µΩ) - As Left
Connection
Resistance
A
B
Torque Check
C
Source
OK
Dest. / Load
OK
Final
Analysis
Comments:
Cable Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form CBL-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CBL-4160V.doc
Project
INSPECTION FORM
POWER CABLE < 1000V
Facility:
Project Name:
Area :
Bid Opportunity:
Source:
Cable Data
Cable ID:
Type:
No. of
Conductors:
Rated Voltage:
V
Conductor:
AWG
MCM
Size:
Operating
Voltage:
Cable Tray
Strapped
Installation:
Visual
Inspection
1 of 1
Dest. / Load:
Manufacturer:
V
EMT
Steel Conduit
Length:
m
Copper
Aluminum
Measured
Jacket Markings
Previous Data
TDR
Date Installed:
Alum. Conduit
PVC Conduit
Direct Buried
Underground Duct
Other:
Physical Damage on Exposed Ends:
Yes
No
Cable Identification Tag Installed:
Yes
No
Visual Signs of Overheating:
Yes
No
Cable Supported Appropriately:
Yes
No
Bend Radius Acceptable:
Yes
No
Comments:
Test
Preparation:
Insulation Resistance Test
Page
Cable Dest. / Load:
Source:
Disconnected
Disconnected
Connected with Source Isolated
Connected with Load Isolated
Cable Temperature:
o
C
Ground all conductors not under test for each
reading.
Temperature Correction Factor for 20oC:
Insulation Resistance (MΩ)
Test
Voltage
A-GND
B-GND
C-GND
Note: Approval of City’s Representative
is required, prior to leaving cables
connected during the test.
Test Summary
N-GND
Reading
1000V
Corrected to 20oC
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Final
Analysis
Connection Resistance
Note: Torque check required for all cables. Connection Resistance Test required for cables 4/0 AWG or larger.
Connection Resistance (µΩ) - As Left
Termination
A
B
C
Torque Check
N
Source
OK
Dest. / Load
OK
Comments:
Cable Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Performed By
Checked By
Form CBL-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CBL-600V.doc
Comments:
Signature
Date (yyyy/mm/dd)
PT Data
Project
INSPECTION FORM
CONTROL POWER TRANSFORMER, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
Visual
Inspection
1 of 1
ID:
Location:
Pri. Voltage
Rating:
Sec. Voltage
Rating:
Manufacturer:
Pri. Fuse Size:
Sec. Fuse Size:
Size:
Insulation Resistance Test
Page
Type:
Other:
Physical Damage:
Yes
No
Defective Connections/Wiring:
Yes
No
Visual Signs of Overheating:
Yes
No
Grounding and Shorting Connections Provide
Contact:
Yes
No
Verify Ground Connection:
Yes
No
Verify Withdrawal Mechanism Function:
Yes
No
Fuse Sizes Match Drawings:
Yes
No
Comments:
Test Preparation:
Source:
Disconnected
Connected with Source Isolated
Test
Voltage
Primary To GND
2500 VDC
Secondary To GND
500 VDC
Primary To Secondary
2500 VDC
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance
(MΩ)
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-CPT-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CPT-4160V.doc
PT Data
Project
INSPECTION FORM
CONTROL POWER TRANSFORMER, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
Visual
Inspection
1 of 1
ID:
Location:
Pri. Voltage
Rating:
Sec. Voltage
Rating:
Manufacturer:
Pri. Fuse Size:
Sec. Fuse Size:
Size:
Insulation Resistance Test
Page
Type:
Other:
Physical Damage:
Yes
No
Defective Connections/Wiring:
Yes
No
Visual Signs of Overheating:
Yes
No
Grounding and Shorting Connections Provide
Contact:
Yes
No
Verify Ground Connection:
Yes
No
Verify Withdrawal Mechanism Function:
Yes
No
Fuse Sizes Match Drawings:
Yes
No
Comments:
Test Preparation:
Source:
Disconnected
Connected with Source Isolated
Test
Voltage
Primary To GND
1000 VDC
Secondary To GND
500 VDC
Primary To Secondary
1000 VDC
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance
(MΩ)
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-CPT-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CPT-600V.doc
Insulation Resistance Test
Visual
Inspection
CT Data
Project
INSPECTION FORM
CURRENT TRANSFORMER
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Current Ratio:
Manufacturer:
Model No.:
Burden Rating:
BIL:
:
Page
ID:
A
Type:
kV
1 of 1
Voltage Class:
Bar
V
Window (Solid)
Split Core
Accuracy Class:
Physical Damage:
Yes
No
Clean and Inspect Insulators:
Yes
No
Visual Signs of Overheating:
Yes
No
Verify Connections are Correct:
Yes
No
Adequate Mounting Support:
Yes
No
Comments:
Test Preparation:
Source:
Disconnected
Connected with Source
Isolated
Test
Insulation Resistance (MΩ)
Voltage
A
Primary To GND
1000 V
Secondary To GND
500 V
Primary To Secondary
1000 V
Note: Approval of City’s Representative
is required, prior to leaving cables
connected during the test.
Cable Dest. / Load:
Disconnected
Connected with Load Isolated
B
Temperature:
C
o
C
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Turns Ratio, Excitation, Saturation
and Polarity Tests
Comments:
Note: Attach supporting data and saturation curve.
