DQJE Service Change Worksheet v1.0

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Customer Information

• What is the customer name, billing address, phone number, fax number, email address, or other contact information?

Job Proposal Information

• Scope of Work

• Are there any specific inclusions?

  Yes

  No

  N/A

• Are there any specific exclusions?

  Yes

  No

  N/A

• Have you offered the customer a verbal amount?

  Yes

  No

  N/A

• When is the proposal promised?

  Date

Additional Information for the Estimator

• Panel Information

• What Is the make of the panel?

  Select Bryant Cutler Hammer FPE GE Square D Homeline Square D QO Sylvania

  • Bryant
  • Cutler Hammer
  • FPE
  • GE
  • Square D Homeline
  • Square D QO
  • Sylvania

• What is the voltage of the panel?

  Select 120/240 1ph 120/208 3ph 240 1ph 240 3ph (delta) 277/480 3ph 480 3 ph (delta) OTHER

  • 120/240 1ph
  • 120/208 3ph
  • 240 1ph
  • 240 3ph (delta)
  • 277/480 3ph
  • 480 3 ph (delta)
  • OTHER

• What is the amperage of the main?

  Select 50 70 90 100 125 150 175 200 225 400 600 800 OTHER

  • 50
  • 70
  • 90
  • 100
  • 125
  • 150
  • 175
  • 200
  • 225
  • 400
  • 600
  • 800
  • OTHER

• What is the disconnecting means?

  Select NONE MCB FUSED NON-FUSED OTHER

  • NONE
  • MCB
  • FUSED
  • NON-FUSED
  • OTHER

• Is this panel the service?

  Yes

  No

  N/A

• Do we need to replace the panel?

  Yes

  No

  N/A

• Are the service entrance conductors underground or overhead?

  UNDERGROUND

  OVERHEAD

• Do the service entrance conductors need to be replaced?

  Yes

  No

  N/A

• Is the cold water bonded?

  Yes

  No

  N/A

• Does the meter need to be replaced?

  Yes

  No

  N/A

• Do we need to add a ground rod?

  Yes

  No

  N/A

• Do we need to run the cold water ground?

  Yes

  No

  N/A

• What is the length of the ground?

• Are there 3 wire circuits?

  Yes

  No

  N/A

• Do we need breakers?

  Yes

  No

  N/A

• Are the GFIs in the panel?

  Yes

  No

  N/A

• Other information

• Branch Circuit information

• What type of wiring is there?

  Romex

  EMT

  Cloth Romex

  OTHER

• Are the devices grounded? What color and style are they?

  Yes

  No

  N/A

• Are there arc fault breakers?

  Yes

  No

  N/A

• Are there CO detector where needed?

  Yes

  No

  N/A

Other Information

• Material List

Sketches

• Sketch #1

• Sketch #1

  Drawing

• Sketch #2

• Sketch #2

  Drawing

Other Photos

• Add media

  Media