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Form : E052

AC UNDERVOLTAGE RELAY Rev. 0


Date : ___________
TESTING / EQUIPMENT IDENTIFICATION
Project Application System Package

Tag No. Circuit Breaker Dwg No.(S/L) Dwg No. CWD

EQUIPMENT NAMEPLATE DATA


Manufacturer Type Serial No. VT Ratio

Voltage Range Control Power CKT. DWG. No.

STARTUP AND TEST DATA

A) SETTINGS

OPERATING VALUE V
TIME SETTING

B) TEST OF OPERATING VALUE :

PHASE A PHASE B PHASE C


VOLTAGE MEASURED VALUE ------V MEASURED VALUE ------V MEASURED VALUE------V
SETTINGS PICK-UP DROP-OUT PICK-UP DROP-OUT PICK-UP DROP-OUT

C) TIME DELAY (TIMER ONLY)


SCALE INJECTED OPERATING OPERATING OPERATING
VALUE-(S) VOLTAGE (V) VALUES (S) VALUES (S) VALUES (S)

Test Equipment Used Model Cal. Due Test Equipment Model Cal Due

Signature Name Company Date


Testing Performed By :
Witnessed by : SBG
Witnessed by : SAMGE
Witnessed by : EWI
Witnessed by : SCECO