Phase
A
Test Summary
B
C
N
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
Calculated Ratio
Measured Ratio
Exciting Current
(mA)
Polarity Correct
Yes
No
Yes
No
Yes
No
Yes
No
CT Saturation
Test Performed:
Yes
No
Yes
No
Yes
No
Yes
No
CT Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-CT Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-CT.doc
Page
Visual
Inspection /
Cleaning
Meter
Data
Project
INSPECTION FORM
DIGITAL METER
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Cell #:
Manufacturer:
Model:
ID:
Cover Gasket:
Good
Acceptable
Poor
General Condition:
Good
Acceptable
Poor
Cleanliness (as found)
Good
Acceptable
Poor
Unit Cleaned:
Yes
Connections (as found)
Good
Acceptable
Poor
Connections
Torqued:
Yes
Test
Value
(V)
Voltage
Phase A
Reading
As Found
(V)
Cover Glass:
Good
Phase B
Reading
As Left
(V)
Reading
As Found
(V)
1 of 1
Reading
As Left
(V)
Acceptable
Poor
Phase C
Reading
As Found
(V)
Reading
As Left
(V)
Accuracy
Accuracy
0
Test
Value
(A)
Current
Phase A
Reading
As Found
(A)
Phase B
Reading
As Left
(A)
Reading
As Found
(A)
Reading
As Left
(A)
Phase C
Reading
As Found
(A)
Reading
As Left
(A)
0
Final
Analysis
Unit Calibrated:
Yes
No
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-DM Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-DM.doc
Visual Inspection
Project
INSPECTION FORM
GROUNDING SYSTEM
Facility:
Project Name:
Area :
Bid Opportunity:
Connection to Ground Electrode is
Visible:
Connecting Conductor: Size:
Yes
No
Qty:
Visual signs of Corrosion:
Yes
Page
1 of 3
ID:
Facility Contains a Main Ground Bus:
Yes
No
Torque Ground Connections:
Yes
No
No
Soil Type:
Soil Condition:
Dry
Damp
Wet
Comments:
Date of Test:
Time of Test:
Weather and Temperature:
Terrain:
Grounding System
Connection Point:
UTM GPS
Coordinate:
E
N
Current Probe
Injection Point:
UTM GPS
Coordinate:
E
N
Test Conditions:
Fall Of Potential Test #1
Voltage Probe
Distance
(meters)
Test Layout:
Test Current
(mA)
UTM GPS Coordinate:
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
Comments:
Form F-GROUNDING Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-GROUNDING.doc
Test Voltage
(mV)
Resistance @
Hz
(Ω)
Resistance @
Hz
(Ω)
INSPECTION FORM
GROUNDING SYSTEM
Page
ID:
Date of Test:
Time of Test:
Weather and Temperature:
Terrain:
Grounding System
Connection Point:
UTM GPS
Coordinate:
E
N
Current Probe
Injection Point:
UTM GPS
Coordinate:
E
N
Test Conditions:
Fall Of Potential Test #2
Voltage Probe
Distance
(meters)
2 of 3
Test Layout:
Test Current
(mA)
UTM GPS Coordinate:
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
Comments:
Form F-GROUNDING Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-GROUNDING.doc
Test Voltage
(mV)
Resistance @
Hz
(Ω)
Resistance @
Hz
(Ω)
INSPECTION FORM
GROUNDING SYSTEM
Resistance Checks
(Ductor Test)
Point A
Resistance
(mΩ)
Point B
Facility Ground Electrode
Main Ground Bus
Facility Ground Electrode
4160V Switchgear GND Bus
Facility Ground Electrode
System Neutral
Facility Ground Electrode
600V Switchgear GND Bus
Facility Ground Electrode
MCC
: GND Bus
Facility Ground Electrode
MCC
: GND Bus
Facility Ground Electrode
Other
:
Facility Ground Electrode
Other
:
Facility Ground Electrode
Other
:
Monitoring / Inspection Required:
Yes
No
Repair / Replacement Required:
Yes
No
Page
3 of 3
ID:
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Comments:
Company
Name
Comments:
Signature
Date
(yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-GROUNDING Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-GROUNDING.doc
Page
Visual Inspection / Cleaning
MCC/CDP Data
Project
INSPECTION FORM
MCC/CDP, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
# of Cells:
Manufacturer:
Model:
Rated Voltage:
V
Copper
Serial #:
Main Bus Rating:
Aluminum
A
Main Bus Neutral Rating:
Current Withstand Rating:
A
A
Identification Tag Installed:
Yes
No
Visual Signs of Overheating:
Yes
No
Visual Signs of Moisture:
Yes
No
Visual Signs of Corona:
Yes
No
Fuse/Breaker Sizes Match Drawings:
Yes
No
PT and CT ratios match drawings:
Yes
No
Elevation Drawings Correct:
Yes
No
Cables Supported Appropriately:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Insulators Condition:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Vents/Filters:
Doors Mechanical:
Good
Acceptable
Poor Exercise Active Components:
Cell Fit and Alignment:
Good
Acceptable
Poor
Required Clearances are
Met:
Good
Acceptable
Poor
Indicating mechanisms:
Good
Acceptable
Poor Unit Cleaned:
Type:
Incoming Power
ID:
Location:
Bus Conductor:
1 of 6
Electro/Mechanical
Interlock System:
Acceptable
Poor
Good
Acceptable
Poor
Good
Acceptable
Poor
Yes
Photograph Taken:
No
Yes
Inspection
Main Breaker
Complete appropriate breaker inspection form.
Disconnect
Complete appropriate disconnect inspection form.
Main Lugs
Yes
Good
Visual Inspection:
Good
Connections Torqued:
Yes
Connection
Resistance (µΩ)
As Left
A
Form F-MCC-CDP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MCC-CDP-600V.doc
Acceptable
Poor
B
C
N
Page
INSPECTION FORM
MCC/CDP, 600V
Insulation Resistance Test
(Buswork)
Test
Preparation:
Source:
Disconnected
Connected with Source
Isolated
Cable Dest. / Load:
Disconnected
Connected with Load Isolated
Insulation Resistance (MΩ)
Phase To Phase
Test
Voltage
(dc)
A-B
B-C
2 of 6
ID:
Note: Approval of City’s Representative is
required, prior to leaving cables connected during
the test.
Test Summary
C-A
1000 V
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Insulation Resistance (MΩ)
Phase To GND
Test
Voltage
A - GND
B - GND
C - GND
1000 V
Ground Resistance
Checks (Ductor Test)
Comments:
Resistance
(µΩ)
Point A
Point B
MCC/CDP GND Bus
Facility Ground Electrode
MCC/CDP GND Bus
MCC/CDP Enclosure
MCC/CDP GND Bus
System Neutral
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Feeder Breakers
Visual Inspect Requirements:
Note:
G=Good, A=Acceptable, P=Poor Comments are required for all items identified in Poor condition.
1.
Confirm identification tag / lamacoid is installed.
2.
Look for visual signs of overheating.
3.
Inspect and torque connections.
4.
Inspect and test any electro/mechanical interlocks.
5.
Confirm disconnect operation.
6.
Check door mechanical condition.
7.
Exercise circuit breaker.
8.
Confirm cables are supported and routed appropriately.
9.
Visually assess the general condition of the installation.
Complete an appropriate Breaker Inspection Form for all breakers with separate adjustable Long and
Short trip settings, Ground trip settings, or > 400A frame size.
Continued on next page
Form F-MCC-CDP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MCC-CDP-600V.doc
Page
INSPECTION FORM
MCC/CDP, 600V
3 of 6
ID:
Model
General
Comments:
Form F-MCC-CDP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MCC-CDP-600V.doc
Trip Unit
Type
Inst Setting
Cleaned
Manuf.
Visual
Inspection
Trip Rating
(A)
Loc./
Cell
Feeder Breakers
ID
Frame
Rating (A)
Continued from previous page
Comments
Page
INSPECTION FORM
MCC/CDP, 600V
4 of 6
ID:
B=Breaker (Thermal Magnetic), M=breaker(Motor Circuit Protector), F=Fuse
Overload Protection Type:
T=Thermal, SS=Solid State
Visual Inspect Requirements:
G=Good, A=Acceptable, P=Poor Comments are required for all items identified in Poor condition.
