Environmental Engineering Reference
In-Depth Information
AccIdent dAtA, electrIcAl
1 of 3
.(1). Voltage.of.circuit.involved:._________.Volts.
_________.AC.
_________.DC
.(2). Voltage.to.which.principal(s).exposed:._________.Volts
.(3). Type.of.supply.circuit:.._____________________________________________________________
.(4). Provide.diagram.of.circuit.involved:.Check._________.when.completed.
.(5). Type.of.conductor:..________________________________________________________________
.(6). Size.of.conductor:..___________________________________________________________________________.Volts
. . Insulation.rating:..____________________________________________________________________________ .Volts
.(7). Condition.of.conductors/protection:._________.Good. _________.Poor
. . Describe.condition.of.failed.or.deteriorated.components:..__________________________________
.(8). Ground.fault.trip.value.(3.phase.only):.. ________________________________________________
.(9). Grounding:.Resistor:._________.Ohms.frame.grounding.type:.._______________________________
. . Ground.fault.relays.type:._____________________________.Delay.setting:.______________________________.
(10). Did.lack.of.grounding.contribute.to.the.accident?.
□
.Yes.
□
.No
(11). Condition.of.building/equipment/loor:._________.Dry. _________.Wet
. . Describe.drainage,.level,.irregularities,.material:.. ________________________________________
(12). Was.interrupted.circuit.tagged?.
□
.Yes.
□
.No. Locked-out?.
□
.Yes.
□
.No
. . ________________________________________________________________________________
(13). Were.power.switches.properly.labeled?.
□
.Yes.
□
.No
. . If.not,.use.diagram.to.identify.labels.needed.
(14). Was.circuit.protection.device.provided?.
□
.Yes.
□
.No
. . Was.it.overridden?.
□
.Yes.
□
.No
(15). Did.the.accident.result.from.a.faulty.splice?.
□
.Yes.
□
.No
. . Was.it.a.temporary.splice?.
□
.Yes.
□
.No. Describe.splice.and.equipment.used:
. . ________________________________________________________________________________
. . ________________________________________________________________________________
. . Manufacturer:..____________________________________________________________________
(16). Did.design.of.equipment.contribute.to.accident?.
□
.Yes.
□
.No
. . How?.(operation,.maintenance,.inherent.safety):.. ________________________________________
. . ________________________________________________________________________________
(17). Was.poor.maintenance.a.factor?.
□
.Yes.
□
.No. If.so,.describe:
. . ________________________________________________________________________________
. . ________________________________________________________________________________
(18). Did.test.equipment.contribute.to.accident?.
□
.Yes.
□
.No.
If.so,.type:
.
.
_________.Voltmeter.
_________.AC.
_________.DC.
_________.Ammeter
.
.
_________.AC.
_________.DC.
_________.Other.(specify).. __________________________________
.
.
Manufacturer:.______________________________________.Model:.______________________________________
.
.
If.person.testing.was.other.than.victim,.was.he.qualiied.to.perform.task?.
□
.Yes.
□
.No
