Uninterruptible Power

QC-167
System (UPS)
CONTRACT# CLIENT / PROJECT SYSTEM

JOB# CWP

CLIENT REF:
Mark “N/A” where Not Applicable. Complete appropriate sections when specified.
Equipment Tag Number: Equipment Location:
CSA or Equivalent: Drawing and Rev # :
1.0 NAMEPLATE DATA:
Rectifier Inverter Static Transfer Panel
Designation
Type
Manufacturer
Serial Number
Manufacture Date
Model Number
Rated Input
Rated Output
Aux Equipment
2.0 VOLTAGE / FREQUENCY / PHASING VERIFICATION: Test Equipment Log:
Description Result Description Result
Input Voltage Bypass Frequency
Input Frequency Bypass Phasing
Input Phasing Inverter Output Voltage
Rectifier Output Voltage Inverter Output Frequency
Bypass Voltage Inverter Output Phasing
3.0 TRANSFER TEST: Test Equipment Log #:
Description Result Comments
Manual Transfer to Bypass
Reset to Inverter
Auto Transfer
4.0 INSPECTION:
Result Result
Grounding Polarity on terminals
Wire Terminations & Tagging Cables & Tagging
Status LED’s Alarm Operation
Air Filters Meters Zeroed
Vendor Startup Report Attached [ ] Inverter Fuse Coordination Verified
5.0 COMMENTS:

TESTED BY: CHEMCO CLIENT OTHER

NAME: NAME: NAME: NAME:

SIGNATURE: SIGNATURE: SIGNATURE: SIGNATURE:

DATE: DATE: DATE: DATE:

Revision 2 December 20, 2005 QC-167 R2 UPS Inspection & Test Record.doc Page 1 of 1