Motor Starters
Overcurrent Protection Type:
Confirm identification tag / lamacoid is installed.
2.
Look for visual signs of overheating.
3.
Inspect and torque connections.
4.
Inspect and test any electro/mechanical interlocks.
5.
Confirm disconnect operation.
6.
Check door mechanical condition.
7.
Exercise circuit breaker.
8.
Confirm cables are supported and routed appropriately.
9.
Visually assess the general condition of the installation.
Complete a Motor Starter Inspection Form for all Motor Starters Size 4 or larger, with VFDs, or with Soft
Starters.
Model
General
Comments:
Form F-MCC-CDP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MCC-CDP-600V.doc
Size /
Rating
Overload
Model
Cleaned
Manuf.
Contactor
Visual Insp.
Rating (A)
Loc./
Cell
Motor Starters
ID
Type
Overcurrent Protection
Type
Note:
1.
Comments
Page
INSPECTION FORM
MCC/CDP, 600V
General
Comments:
Form F-MCC-CDP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MCC-CDP-600V.doc
Size /
Rating
Overload
Model
Cleaned
Model
ID:
Visual Insp.
Manuf.
Contactor
Type
Rating (A)
Loc./
Cell
Motor Starters
ID
Type
Overcurrent Protection
5 of 6
Comments
Final
Analysis
INSPECTION FORM
MCC/CDP, 600V
Returned to Service:
Yes
No
Monitoring / Inspection Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Page
6 of 6
ID:
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-MCC-CDP-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MCC-CDP-600V.doc
Page
Project
INSPECTION FORM
MOTOR STARTER, FVNR, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
Load:
Starter Data
Cell #:
Model:
Size:
Rated Voltage:
Interrupting Rating:
kA @
Fused Disc.
Current Transformer:
Serial #:
V
Current Rating:
Rating:
Fuse
Size:
A
Voltage:
Primary Fuse:
Ratio:
A
Control Voltage:
V
A
Fuse Mfg.
Cat. #:
V
Manufacturer:
Cat. #:
Secondary Fuse:
Type:
Starter Identification Tag Installed:
A
kV
kVA:
Control Power
Transformer:
Visual Inspection / Cleaning
ID
Starter Location:
Manufacturer:
Isolation:
1 of 4
A
Manufacturer:
Yes
No
Cat. #:
Visual Signs of Overheating:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Support Insulators:
Good
Acceptable
Poor
Connections
Good
Acceptable
Poor
Electro/Mechanical
Interlock:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Contactor Condition:
Good
Acceptable
Poor
Door Mechanical
Good
Acceptable
Poor Contact Alignment:
Good
Acceptable
Poor
Good
Acceptable
Poor Racking Devices
Good
Acceptable
Poor
Shutter
N/A
Cables Supported Appropriately:
Yes
Comments:
Form F-MS-FVNR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MS-FVNR-4160V.doc
No Unit Cleaned:
N/A
Yes
Photograph Taken:
Yes
Page
INSPECTION FORM
MOTOR STARTER, 4160V
Test
A
B
ID
C
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Contact Resistance (µΩ)
Disconnect / Breaker/MCP
Resistance (µΩ)
Contact/Pole Measurements
2 of 4
Fuse Resistance (µΩ)
Air Contactor:
Arcing Contact Gap (mm)
Arcing Contact Wipe (mm)
Main Contact Gap (mm)
Main Contact Wipe (mm)
Vacuum Contactor:
Contact Travel (mm)
Comments:
Insulation Resistance Test
Test Preparation:
Source:
Isolated
Open
Contactor:
Test
Cable Dest. / Load:
Note: Approval of City’s Representative is required,
Disconnected
prior to leaving cables connected during the test.
Connected with Load Isolated
Insulation Resistance (MΩ)
Voltage
A
Disc. To Contactor Stabs
2500 VDC
Contactor Line To GND
2500 VDC
Contactor Load To GND
2500 VDC
Contactor Line to Load
2500 VDC
Load Buswork
2500 VDC
B
C
Ground all phases not
under test!
Test Summary
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
Insulation Resistance
(Control Wiring)
Comments:
Wire Tag
Insulation
Resistance (MΩ)
Wire Tag
Comments:
Form F-MS-FVNR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MS-FVNR-4160V.doc
Insulation
Resistance (MΩ)
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Page
INSPECTION FORM
MOTOR STARTER, 4160V
High Potential Test
Test Preparation:
Voltage
(kV DC)
Time
(Minutes)
Disconnect – Contactor Stabs
12
1
Contactor - Line
12
1
Contactor - Load
12
1
Load Buswork
12
1
Test
ID
Note: Approval of City’s Representative is
required, prior to leaving cables connected
during the test.
Load Cables:
Disconnected
Connected
Source:
Isolated
3 of 4
Test Summary
(µA)
A
B
C
Ground all phases not under
test!
Test Summary
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
Comments:
Manufacturer:
Model
Verify Relay Set Points Configured Correctly:
Yes
No
Verify Input Current Readings Match Test Current:
Yes
No
Verify the following relay settings:
Relay Setting
Setpoint
FLA – Full Load Amps
Motor Protection Relay
UTC – Ultimate Trip Current
JMA – Jam Alarm Level
JMT – Jam Trip Level
JAMS – Jam Start Delay
JAMR – Jam Run Delay
LRC – Locked Rotor Current
LRT – L.R. Stall Time
IOC – Inst. Overcurrent
GFT – Ground Fault Trip
PUA – Phase Unbalance Alarm
PURD – P.U. Run Delay
Phase Unbalance Trip
ST/T – Starts per Time Allowed
ULT – Under-load Trip
Form F-MS-FVNR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MS-FVNR-4160V.doc
Secondary Amps
Test Result
Final
Analysis
INSPECTION FORM
MOTOR STARTER, 4160V
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Page
4 of 4
ID
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-MS-FVNR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MS-FVNR-4160V.doc
Page
Project
INSPECTION FORM
MOTOR STARTER, FVNR, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
Load:
Serial #:
Rated Voltage:
Circuit
Protection:
Overload
Protection:
Cell #:
Type:
Size:
Starter Data
ID:
Starter Location:
Manufacturer:
V
Current Rating:
A
Control Voltage:
V
Fused Disc.
Rating:
A
Fuse
Size:
A
Fuse Mfg.
Cat. #:
Breaker
MCP
Rating:
A
Inst.
Setting
A
Manufacturer:
Cat. #:
Manufacturer:
Cat. #:
Thermal
Electronic
Current Transformer:
Class:
10
20
Rating:
30
Not displ.
