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Technician: Site In charge

Name: Sign: Name: Sign:

Date: Date:

Monthly Inspection, Test and Maintenance Checklist for DB’s


Date
Building
Location
Equipment Type
Equipment Tag Number
Equipment Make
Equipment Model
Item/Action Complete[] Remarks
Residual Current Device
Check operation via fast button
Fuse Carrier and Miniature Circuit Breaker
Check for damage
Check fuse ratings
Check free operation of Miniature Circuit
Breaker mechanism

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