FULL LOOP TEST FORM

Instrumentation/Field Devices Test Formexcellink

System/ Package No. BMS PLC/RIO Panel Drawing BBB
Name
Device Tag No. CCC PLC/RIO Panel Tag DDD

NOTE: If a section is NOT relevant enter N/A

Full Loop Check:
YES NO N/A
1. Is all Instrument range settings correct as per Panel Drawing? √
2. Are all Instrument / Field Devices tagged correctly as per Panel Drawing? √

FULL LOOP TEST RECORDS

Analog Input Analog Output
Field Device Field Device
% Range HMI Value FMCS Value % Range HMI Input FMCS Value
Input Position
0 N/A N/A N/A 0 N/A N/A N/A
25 N/A N/A N/A 25 N/A N/A N/A
50 N/A N/A N/A 50 N/A N/A N/A
75 N/A N/A N/A 75 N/A N/A N/A
100 N/A N/A N/A 100 N/A N/A N/A
Digital Input Digital Output
Field Device Field Device
HMI Value FMCS Value HMI Input FMCS Value
Input Status
N/A N/A N/A
N/A N/A N/A
Simulate BAD IO Condition from field, BAD IO received on FMCS: Yes √ No N/A
Direct Acting Valve Inverse Acting Valve
Valve Fail Safe Position (Control Signal Lost): Open Last N/A √ Close
Valve Fail Safe Position (Power Lost): Open Last N/A √ Close
Direction of Action Correct: Yes No N/A Failure Action Correct: Yes No N/A √

Simulate Alarm for Analog Instruments based on the changing Alarm Limits on FMCS:
Yes No N/A √

Test Equipment Calibration Reference:

Test equipment reference: 789 FLUKE Processmeter Serial no: Range:

Certification trace no: Issue date: Due date:
Comments: (If there are NO ADDITIONAL comments enter NONE, initial and date)
Reason to be written in comments section and, where applicable, raised as an exception or outstanding issue as part of the
system handover. If resolved prior to handover comments to be marked appropriately and signed off accordingly.

Test By Witnessed by Approved By Verified By

Company MACRO BOSTON FACILITY PLA BOSTON
Signature As per master summary list
Print Name
Date

Prepared By: Ken Yeo (Macro-Integration)

Document Name: MMM_PC_MI_FMCS_LT
Revision: 0
Revision Date: 16-Oct-2019 Page 1 of 1