Eaton SC300 - Equipment Incident Report

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150

IPN 997-00012-03 B2 Issue B2 July 2018

Equip me nt Inci de nt R ep ort

EQUIPMENT INCIDENT REPORT

Please enter as much information as you can. Send the completed form, together with the item for repair to your nearest

authorized service agent. NOTE: Only one fault to be recorded per form.

For further information contact your local Eaton dc product supplier or Eaton (see contact details on page 153).

Date: ________________

Customer Information

Company: _______________________________________________________________________

Postal Address: _______________________________________________________________________

_______________________________________________________________________

Return Address:

(Not PO Box)

_______________________________________________________________________

Telephone: _______________ Fax:

_______________ Email:

_________________

Contact Name: _______________________________________________________________________

Location of Failure

Product code: ___________ Serial number: __________ Document number: _____________

System type installed in:

_________________________ Serial number: _____________

Site name or location:

__________________________________________________________

Fault discovered

Delivery Unpacking Installation

Initial test Operation after _____ years Other _______________

Failure source

Design Manufacturing Documentation

Transportation Installation Handling

______________

Effect on system operation

None Minor Major _______________________

INFORMATION (fault details, circumstances, consequences, actions)

______________________________________________________________________________________

Internal use only.

Reference No: __________ RMA: __________ NCR: __________ Signature: _________________ Date: _______________

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