7/22/2019 Prefunctional Test Checklist

1/4

PREFUNCTIONAL TEST CHECKLISTSwitchgear, Switchboards, Panel Boards, Motor Control Centers,

Transformers (Swtchgr) - _________Specification Section 1______

Pro!ect" __________________________________ Pro!ect #o" __________

Components incl$ded:___disconnects, ___ fuses, ___meters, ____ other __________________

%ssociated Chec&lists"___ _______________________

1' S$bmittal %pproalsS$bmittal' The above equipment and !tem inte"#a$ to them a#e %omp$ete and#ead! &o# &un%tiona$ tetin"' The %he%($it item a#e %omp$ete and have been %he%(edo&& on$! b! pa#tie havin" di#e%t (no)$ed"e o& the event, as marked below, respective to each

responsible contractor. This prefunctional checklist is submitted for approval, subject to an attached list ofoutstanding items yet to be completed. A Statement of orrection will be submitted upon completion ofany outstanding areas. !one of the outstanding items preclude safe and reliable operation of the system.

___ "ist attached.

_____________________ __________ _____________________ __________#lectrical ontractor $ate ontrols ontractor $ate

_____________________ __________%eneral ontractor $ate

This checklist is to be completed prior to activation by &$A$.

This checklist does not take the place of the manufacturer's recommended checkout and startup

procedures or report.

ontractors assigned responsibility for sections of the checklist shall be responsible to see that

checklist items by their subcontractors are completed and checked off.

%pproals' This filled(out checklist has been reviewed. )ts completion is approved.

_____________________ __________ ____________________ __________ommissioning Authority*Agent $ate +wner's epresentative $ate

*' +e$ested doc$mentation s$bmitted

a* &anufacturer's cut sheets: -es * !o ( date to be submitted _______ b* erformance data: -es * !o ( date to be submitted _______ %* Se/uences and control strategies: -es * !o ( date to be submitted _______ d* + 0 & &anuals: -es * !o ( date to be submitted _______

PREFUNCTIONAL TEST CHECKLISTS.TC/0%+, S.TC/B2%+3S, P%#4 B2%+3S, M2T2+ C2#T+24 C#T+S,

T+%#S52+M+S+,-+. /01123+.3/ OF 4 5675OCS75I8/7+,3+.7/01123+.'5OC

7/22/2019 Prefunctional Test Checklist

2/4

PREFUNCTIONAL TEST CHECKLISTSwitchgear, Switchboards, Panel Boards, Motor Control Centers,

Transformers (Swtchgr) - _________e* $ata base sheets: -es * !o ( date to be submitted _______ 6' Model 7erification

Item Spe%i&ied Submitted Inta$$ed9anu&a%tu#e#

9ode$

Se#ia$ Numbe#8o$ta"e-Phae

Equipment Ratin" :amp*

Fue Ratin" :amp*

4. .nstallation Chec&s

a1 0eneral .nstallationi1 Pe#manent $abe$ a&&i;ed6

7/22/2019 Prefunctional Test Checklist

3/4

PREFUNCTIONAL TEST CHECKLISTSwitchgear, Switchboards, Panel Boards, Motor Control Centers,

Transformers (Swtchgr) - _________d* Motor Control Centers

i1 Tin p$ated %oppe# bue6 N-A -

7/22/2019 Prefunctional Test Checklist

4/4

PREFUNCTIONAL TEST CHECKLISTSwitchgear, Switchboards, Panel Boards, Motor Control Centers,

Transformers (Swtchgr) - _________Sensor*%age 8erification Table

Seno# o#>a"e

Lo%ationOK :a"e 8a$ue

?9S 8a$ue Int#ument9eau#ed

8a$ue

Pa :a"e #eadin" @ #eadin" o& the pe#manent int#ument on the equipment'?9S @ bui$din" mana"ement !tem' Int#ument @ tetin" int#ument'

All sensors/gages are calibrated within required tolerances ___ YES ___ NO

-- #3 25 SCT.2#--

PREFUNCTIONAL TEST CHECKLISTS.TC/0%+, S.TC/B2%+3S, P%#4 B2%+3S, M2T2+ C2#T+24 C#T+S,

T+%#S52+M+S+,-+. /01123+.34 OF 4 5675OCS75I8/7+,3+.7/01123+.'5OC