A
Sec. Voltage:
V
VA:
Control Power
Transformer:
Primary Fuse:
Ratio:
A
Secondary Fuse:
A
Type:
Starter Identification Tag Installed:
Visual Inspection / Cleaning
1 of 2
Yes
No
Visual Signs of Overheating:
Yes
Cleanliness (As Found):
Good
Acceptable
Poor Support Insulators:
Good
Acceptable
Poor
Connections
Good
Acceptable
Poor
Electro/Mechanical
Interlock:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Contactor Condition:
Good
Acceptable
Poor
Door Mechanical
Good
Acceptable
Poor Contact Alignment:
Good
Acceptable
Poor
Verify O/L element is correctly sized for
the load:
Yes
No Exercise Circuit Breaker/MCP/Disconnect
Cables Supported Appropriately:
Yes
No Unit Cleaned:
Yes
Photograph Taken:
Comments:
Test
Contact/Pole
Measurements
No
A
Contact Resistance (µΩ)
Disconnect / Breaker / MCP
Resistance (µΩ)
Fuse Resistance (µΩ)
Comments:
Form MS-FVNR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MS-FVNR-600V.doc
B
C
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Yes
Yes
Page
INSPECTION FORM
MOTOR STARTER, FVNR, 600V
Insulation Resistance Test
Test Preparation:
Source:
Isolated
Open
Contactor:
Test
2 of 2
ID:
Cable Dest. / Load:
Note: Approval of City’s Representative is required,
Disconnected
prior to leaving cables connected during the test.
Connected with Load Isolated
Insulation Resistance (MΩ)
Voltage
A
Contactor Line To GND
1000 VDC
Contactor Load To GND
1000 VDC
Contactor Line to Load
1000 VDC
B
C
Ground all phases not
under test!
Test Summary
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form MS-FVNR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MS-FVNR-600V.doc
Project
INSPECTION FORM
AC MOTOR, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
Motor Data
Size:
kW /
HP
Voltage:
Visual Inspection / Cleaning
V
R.P.M:
Model:
Serial Number:
Frame Type:
Service
Factor:
Other:
Air
Fan
Winding
Material:
# Cooling Fans:
Motor Identification Tag Installed:
Yes
No
Visual Signs of Overheating:
Yes
Connections:
Good
Acceptable
Poor Air Baffles:
Paint:
Good
Acceptable
Poor Filter Media:
Good
Acceptable
Poor Fan Controls:
Anchorage/Alignment:
Good
Acceptable
Poor Brushes:
Ground Connection:
Good
Acceptable
Poor Slip Ring Wear Within Tolerances:
Cooling Fans:
N/A
Mechanical/Electrical Noise
During Operation:
Yes
Cleanliness (As Found):
Good
Stator Winding
Insulation
Resistance
ID:
Manufacturer:
Cooling:
Acceptable
Poor Unit Cleaned:
2500
Phase B – GND
2500
Phase C – GND
2500
A-B
B–C
Comments:
Form F-MTR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MTR-4160.doc
Acceptable
Poor
N/A
Good
Acceptable
Poor
N/A
Good
Acceptable
Poor
Good
Acceptable
Poor
Photograph Taken:
Resistance (MΩ)
30 Sec
Phase A – GND
Yes
1 min.
Yes
No
Yes
No
Yes
Polarization Index
10 min.
Test Summary
A-C
No
Good
No Lubrication Required:
Test Voltage (Vdc)
Resistance (µΩ)
Stator
Resistance
Page: 1 of 2
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
INSPECTION FORM
AC MOTOR, 4160V
Source:
Disconnected
Connected with
Source Isolated
Test Preparation:
Elapsed
Time (min)
7
0
7
1
7
2
7
3
7
4
7
5
7
6
7
7
7
8
7
9
7
10
High Potential
Test
Max
Test DC
Voltage
(kV)
Page: 2 of 2
ID:
Note: Approval of City’s Representative is required, prior to leaving cables
connected during the test.
Test Summary
A
B
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-MTR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-MTR-4160.doc
Visual Inspection /
Cleaning
Panelboard Data
Project
INSPECTION FORM
PANELBOARD, LOW VOLTAGE
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Fed From:
Manufacturer:
Model:
Rated Voltage:
V
3 Phase, 3 Wire
Main Lugs
Main Breaker:
3 Phase, 4 Wire
A
Withstand Rating:
A
Neutral Bonded to Ground
Manufacturer:
Yes
No
Model:
Identification Tag Installed:
Yes
No
Visual Signs of Overheating:
Yes
No
Visual signs of Moisture:
Yes
No
Visual Signs of Corona:
Yes
No
Fuse/Breaker Sizes Match Drawings:
Yes
No
Cables Supported Appropriately:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Connections:
Good
Acceptable
Poor
Door Mechanical:
Good
Acceptable
Poor Ground Connection:
Good
Acceptable
Poor
Exercise Circuit Breakers:
Insulation Resistance Test
ID:
Serial No:
A
Rating:
1 of 1
No. of Circuits:
Current Rating:
Single Phase
Page
Yes
Source:
Disconnected
Connected with
Source Isolated
Test
Preparation:
No
Comments:
Note: Approval of City’s Representative is
required, prior to leaving cables connected
during the test.
Insulation Resistance (MΩ)
Ground all Phases not under test!
Test
Voltage
A-GND
RDG
Test Voltages:
20°C
B-GND
RDG
RDG
120-300V ! 500 VDC Test Voltage
N-GND
20°C
°C
Temperature Correction
Factor to 20°C:
Test Summary
C-GND
20°C
Equipment Temperature:
RDG
20°C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
301-600V ! 1000 VDC Test Voltage
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Inspection Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-PNL-LV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-PNL-LV.doc
Project
INSPECTION FORM
POTENTIAL TRANSFORMER, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
PT Data
PT Location or Designation:
Manufacturer:
Catalogue #:
Visual
Inspection
Size:
VA
1 of 2
ID:
Pri. Voltage
Rating:
Sec. Voltage
Rating:
Pri. Fuse Size:
Sec. Fuse Size:
Type:
Other:
Physical Damage:
Yes
No
Verify Connections are Correct:
Yes
No
Visual Signs of Overheating:
Yes
No
Grounding and Shorting Connections Provide
Contact:
Yes
No
Verify Ground Connection:
Yes
No
Verify Withdrawal Mechanism Function:
Yes
No
Fuse Sizes Match Drawings:
Yes
No
Comments:
Test Preparation:
Insulation Resistance Test
Page
Source:
Disconnected
Connected with Source Isolated
Test
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance (MΩ)
Voltage
PT 1
Primary To GND
2500 V
Secondary To GND
500 V
Primary To Secondary
2500 V
PT 2
o
Temperature:
PT 3
C
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Turns Ratio and Polarity Tests
Comments:
Test
Preparation:
Source:
Disconnected
Connected with Source
Isolated
Phase
PT 1
Test Summary
PT 2
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
PT 3
Calculated Ratio
Measured Ratio
Polarity Correct
Yes
No
Yes
No
Yes
No
Final
Analysis
Comments:
PT Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Form F-PT-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-PT-4160V.doc
Comments:
Signature
Date (yyyy/mm/dd)
INSPECTION FORM
POTENTIAL TRANSFORMER, 4160V
Page
2 of 2
ID:
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-PT-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-PT-4160V.doc
Project
INSPECTION FORM
POTENTIAL TRANSFORMER, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
PT Data
PT Location or Designation:
Manufacturer:
Catalogue #:
Visual
Inspection
Size:
VA
1 of 2
ID:
Pri. Voltage
Rating:
Sec. Voltage
Rating:
Pri. Fuse Size:
Sec. Fuse Size:
Type:
Other:
Physical Damage:
Yes
No
Verify Connections are Correct:
Yes
No
Visual Signs of Overheating:
Yes
No
Grounding and Shorting Connections Provide
Contact:
Yes
No
Verify Ground Connection:
Yes
No
Verify Withdrawal Mechanism Function:
Yes
No
Fuse Sizes Match Drawings:
Yes
No
Comments:
Test Preparation:
Insulation Resistance Test
Page
Source:
Disconnected
Connected with Source Isolated
Test
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance (MΩ)
Voltage
PT 1
Primary To GND
1000 V
Secondary To GND
500 V
Primary To Secondary
1000 V
PT 2
o
Temperature:
PT 3
C
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Turns Ratio and Polarity Tests
Comments:
Test
Preparation:
Source:
Disconnected
Connected with Source
Isolated
Phase
PT 1
Test Summary
PT 2
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
PT 3
Calculated Ratio
Measured Ratio
Polarity Correct
Yes
No
Yes
No
Yes
No
Final
Analysis
Comments:
PT Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Form F-PT-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-PT-600V.doc
Comments:
Signature
Date (yyyy/mm/dd)
INSPECTION FORM
POTENTIAL TRANSFORMER, 600V
Page
2 of 2
ID:
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-PT-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-PT-600V.doc
Relay Data
Project
INSPECTION FORM
TIME OVERCURRENT PROTECTION RELAY
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Cell #:
Manufacturer:
Model:
Style:
Serial No:
Page
1 of 3
ID:
Electro-mechanical
Electronic
Type:
CT
Data
Comments:
Current Ratio:
:
A
Visual Inspection
A
B
C
N
A
Moisture/Rust:
Relay Cleaned:
Spiral Spring:
Screws Tightened:
Disk Clearance:
Trip Indicator & Reset
Over-heating:
Zero Adjustment Check:
Cover/Case:
Magnet:
Paddle:
Jewel Bearing:
B
C
Trip Function Test:
Legend:
A-Acceptable
C-Corrected
N-Needs Repair
NA-Not Applicable
Comments:
Phase
Relay Settings
Parameter
Setting
(As Found)
Neutral
Setting
(As Left)
Parameter
Curve
Curve
TOC Tap
TOC Tap
TOC Multiplier
TOC Multiplier
Time Dial/Delay
Time Dial/Delay
Inst. Tap
Inst. Tap
Seal-in
Seal-in
Setting
(As Found)
Setting
(As Left)
N
INSPECTION FORM
TIME OVERCURRENT PROTECTION RELAY
Parameter
Calculated Value
Page
2 of 3
ID:
Measured Pick-Up (Amps)
Phase
A
Neutral
N
B
C
TOC Pick-up
Relay Pick-up Tests
Seal-in Pick-up
IOC Pick-up
TOC Pick-up
Seal-in Pick-up
IOC Pick-up
Comments:
Parameter
x PU
Test
Value
(Amps)
Calculated
Value
(sec.)
Measured Timing (sec.)
Phase
A
Neutral
N
Relay Timing Tests
TOC
TOC
IOC
TOC
TOC
IOC
Comments:
Form F-RELAY-TOC Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-RELAY-TOC.doc
B
C
Insulation Resistance
Test
INSPECTION FORM
TIME OVERCURRENT PROTECTION RELAY
Test
Preparation:
3 of 3
ID:
Source:
Note: Approval of City’s Representative is required, prior to
Disconnected
leaving cables connected during the test.
Connected with Source Isolated
Test Summary
Insulation Resistance (MΩ)
Test
Voltage
Page
A-GND
B-GND
C-GND
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
N-GND
500V
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-RELAY-TOC Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-RELAY-TOC.doc
Relay Data
Project
INSPECTION FORM
UNDER-VOLTAGE PROTECTION RELAY
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
Cell #:
Manufacturer:
Model:
Style:
Serial No:
Page
1 of 2
ID:
Electro-mechanical
Electronic
Type:
PT
Data
Comments:
Voltage Ratio:
:
V
Visual Inspection
A
B
C
A
Moisture/Rust:
Relay Cleaned:
Spiral Spring:
Screws Tightened:
Disk Clearance:
Trip Indicator & Reset
Over-heating:
Zero Adjustment Check:
Cover/Case:
Magnet:
Paddle:
Jewel Bearing:
B
Trip Function Test:
Legend:
A-Acceptable
C-Corrected
N-Needs Repair
NA-Not Applicable
Relay Settings
Comments:
Phase
Parameter
Setting
(As Found)
Setting
(As Left)
U.V. Pick-up
Relay Timing
Tests
Relay Pick-up
Tests
U.V. Delay
Parameter
Calculated Value
Phase
Measured Pick-Up (Volts)
A
B
C
U.V. Pick-up
Comments:
Parameter
Injected
Value
(Voltage)
Calculated
Value
(sec.)
Phase
U.V. Delay
Form F-RELAY-UV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-RELAY-UV.doc
Measured Timing (sec.)
A
B
C
C
Insulation Resistance Test
INSPECTION FORM
UNDER-VOLTAGE PROTECTION RELAY
Test
Preparation:
2 of 2
ID:
Source:
Note: Approval of City’s Representative is required, prior to
Disconnected
leaving cables connected during the test.
