Electrical testing · RMS Automation

Medium Voltage Circuit Breaker

ANSI/NETA ATS-2021 §7.6.3 · Vacuum

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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

Inventory #

End User Asset/ID

DBID Asset ID

Equipment Used

Breaker Nameplate

Manufacturer

Serial Number

Catalog Number

Rated Volts

AIC

Amperes

Mfg Date

Max Volts

Breaker Type

BIL

Int Time

Frequency

K Factor

OPS No.

Custom Field 1: Name

Custom Field 1: Value

Custom Field 2: Name

Custom Field 2: Value

Mounting

D.O.B.I.

Counter Reading, Begin

Counter Reading, End

Visual & Mechanical Inspection

Required

Description

Condition

Clean / Lube

Description

Condition

Clean / Lube

Description

Condition

Clean / Lube

Cell / Racking Device

Contact Fingers

Contact Erosion

Contact Wipe

Push / Pull Rod

Matches Dwg / Spec

Secondary Disconnect

Ground Connection

Operating Mechanism

Interlocks

Anti-Pump

Phase Barriers

Overall Condition

Auxiliary Devices

Ins. Linkages / Braces

Summary:SATISFACTORY: 0UNSATISFACTORY: 0N/A: 0Pending: 15

Insulation Resistance & Contact Resistance

ATS-2021 §7.6.3.B.2, B.4

Test Voltage:

VUnits:

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

MeasurementPh A20°CPh B20°CPh C20°C

Closed: Pole-Pole---

Closed: Pole-Ground---

Open: Line-Load---

Contact Resistance, Micro-Ohms

Pole 1Pole 2Pole 3

Resistance (μΩ)

Fuse Resistance

Tech Notes / Comments / Deficiencies

Tech Note(s)

Comments

Deficiencies

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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.

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MV Circuit Breaker test form

Job Information

Breaker Nameplate

Visual & Mechanical Inspection

Insulation Resistance & Contact Resistance

Tech Notes / Comments / Deficiencies

Finalize and sign

MV Circuit Breaker test form

Job Information

Breaker Nameplate

Visual & Mechanical Inspection

Insulation Resistance & Contact Resistance

Tech Notes / Comments / Deficiencies

Finalize and sign