GE Industrial Solutions PowerVac PV-VL 13.8-1000-0 and -1 - Manual (Page 68)

FAILURE REPORTING FORM FOR POWER CIRCUIT BREAKERS User report No.
Check all appropriate blocks and provide information indicated. For major trouble provide additional information requested on next page
supplemented with additional pages if necessary.
User Ident
EQUIPMENT: Station of Breaker
Equipment Nameplate Mfgr. Type Serial #
Information KV Inter Amps/MVA Continuous Amps BIL
Breaker Background: Counter Reading:
Shipped: , Installed: , Maintained: Trouble Date:
(Mo/Day/Yr)
Location:
r
Indoor
r
Outdoor Enclosure:
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Non-metal Clad,
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Metal-clad,
r
GIS
Interrupter:
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Air Blast,
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Air Magnetic,
r
Oil,
r
SF
6
,
r
Vacuum, Other:
ENVIRONMENT:
General:
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Industrial,
r
Urban,
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Suburban,
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Rural,
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Sea Coast,
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Above 3300',
r
High Contamination,
Other:
Weather Conditions:
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Dry,
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Rain,
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Lightning in Area,
r
Snow,
r
Fog,
r
Freezing Rain,
r
Frost,
r
Condensation,
Temperature. Trend -
r
Rising,
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Falling,
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Steady,
r
Extreme Cold, Temperature °F,
Wind: -
r
Calm,
r
Light,
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Strong,
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Steady,
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Strong-Gusty
External Mechanical Stresses Involved:
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Normal,
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Earthquake,
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Wind,
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Abnormal Terminal Loading,
Other:
Nominal System voltage:
TROUBLE:
When Discovered:
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Installation,
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In Service,
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Maintenance,
r
Test, Other:
Breaker Mode at Time of Trouble:
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De-energized,
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Closed,
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Open,
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Tripping,
r
Closing,
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Reclosing,
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Fault Interruption,
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Load Switching,
r
Line Switching
Breaker Response at Time of Trouble:
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Not Called Upon to Operate,
r
Performed as Intended,
r
Unsatisfactory Operation,
r
Failed to Operate
Subsystem in Trouble:
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External Insulation to Ground,
r
Internal Insulation to Ground,
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Insulating Medium,
r
Isolating Contact,
r
Bushing,
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Interrupter,
r
Seals-Gaskets,
r
Air System,
r
SF6 System,
r
C.T.,
r
Resistor Sw or Aux. Int.,
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Voltage Grading Device,
r
Line Terminals,
r
Compressor,
r
Heater,
r
Electrical Controls,
r
Wiring,
r
Operating Mechanism,
r
Mechanical Linkage,
r
Other:
State Specifically What Failed (With Instr. Book Ref.):
Has it occurred before on this type of breaker?
r
No,
r
Yes, How many times:
State how problem was corrected:
POSSIBLE CAUSE:
r
Design/Manufacture,
r
Shipping,
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Storage,
r
Installation,
r
Instructions,
r
Maintenance,
r
Wear/Aging,
r
Animal/Birds,
r
Other,
r
Not Obvious
Comments and Suggestions:
EFFECT:
Breaker Down Time:
r
No Interruption,
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30 Min or Less,
r
1 Hr,
r
2 Hr,
r
6 Hr,
r
12 Hr,
r
24 Hr, Other:
Repair Time:
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Less than 30 Min,
r
1 Hr,
r
2 Hr,
r
6 Hr,
r
1 Day,
r
2 Days,
r
3 Days,
r
1 Week, Other:
Breaker Outage Status:
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Immediate Forced Outage,
r
Outage Within 20 Min.,
r
Required Subsequent Outage,
r
Repair Deferred Until Regular Maintenance,
r
No Outage for Repair
Person Completing Report: Date:
User Approval Name: Date:
User Contact Name: Telephone Number:
User Company: