GE Industrial Solutions Power-Vac ML-20 Mechanism - Manual (Page 37)

USER REPORT NO.
FAILURE REPORTING FORM FOR POWER CIRCUIT BREAKERS
Check all appropriate blocks and provide information indicated. For major trouble provide additional information requested on back of
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______________
Trouble
Breaker Background: Shipped________, Installed________, Maintained_________, Modernized_______, Date _____________
(Mo/Yr)
(Mo/Yr) (Mo/Yr) (Mo/Day/Yr)
Operational Counter Reading _________________________________________________________________________________
Location:
! Indoor ! Outdoor Enclosure: ! Non-metal Clad, ! Metalclad, ! GIS
Interrupter: ! Air Blast, ! Air Magnetic, ! Oil, ! SF
6
, ! Vacuum, Other____________________________________
ENVIRONMENT:
General: ! Industrial, ! Urban, ! Suburban, ! Rural, ! Sea Coast, ! Above 3300', ! High Contamination,
Other________________________________________________________________________________________
Weather Conditions:
! Dry, ! Rain, ! Lightning in Area, ! Snow, ! Fog, ! Freezing Rain, ! Frost, ! Condensation,
Temp. Trend
 ! Rising, ! Falling, ! Steady, ! Extreme Cold, Temperature_____ °
F,
Wind
 ! Calm, ! Light, ! Strong-Steady, ! Strong-Gusty
External Mechanical Stresses Involved: ! Normal, ! Earthquake, ! Wind, ! Abnormal Terminal Loading,
Other___________________________________________________________________________________________________
Nominal System voltage__________________________
TROUBLE:
When Discovered:
! Installation, ! In Service, ! Maintenance, ! Test, Other _____________________________________
Breaker Mode at Time of Trouble: ! De-energized, ! Closed, ! Open, ! Tripping, ! Closing, ! Reclosing,
! Fault Interruption, ! Load Switching, ! Line Switching
Breaker Response at Time of Trouble: ! Not Called Upon to Operate, ! Performed at Intended, ! Unsatisfactory Operation,
! Failed to Operate
Subsystem in Trouble: ! External Insulation to Ground, ! Internal Insulation to Ground, ! Insulating Medium,
! Isolating Contact, ! Bushing, ! Interrupter, ! Seals-Gaskets, ! Air System, ! SF
6
System, ! C.T.,
! Resistor Sw or Aux. Int., ! Voltage Grading Device, ! Line Terminals, ! Compressor, ! Heater, ! Electrical Controls,
! Wiring, ! Operating Mechanism, ! Mechanical Linkage, ! Other _______________________________________________
________________________________________________________________________________________________________
State Specifically What Failed (With Instr. Book Ref.):____________________________________________________________
________________________________________________________________________________________________________
Has it occurred before on this type of breaker? ! No, ! Yes, How many times______________________________________
State How Problem was Corrected : ___________________________________________________________________________
________________________________________________________________________________________________________
POSSIBLE CAUSE: ! Design/Manufacture, ! Shipping, ! Storage, ! Installation, ! Instructions, ! Maintenance,
! Wear/Aging, ! Animal/Birds, ! Other, ! Not Obvious
Comments and Suggestions: _______________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
EFFECT:
Breaker Down Time:
! No Interruption, ! 30 Min. or Less, ! 1 Hr, ! 2 Hr, ! 6 Hr, ! 12 Hr, ! 24 Hr, Other ______________
Repair Time: ! Less than 30 Min., ! 1 Hr, ! 2 Hr, ! 6 Hr, ! 1 Day, ! 2 Days, ! 3 Days, ! 1 Week, Other ______________
Breaker Outage Status: ! Immediate Forced Outage, ! Outage Within 20 Min., ! Required Subsequent Outage,
! Repair Deferred Until Regular Maintenance, ! No Outage for Repair
User Person
Completing Report ______________________________________________________Date__________________________________
User Approval Name_____________________________________________________Date _________________________________
User Contact Name____________________________________________Telephone Number________________________________
User Company_______________________________________________