Connected with Source Isolated
Insulation Resistance (MΩ)
Test
Voltage
Page
A-GND
B-GND
Test Summary
C-GND
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
500V
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-RELAY-UV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-RELAY-UV.doc
Project
INSPECTION FORM
SURGE ARRESTOR, MEDIUM VOLTAGE
Facility:
Project Name:
Area :
Bid Opportunity:
Arrestor Data
Switchgear:
Manufacturer:
Catalogue #:
Housing:
Rated Voltage:
RMS Current Rating:
A
Material:
Polymer
Porcelain
Visual
Inspection /
Cleaning
1 of 1
ID:
Location:
Cell:
Type:
Serial #:
V
Arrestor Class:
Rated MCOV:
Station
Distribution
V
Intermediate
Other:
Identification Tag Installed:
Yes
No
General Condition:
Good
Acceptable
Poor
Cleanliness (As Found):
Good
Acceptable
Poor
Anchorage, alignment:
Good
Acceptable
Poor
Connections:
Good
Acceptable
Poor
Required Clearances:
Good
Acceptable
Poor
Ground Connections:
Good
Acceptable
Test Preparation:
Poor Unit Cleaned:
Source:
Disconnected
Connected with
Source Isolated
A
Yes
Photograph Taken:
Yes
Note: Approval of City’s Representative is required,
prior to leaving cables connected during the test.
Insulation Resistance (MΩ)
Phase To GND
Test
Voltage
B
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C
1000 V
Comments:
Point A
Resistance
Check
Insulation Resistance Test
Page
Ground Terminal
Resistance
(µΩ)
Point B
Facility Ground Electrode
Test Summary
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Visual Inspection / Cleaning
Switchgear
Data
Project
INSPECTION FORM
SWITCHGEAR, 4160V
Facility:
Project Name:
Area :
Bid Opportunity:
ID:
Location:
Manufacturer:
Type:
Rated Voltage:
1 of 2
ID:
# of Cells:
Serial #:
Current Rating:
A
Withstand Rating:
A
Identification Tag Installed:
Yes
No
Visual Signs of Overheating:
Yes
No
Visual signs of Moisture:
Yes
No
Visual Signs of Corona:
Yes
No
Fuse/Breaker Sizes Match Drawings:
Yes
No
PT and CT ratios match drawings:
Yes
No
Elevation Drawings Correct:
Yes
No
Cables Supported Appropriately:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Insulators Condition:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Vents/Filters:
Doors Mechanical:
Good
Acceptable
Poor
Cell Fit and Alignment:
Good
Acceptable
Poor
Required Clearances are
Met:
Good
Acceptable
Poor
Indicating mechanisms:
Good
Acceptable
Poor Unit Cleaned:
Test Preparation:
Insulation Resistance Test
(Buswork)
V
Page
Test
Voltage
Electro/Mechanical
Interlock Systems:
Acceptable
Poor
Good
Acceptable
Poor
Good
Acceptable
Poor
Photograph Taken:
Yes
Source:
Cable Dest. / Load:
Disconnected
Note: Approval of City’s Representative is required,
Disconnected
Connected with
prior to leaving cables connected during the test.
Connected with Load Isolated
Source Isolated
Insulation Resistance (MΩ)
Phase To GND
A
B
Temperature:
C
2500 V
Test
Voltage
Yes
Good
Insulation Resistance (MΩ)
Phase To Phase
A–B
B–C
2500 V
Comments:
Form F-SGR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-SGR-4160V.doc
A-C
o
C
Ground Resistance
INSPECTION FORM
SWITCHGEAR, 4160V
Point A
Page
ID:
Test Summary
Resistance
(µΩ)
Point B
Switchgear GND Bus
Facility Ground Electrode
Switchgear GND Bus
Switchgear Enclosure
Switchgear GND Bus
System Neutral
2 of 2
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
To
Resistance
(mΩ)
From
B
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Connection Resistance
A
Test Summary
Comments:
High Potential Test
Test Preparation:
Source:
Disconnected
Connected with
Source Isolated
Peak DC
Test
Voltage
(1 minute
duration)
Note: Approval of City’s Representative is required, prior to leaving cables
connected during the test.
Test Summary
(mA)
A
Test Summary
B
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
C
12 kV
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Inspection Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note:
The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-SGR-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-SGR-4160V.doc
Visual Inspection / Cleaning
Switchgear
Data
Project
INSPECTION FORM
SWITCHGEAR, 600V
Facility:
Project Name:
Area :
Bid Opportunity:
Location:
No. of Cells:
Manufacturer:
Type:
Rated Voltage:
1 of 2
ID:
Serial #:
Current Rating:
A
Interrupting Rating:
A
Identification Tag Installed:
Yes
No
Visual Signs of Overheating:
Yes
No
Visual signs of Moisture:
Yes
No
Visual Signs of Corona:
Yes
No
Fuse/Breaker Sizes Match Drawings:
Yes
No
PT and CT ratios match drawings:
Yes
No
Elevation Drawings Correct:
Yes
No
Cables Supported Appropriately:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Insulators Condition:
Connections:
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Vents/Filters:
Doors Mechanical:
Good
Acceptable
Poor Exercise Active Components:
Cell Fit and Alignment:
Good
Acceptable
Poor
Required Clearances are
Met:
Good
Acceptable
Poor
Indicating mechanisms:
Good
Acceptable
Poor Unit Cleaned:
Test Preparation:
Insulation Resistance Test
V
Page
Test
Voltage
Electro/Mechanical
Interlock System:
Acceptable
Poor
Good
Acceptable
Poor
Good
Acceptable
Poor
Yes
Photograph Taken:
No
Yes
Source:
Cable Dest. / Load:
Disconnected
Note: Approval of City’s Representative is required,
Disconnected
Connected with
prior to leaving cables connected during the test.
Connected with Load Isolated
Source Isolated
Insulation Resistance (MΩ)
Phase To GND
A
B
Temperature:
C
1000 V
Test
Voltage
Yes
Good
Insulation Resistance (MΩ)
Phase To Phase
A–B
B–C
1000 V
Comments:
Form F-SGR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-SGR-600V.doc
A-C
o
C
Ground Resistance
INSPECTION FORM
SWITCHGEAR, 600V
Point A
Page
ID:
Test Summary
Resistance
(µΩ)
Point B
Switchgear GND Bus
Facility Ground Electrode
Switchgear GND Bus
Switchgear Enclosure
Switchgear GND Bus
System Neutral
2 of 2
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
To
Resistance
(µΩ)
From
B
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Connection Resistance
A
Test Summary
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Inspection Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-SGR-600V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-SGR-600V.doc
Project
Location:
Switchgear:
Manufacturer:
Model:
Fuse
Data
Facility:
Disconnect Data
INSPECTION FORM
SWITCH, AIR, METAL-ENCLOSED, 4160V
Project Name:
Area :
Bid Opportunity:
Rated Voltage:
V
Momentary Fault
Closing Amps:
Current Rating:
Visual Inspection / Cleaning
Serial #:
Interrupting Rating:
A
BIL Rating:
Type:
V
Current Rating:
Disconnect Identification Tag Installed:
Switchblade
Resistance
ID:
Type of Operating
Mechanism:
A
Cat. #:
A
Yes
No
Holder:
Visual Signs of Overheating:
Yes
No
Cleanliness (As Found):
Good
Acceptable
Poor Support Insulators:
Good
Acceptable
Poor
Connections
Good
Acceptable
Poor
Electro/Mechanical
Interlock
Good
Acceptable
Poor
Ground Connection:
Good
Acceptable
Poor Blade Condition:
Good
Acceptable
Poor
Door Mechanical
Good
Acceptable
Poor Blade Alignment:
Good
Acceptable
Poor
Good
Acceptable
Poor
Fit Plumb & Square:
Yes
No
Verify Blade Mechanical
Operation
Cables Supported Appropriately:
Yes
No
Fuse Holder Support and
Contact Integrity
Phase Barrier Intact:
Yes
No Unit Cleaned:
Indicating and Control Devices
are Working Correctly
Yes
No Other:
Resistance (µΩ)
(As Left)
A
B
Yes
Good
Unit Lubricated:
Test Summary
C
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Comments:
Fuse Resistance
1 of 2
Cell #:
A
Manufacturer:
Rated Voltage:
Page
Resistance (µΩ)
(As Left)
A
B
Test Summary
C
Comments:
Form F-SW-AIR-ME-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-SW-AIR-ME-4160V.doc
Test Passed
Test Inconclusive
Further Investigation Required.
