CONFIDENTIAL Contains Protected Critical Electric Infrastructure Information (CEII) ReliabilityFirst Disturbance Event Report Report Date - mm/dd/yyyy 1. 2. 3. 4. 5. Entity filing the report: Date and Time of disturbance. Date: (mm/dd/yy) Time/Zone: Name of contact person: Email address: Telephone Number: Did the disturbance originate in your system? Under which NERC function are you reporting? Yes No (More detail should be provided in the Sequence of Events section below.) 6. Brief Description of Event: 7. Generation tripped off-line. MW Total List units tripped Frequency. Just prior to disturbance (Hz): Immediately after disturbance (Hz max): Immediately after disturbance (Hz min): List transmission facilities (lines, transformers, buses, etc.) tripped and locked-out. (Specify voltage level of each facility listed). 8. 9. 10. FIRM INTERRUPTIBLE CONFIDENTIAL Contains Protected Critical Electric Infrastructure Information (CEII) Demand tripped (MW): Number of affected customers: Demand lost (MW-Minutes): 11. Restoration Time. INITIAL FINAL Transmission: Generation: Demand: 12. Sequence of Events: 13. Identify root cause of the disturbance: 14. Identify any protection system misoperation(s): 15. Additional Information the helps to further explain the event (if needed, including diagrams): 2 ReliabilityFirst Corporation