Electrical testing · RMS Automation

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Tests performed

Visual / Inspection

Job Information

Customer

Job #

End User

Test Date

Temperature

Unit

Humidity %

DBID

Site Location

Substation

Designation

Element (Org 5)

Sub-Element (Org 6)

Device Type

Tested By

End User Asset/ID

DBID Asset ID

Equipment Used

Breaker Nameplate

Manufacturer

SN / SO No.

Mounting

D.O.B.I.

Breaker Type

Frame Size

Thermal Memory

ONOFF

BKR Catalog No.

BKR Int. Rating

Zone Intlk / Targets

Zone IntlkTargets

Trip Unit Type

Sensor Taps

Counter Reading AF

MFR Date / Code

Counter Reading AL

Fuse MFR

Fuse Cat. No.

Fuse Amps

OPS No.

Sensor Rating

Rating Plug

CT Tap

Custom Field 1: Name

Custom Field 1: Value

Visual & Mechanical Inspection

Required

Description

Condition

Clean / Lube

Description

Condition

Clean / Lube

Description

Condition

Clean / Lube

Cell / Racking Device

Matches Dwg / Spec

Arc Chutes

Primary Disconnects

Secondary Disconnect

Phase Barriers

Main / Arcing Contacts

Ground Connection

Overall Condition

Battery Status

Operating Mechanism

Auxiliary Devices

Blown Fuse Indicator

Interlocks

Other (specify)

Summary:SATISFACTORY: 14UNSATISFACTORY: 0N/A: 1Unreviewed: 15

Insulation Resistance & Contact Resistance

ATS-2021 §7.6.1.1.B.2, B.3 (insulated/molded case) / §7.6.1.2.B.2, B.3 (LV power)

Insulation Resistance In:

TCF to 20°C:enter temperature in the job headerANSI/NETA ATS-2021 Table 100.14.1, solid column

Closed: Pole-Pole

Closed: Pole-Ground

Open: Line-Load

Actual20°C

1 A-Bcalc

A-GNDcalc

PH Acalc

2 B-Ccalc

B-GNDcalc

PH Bcalc

3 C-Acalc

C-GNDcalc

PH Ccalc

Contact Resistance, Micro-Ohms

Pole 1Pole 2Pole 3

Contact

Fuse

Overcurrent Settings

ATS-2021 §7.6.1.1.A.8 (insulated/molded case) / §7.6.1.2.A.14 (LV power)

CT / Sensor Ratings

CT / Sensor Tap

Rating Plug, AF

ParameterAs Found SettingAs Tested SettingAs Left SettingI²T ON

Long Time Pickup

Long Time Delay

Short Time Pickup

Short Time Delay

Instantaneous Pickup

Ground Fault Pickup

Ground Fault Delay

Trip Unit Settings

ATS-2021 §7.6.1.1.A.8 (insulated/molded case) / §7.6.1.2.A.14 (LV power)

ParameterAs Found SettingAs Tested SettingAs Left SettingI²T ON

Sensor Rating (In)

LT Switch Setting (Io)

Long Time Pickup (Ir)

Long Time Delay (tr)

Inv. Def. Min. Time Lag (idmtl)

Short Time Pickup (Isd)

Short Time Delay (tsd)

Instantaneous Pickup (Ii)

Ground Fault Pickup (Ig)

Ground Fault Delay (tg)

Ground Fault Push to Trip Button

Test Results, Full Function Test Kit

ATS-2021 §7.6.1.1.B.9 (insulated/molded case) / §7.6.1.2.B.9 (LV power)

Parameter Tested

Mult

Test Amps

Range

Test Results

MinimumMaximumTrip TimeStatus

Long Time Pickup (Ir)

Short Time Pickup

Instantaneous Pickup

Ground Fault Pickup

Tech Notes / Comments / Deficiencies

Tech Note(s)

Comments

Deficiencies

Finalize and sign

Before this sheet can be finalized

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Technician name required (Job Info)
Attestation checkbox not checked

I attest that all tests listed herein were performed in accordance with ANSI/NETA ATS-2021 and that the results recorded are true and accurate to the best of my knowledge.

Verify every section and sign the report above to unlock the downloads.

Scan a paper sheet

Upload a photo, each section extracts independently for accuracy

Tests performed

Visual / Inspection

Job Information

Customer

Job #

End User

Test Date

Temperature

Unit

Humidity %

DBID

Site Location

Substation

Designation

Element (Org 5)

Sub-Element (Org 6)

Device Type

Tested By

End User Asset/ID

DBID Asset ID

Equipment Used

Breaker Nameplate

Manufacturer

SN / SO No.

Mounting

D.O.B.I.

Breaker Type

Frame Size

Thermal Memory

ONOFF

BKR Catalog No.

BKR Int. Rating

Zone Intlk / Targets

Zone IntlkTargets

Trip Unit Type

Sensor Taps

Counter Reading AF

MFR Date / Code

Counter Reading AL

Fuse MFR

Fuse Cat. No.

Fuse Amps

OPS No.

Sensor Rating

Rating Plug

CT Tap

Custom Field 1: Name

Custom Field 1: Value

Visual & Mechanical Inspection

Required

Description

Condition

Clean / Lube

Description

Condition

Clean / Lube

Description

Condition

Clean / Lube

Cell / Racking Device

Matches Dwg / Spec

Arc Chutes

Primary Disconnects

Secondary Disconnect

Phase Barriers

Main / Arcing Contacts

Ground Connection

Overall Condition

Battery Status

Operating Mechanism

Auxiliary Devices

Blown Fuse Indicator

Interlocks

Other (specify)

Summary:SATISFACTORY: 14UNSATISFACTORY: 0N/A: 1Unreviewed: 15

Insulation Resistance & Contact Resistance

ATS-2021 §7.6.1.1.B.2, B.3 (insulated/molded case) / §7.6.1.2.B.2, B.3 (LV power)

Insulation Resistance In:

TCF to 20°C:enter temperature in the job headerANSI/NETA ATS-2021 Table 100.14.1, solid column

Closed: Pole-Pole

Closed: Pole-Ground

Open: Line-Load

Actual20°C

1 A-Bcalc

A-GNDcalc

PH Acalc

2 B-Ccalc

B-GNDcalc

PH Bcalc

3 C-Acalc

C-GNDcalc

PH Ccalc

Contact Resistance, Micro-Ohms

Pole 1Pole 2Pole 3

Contact

Fuse

Overcurrent Settings

ATS-2021 §7.6.1.1.A.8 (insulated/molded case) / §7.6.1.2.A.14 (LV power)

CT / Sensor Ratings

CT / Sensor Tap

Rating Plug, AF

ParameterAs Found SettingAs Tested SettingAs Left SettingI²T ON

Long Time Pickup

Long Time Delay

Short Time Pickup

Short Time Delay

Instantaneous Pickup

Ground Fault Pickup

Ground Fault Delay

Trip Unit Settings

ATS-2021 §7.6.1.1.A.8 (insulated/molded case) / §7.6.1.2.A.14 (LV power)

ParameterAs Found SettingAs Tested SettingAs Left SettingI²T ON

Sensor Rating (In)

LT Switch Setting (Io)

Long Time Pickup (Ir)

Long Time Delay (tr)

Inv. Def. Min. Time Lag (idmtl)

Short Time Pickup (Isd)

Short Time Delay (tsd)

Instantaneous Pickup (Ii)

Ground Fault Pickup (Ig)

Ground Fault Delay (tg)

Ground Fault Push to Trip Button

Test Results, Full Function Test Kit

ATS-2021 §7.6.1.1.B.9 (insulated/molded case) / §7.6.1.2.B.9 (LV power)

Parameter Tested

Mult

Test Amps

Range

Test Results

MinimumMaximumTrip TimeStatus

Long Time Pickup (Ir)

Short Time Pickup

Instantaneous Pickup

Ground Fault Pickup

Tech Notes / Comments / Deficiencies

Tech Note(s)

Comments

Deficiencies

Finalize and sign

Before this sheet can be finalized

8 section(s) not yet verified
Technician name required (Job Info)
Attestation checkbox not checked

I attest that all tests listed herein were performed in accordance with ANSI/NETA ATS-2021 and that the results recorded are true and accurate to the best of my knowledge.

Verify every section and sign the report above to unlock the downloads.

LV Circuit Breaker test form

Job Information

Breaker Nameplate

Visual & Mechanical Inspection

Insulation Resistance & Contact Resistance

Overcurrent Settings

Trip Unit Settings

Test Results, Full Function Test Kit

Tech Notes / Comments / Deficiencies

Finalize and sign

LV Circuit Breaker test form

Job Information

Breaker Nameplate

Visual & Mechanical Inspection

Insulation Resistance & Contact Resistance

Overcurrent Settings

Trip Unit Settings

Test Results, Full Function Test Kit

Tech Notes / Comments / Deficiencies

Finalize and sign