Test Failed
Acceptable
Yes
Poor
INSPECTION FORM
SWITCH, AIR, METAL-ENCLOSED, 4160V
Insulation Resistance Test
Test Preparation:
Source:
Isolated
Disconnect:
Open
Test
Page
2 of 2
ID
Cable Dest. / Load:
Note: Approval of City’s Representative is required,
Disconnected
prior to leaving cables connected during the test.
Connected with Load Isolated
Insulation Resistance (MΩ)
Voltage
A
Disconnect Line To GND
2500 VDC
Disconnect Load To GND
2500 VDC
Disconnect Line to Load
2500 VDC
B
C
Ground all phases not
under test!
Test Summary
Test Passed
Test Inconclusive
Further Investigation
Required.
Test Failed
Final
Analysis
Comments:
Returned to Service:
Yes
No
Monitoring / Further Inspection Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Signature
Comments:
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-SW-AIR-ME-4160V Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-SW-AIR-ME-4160V.doc
Page: 1 of 3
Project
INSPECTION FORM
TRANSFORMER, DRY TYPE, MEDIUM VOLTAGE
Facility:
Project Name:
Area :
Bid Opportunity:
Transformer Data
KVA:
Phase:
Primary Voltage:
Manufacturer:
Secondary
Winding:
∆
Υ
Cooling:
ANN
# Cooling Fans:
ANF
No Load Tap
Changer
Tap
1
∆
Υ
Serial Number:
Impedance:
%Z Temp Rise:
3
4
°C K Factor:
5
Tap Setting
(As Found):
Voltage
Yes
No
Visual Signs of Overheating:
Bushings:
Good
Acceptable
Poor Support Insulators:
Paint:
Good
Acceptable
Poor
No Load Tap
Changer:
Fans:
N/A
Good
Acceptable
Poor Fan Controls:
Temp. Gauge:
N/A
Good
Acceptable
Poor Connections:
Ground
Connection:
Good
Acceptable
Poor Ground Conductor Size:
Cleanliness (As Found):
Good
Acceptable
Poor Unit Cleaned:
Yes
Yes
Acceptable
Poor
N/A
Good
Acceptable
Poor
N/A
Good
Acceptable
Poor
Good
Acceptable
Poor
Photograph Taken:
Operational Inspection
Primary Voltage:
H1:H2:
V H2:H3:
V H3:H1:
V Measured at:
Secondary Voltage:
X1:X2:
V X2:X3:
V X3:X1:
V Measured at:
Current:
Ph A:
A Ph B:
A Ph C:
A Measured at:
Appears Satisfactory
Further Monitoring Recommended.
Recommend Changing Tap.
Thermographic Inspection
Performed:
Yes
Attach report
separately
Form F-XFMR-DRY-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-DRY-MV.doc
Results:
No
Good
Operational Conditions / Notes:
Tap Setting:
V
Winding
Material:
2
Transformer Identification Tag Installed:
Visual Inspection / Cleaning
V Secondary Voltage:
Model:
Primary
Winding:
ID:
Tap Setting (As Left):
No Issues Found
Potential Issue Identified.
Yes
Page: 2 of 3
TRANSFORMER INSPECTION FORM
DRY TYPE, MEDIUM VOLTAGE
o
Winding Temperature:
ID:
Temperature Correction Factor (20oC):
C
Resistance (MΩ)
PRI-GND
SEC-GND
Test Voltage:
Time
Test Voltage:
Corrected to
20oC
Reading
PRI-SEC
Test Voltage:
Corrected to
20oC
Reading
Corrected to
20oC
Reading
Insulation Resistance
1 min.
2 min.
3 min.
4 min.
5 min.
6 min.
7 min.
8 min.
9 min.
10 min.
Turns
Ratio Test
Winding Resistance
Polarization
Index
Winding Temperature:
Winding
o
C
Winding Resistance (mΩ)
Winding
H2 – H1
X0 – X1
H3 – H2
X0 – X2
H3 – H1
X0 – X3
Tap
(Designated)
Primary
Voltage (V)
Secondary
Voltage (V)
Calculated
Ratio
Winding Resistance (mΩ)
Measured Ratios
H3 H1 / X0 X1
H1 H2 / X0 X2
H2 H3 / X0 X3
Connection
Resistance
Note: Torque check required for all cables. Connection Resistance Test required for cables 250MCM or larger.
Connection Resistance (µΩ) - As Left
Termination
A
B
C
Torque Check
N
Source
OK
Dest. / Load
OK
Form F-XFMR-DRY-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-DRY-MV.doc
Final
Analysis
TRANSFORMER INSPECTION FORM
DRY TYPE, MEDIUM VOLTAGE
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Page: 3 of 3
ID:
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-XFMR-DRY-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-DRY-MV.doc
Page:
Project
INSPECTION FORM
TRANSFORMER, LIQUID-FILLED, MEDIUM VOLTAGE
Facility:
Project Name:
Area :
Bid Opportunity:
KVA:
/
/
Phase:
Primary Voltage:
Transformer Data
Manufacturer:
Secondary
Winding:
∆
Υ
Cooling:
ONAN
ONAF
∆
Υ
%Z Temp Rise:
Winding
Material:
1
2
3
4
°C K Factor:
Oil Type:
Oil Capacity:
5
Tap Setting
(As Found):
Voltage
Transformer Identification Tag Installed:
Visual Inspection / Cleaning
Impedance:
BIL Rating Secondary:
Tap
Yes
No
Visual Signs of Overheating:
Bushings:
Good
Acceptable
Poor Support Insulators:
Paint:
Good
Acceptable
Poor
No Load Tap
Changer:
Fans:
N/A
Good
Acceptable
Poor Fan Controls:
Temp. Gauge:
N/A
Good
Acceptable
Poor Connections:
Good
Acceptable
Poor Liquid Level Correct:
Ground
Connection:
Ground Conductor Size:
Good
Acceptable
Poor Unit Cleaned:
Yes
Acceptable
Poor
N/A
Good
Acceptable
Poor
N/A
Good
Acceptable
Poor
Good
Acceptable
Poor
Yes
Good
Yes
Operational Inspection
Primary Voltage:
H1:H2:
V H2:H3:
V H3:H1:
V Measured at:
Secondary Voltage:
X1:X2:
V X2:X3:
V X3:X1:
V Measured at:
Current:
Ph A:
A Ph B:
A Ph C:
A Measured at:
Appears Satisfactory
Further Monitoring Recommended.
