Breakaway Switch Audit

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Model/Floorplan of Unit Inspected

• Serial Number of Unit Inspected

undefined

• Document Number

Installation

• Breakaway Switch is Not Damaged and in Installable Condition

  Yes

  No

• Breakaway Switch Housing Assembly Secured to Chassis via Screw through Mounting Hole on Fixed Metal Plate

  Yes

  No

• Plunger is Properly Seated Into the Switch Housing

  Pass

  Fail

• Power Leads are Properly Connected to the Battery Lead and Break-Away Box

  Compliant

  Non-Compliant

Sign Off

• Installer

• Installer Signature

  Sign

• Plant Manager

• Plant Manager Signature

  Sign

• Auditor

• Auditor Signature

  Sign