Doc. No.

IMS 468

Review: 01

Date : 10/2015

EARTH LEAKAGE TEST RECORD SHEET Page 1 of 1

MAXIMUM TRIPPING VALUE – 30mA

BUILDING / DB SOCKET OUTLETS PHASE ROTATION TRIPPING AT TESTED DATE
TAG # BY
PH.A PH.B PH.C PH.A PH.B PH.C PH.A PH.B PH.C
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Remarks:

TESTS ACCEPTED BY:

CONTRACTOR QA/QC CLIENT
Name:
Signature:
Date: