✁
6. What did happen?
___________________________________________________________________________
___________________________________________________________________________
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7. When did the fault occur?
Instant Yes/No Intermittent Yes/No
Time delayed Yes/No (Delete as appropriate).
By how long? ___________
8. What indications if any did the relay show?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. Was there any visual damage?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
10. Any other remarks which may be useful:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
______________________________________ _____________________________________
Signature Title
______________________________________ _____________________________________
Name (in capitals) Company name
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