Complete one form per rating *This information will appear on the test report as it appears below.
Billing and Contact Information – (the report will be sent to this address)
Name
Company
Address
City, State/Province Zip
,
Country
Phone
E-mail
Report Contact information as you want it to appear on the final report (if different than above)
Name
Company
Address
City, State/Province Zip
,
Country
Phone
E-mail
Test to be conducted:
Standard testing to ASTM F2178*
F2178 Hoods
F2178 Faceshield
F2178 Faceshield with Balaclava
F2178 Balaclava –Goggles System
Rating trying to achieve
Product evaluation with instrumented or noninstrumented mannequin head*
Marketing exposure with higher quality Video.
R&D or Scouting Test
Type of product
# of Shots
Special Instructions:
Your test reference number (optional):
Description of Item
1. Overall General Product Description (Hood, Balaclava)
Manufacturer
Style/Model Number
2. Lens/Window Description (faceshield, hood, goggles):
Manufacturer
Style/Model Number
Lens Layer 1 Color
Lens Layer 2 Color
Lens Layer 1 Thickness
Lens Layer 2 Thickness
Lens Layer 1 Material
Lens Layer 2 Material
3. Mounting Bracket Description (if applicable and want included in test report)
Manufacturer
Part Number
Other bracket info
4. Hardhat Description:
Manufacturer
Type
Style/Model Number
Class
Revised 3-18-15 slk
5. Balaclava or Hood Fabric System Description:
cal/cm2
Fabric System Arc Rating:
ATPV or
Layer 1: (Top Layer)
Manufacturer:
Nominal Weight:
2
oz/yd or
Arc Rating Test Report Number:
EBT
g/m
2
Color:
Style No.
Fabric:
Woven
Type of weave: (plain weave, twill, sateen, etc.)
Knit
Type of knit: (jersey, pique, interlock, mesh, etc.)
Non-Woven (spunlace, felt, etc.)
Fiber Content and Percentage of Each Fiber:
Layer 2:
Manufacturer:
Color:
Nominal Weight:
oz/yd2 or
g/m2
Style No.
Fabric:
Woven
Type of weave: (plain weave, twill, sateen, etc.)
Knit
Type of knit: (jersey, pique, interlock, mesh, etc.)
Non-Woven (spunlace, felt, etc.)
Fiber Content and Percentage of Each Fiber:
Layer 3:
Manufacturer:
Color:
2
2
Nominal Weight:
oz/yd or
g/m
Style No.
Fabric:
Woven
Type of weave: (plain weave, twill, sateen, etc.)
Knit
Type of knit: (jersey, pique, interlock, mesh, etc.)
Non-Woven (spunlace, felt, etc.)
Fiber Content and Percentage of Each Fiber:
Layer 4:
Color:
Manufacturer:
Style No.
Nominal Weight:
oz/yd2 or
g/m2
Fabric:
Woven
Type of weave: (plain weave, twill, sateen, etc.)
Knit
Type of knit: (jersey, pique, interlock, mesh, etc.)
Non-Woven (spunlace, felt, etc.)
Fiber Content and Percentage of Each Fiber:
Layer 5:
Color:
Manufacturer:
Style No.
2
2
Nominal Weight:
oz/yd or
g/m
Fabric:
Woven
Type of weave: (plain weave, twill, sateen, etc.)
Knit
Type of knit: (jersey, pique, interlock, mesh, etc.)
Non-Woven (spunlace, felt, etc.)
Fiber Content and Percentage of Each Fiber:
*Arc testing is subcontracted.
Test Reports will be sent by email and stored in your account at www.arcwearonline.com. To have a
paper copy sent to you at an additional fee of $50:
Number of Copies:
Revised 3-18-15 slk