Recommend Changing Tap.
Tap Setting (As Left):
Cooling Temperature:
Gauges:
o
C
Current
Maximum:
o
Pressure/Vacuum:
Thermographic Inspection
Performed:
Yes
Coolant Level:
C
Other:
Attach report
separately
Form F-XFMR-LIQ-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-LIQ-MV.doc
Results:
No Issues Found
Potential Issue Identified.
No
Acceptable
Photograph Taken:
Operational Conditions / Notes:
Tap Setting:
No
Good
Radiators:
Cleanliness (As Found):
V
Serial Number:
# Cooling Fans:
BIL Rating Primary:
No Load Tap
Changer
ID:
V Secondary Voltage:
Model:
Primary
Winding:
1 of 3
Yes
Poor
TRANSFORMER INSPECTION FORM
TRANSFORMER, LIQUID-FILLED, MEDIUM VOLTAGE
o
2 of 3
ID:
Temperature Correction Factor (20oC):
C
Winding Temperature:
Page:
Resistance (MΩ)
PRI-GND
SEC-GND
Test Voltage:
Time
Reading
PRI-SEC
Test Voltage:
Corrected to
20oC
Test Voltage:
Corrected to
20oC
Reading
Corrected to
20oC
Reading
Insulation Resistance
1 min.
2 min.
3 min.
4 min.
5 min.
6 min.
7 min.
8 min.
9 min.
10 min.
Turns
Ratio Test
Winding Resistance
Polarization
Index
o
Winding Temperature:
Winding
Winding Resistance (mΩ)
C
Winding
H2 – H1
X0 – X1
H3 – H2
X0 – X2
H3 – H1
X0 – X3
Tap
(Designated)
Primary
Voltage (V)
Secondary
Voltage (V)
Calculated
Ratio
Winding Resistance (mΩ)
Measured Ratios
H3 H1 / X0 X1
H1 H2 / X0 X2
H2 H3 / X0 X3
Connection
Resistance
Note: Torque check required for all cables. Connection Resistance Test required for cables 250MCM or larger.
Connection Resistance (µΩ) - As Left
Termination
A
B
C
Torque Check
N
Source
OK
Dest. / Load
OK
Form F-XFMR-LIQ-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-LIQ-MV.doc
Final
Analysis
Insulating Liquid
Tests
TRANSFORMER INSPECTION FORM
TRANSFORMER, LIQUID-FILLED, MEDIUM VOLTAGE
Dielectric Breakdown
Voltage:
Colour:
Acid Neutralization
Number:
Visual Condition:
Specific Gravity:
Power Factor or
Dissipation Factor:
Dissolved Gas
Analysis:
Other:
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Page:
3 of 3
ID:
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and that
the analysis results are correct.
Form F-XFMR-LIQ-MV Rev 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-LIQ-MV.doc
Page
Project
INSPECTION FORM
TRANSFORMER, DRY TYPE, LOW VOLTAGE
Facility:
Project Name:
Area :
Bid Opportunity:
Transformer Data
KVA:
Phase:
Primary Voltage:
Manufacturer:
Type:
Primary
Winding:
∆
Υ
Copper
Tap
ID:
Secondary
Voltage:
V
Serial Number:
Impedance:
%Z Temp Rise:
°C K Factor:
Aluminum
1
2
3
4
5
Tap Setting
(As Found):
Voltage
Transformer Identification Tag Installed:
Visual Inspection / Cleaning
∆
Υ
Secondary
Winding:
Winding Material:
No Load Tap
Changer
V
1 of 2
Yes
No
Visual Signs of Overheating:
Bushings:
Good
Acceptable
Poor Support Insulators:
Paint:
Good
Acceptable
Poor
No Load Tap
Changer:
Fans:
N/A
Good
Acceptable
Poor Fan Controls:
Temp. Gauge:
N/A
Good
Acceptable
Poor Connections:
Ground
Connection:
Good
Acceptable
Poor
Cleanliness (As Found):
Good
Acceptable
Poor Unit Cleaned:
Yes
Yes
No
Good
Acceptable
Poor
N/A
Good
Acceptable
Poor
N/A
Good
Acceptable
Poor
Good
Acceptable
Poor
Photograph Taken:
Yes
Operational Inspection
Operational Conditions / Notes:
Primary Voltage:
H1:H2:
V H2:H3:
V H3:H1:
V Measured at:
Secondary Voltage:
X1:X2:
V X2:X3:
V X3:X1:
V Measured at:
Current:
Ph A:
A Ph B:
A Ph C:
A Measured at:
Appears Satisfactory
Further Monitoring Recommended.
Recommend Changing Tap.
Tap Setting:
Insulation Resistance
Thermographic Inspection
Performed:
Yes
Winding
Attach report
separately
Test Voltage
(Vdc)
Primary to Ground, Secondary Guarded
Secondary to Ground, Primary Guarded
Primary to Secondary, Ground Guarded
Form F-XFMR-LV 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-LV.doc
Results:
Tap Setting (As Left):
No Issues Found
Potential Issue Identified.
Resistance (MΩ)
30 sec
60 sec.
Dielectric
Absorption Ratio
60s/30s
Final
Analysis
INSPECTION FORM
TRANSFORMER, DRY TYPE, LOW VOLTAGE
Returned to Service:
Yes
No
Monitoring / Further Inspection
Required:
Yes
No
Repair / Replacement Required:
Yes
No
Company
Name
Page
2 of 2
ID:
Comments:
Signature
Date (yyyy/mm/dd)
Performed By
Checked By
Note: The person(s) performing the check is responsible for ensuring that the data is transcribed from the handwritten form correctly, and
that the analysis results are correct.
Form F-XFMR-LV 00, Created by SNC-Lavalin Inc.
M:\113099\4ENG\47ELE\RA - Misc Reports & Forms\Forms\F-XFMR-LV.doc