Raychem ElectroMelt System Installation Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

BARRIER INFORMATION

• Entered Barrier Model number?

  Yes

  No

  N/A

• Entered Barrier Serial Number?

  Yes

  No

  N/A

• Enter Type of barrier:

  EPU Electric

  HPU Hydraulic

• Enter software version? (if ANY)

  Yes

  No

  N/A

Prior to concrete pour, perform ONLY the Visual Inspection and Insulation Resistance Tests. After the pour perform ALL tests.

1. Perform Visual Inspection.

• 1.1. Confirm 30-mA ground-fault device marked for proper rating. Is device marked per drawing?

  Yes

  No

  N/A

• Enter description/explanation of device markings.

• If possible, take a picture of the device markings.

  Media

• 1.2. Visually inspect inside connection boxes for overheating, corrosion, moisture, loose connections, or other problems. Are there any problems?

  Yes

  No

  N/A

• Enter description/explanation of problem or problems.

• If possible, take a picture or pictures showing problems.

  Media

• 1.4. Barrier goes to the UNSECURED/OPEN/DOWN position in standard operating time?

  Yes

  No

  N/A

• 1.5. SECURED/CLOSED/UP position initiated via the push button on Remote panel(s)?

  Yes

  No

  N/A

• 1.6.UNSECURED/OPEN/DOWN position initiated via the push button on Remote panel(s)?

  Yes

  No

  N/A

• 1.7.Verified Indicating lights for status of barrier position on master panel?

  Yes

  No

  N/A

• 1.8. Verified Indicating lights for status of barrier position on remote panel?

  Yes

  No

  N/A

• 1.9. Verified all ILLUMINATED SWITCHES or LIGHTS are functional on both Master control panel(s) and Remote panel(s), If applicable.

  Yes

  No

  N/A

• 1.10. Verified AUDIBLE ALRAM to indicate barrier left in the UNSECURED/OPEN/DOWN <br>position for operator determined time period, If applicable.

  Yes

  No

  N/A

• 1.11. Verified all TRAFFIC LIGHTS - RED ON SECURED/CLOSED/UP Position are functional, If applicable.

  Yes

  No

  N/A

• 1.12. Verified all TRAFFIC LIGHTS - AMBER ON UNSECURED/OPEN/DOWN Position are functional, If applicable.

  Yes

  No

  N/A

• 1.13. Verified all TRAFFIC ARMS - ARM in the DOWN POSITION when Barrier is in the SECURED/CLOSED/UP Position are functional, If applicable.

  Yes

  No

  N/A

• 1.14. Verified all TRAFFIC ARMS - ARM in the UP POSITION when Barrier is in the UNSECURED/OPEN/DOWN Position are functional, If applicable.

  Yes

  No

  N/A

• 1.15.Verified all SAFETY Control Loops are functional, If applicable.

  Yes

  No

  N/A

• 1.16.Verified all EXIT Control Loops are functional, If applicable.

  Yes

  No

  N/A

• 1.17.Verified all CARD ACCESS Control Loops are functional, If applicable.

  Yes

  No

  N/A

• 1.18.Verified all SPEED DETECTION Loops are functional, If applicable.

  Yes

  No

  N/A

• 1.19.Verified all WRONG WAY DETECTION Loops are functional, If applicable.

  Yes

  No

  N/A

• Enter any corrective actions that WILL NEED to be undertaken.

• Perform a Visual Inspection of Barrier for any damages.

  Yes

  No

  N/A

2. Sequence of Operations - EMERGENCY MODE

• 2.1. ALL Barriers in SECURED/CLOSED/UP Position initiated via the EFO/E-UP Push Button on Master Panel?

  Yes

  No

  N/A

• 2.2. ALL Barriers in SECURED/CLOSED/UP Position initiated via the EFO/E-UP Push Button on REMOTE Panel?

  Yes

  No

  N/A

• 2.3. ALARM sounds continuously , until MANUAL (KEY) RESET of the system.

  Yes

  No

  N/A

• 2.4. Barrier goes to SECURED/CLOSED/UP position in Approx. one (1) second. ALARM sounds continuously , until MANUAL (KEY) RESET of the system.

  Yes

  No

  N/A

• 2.5. Verified all ILLUMINATED SWITCHES or LIGHTS are functional on both Master control panel(s) and Remote panel(s) during EFO/E-UP, If applicable.

  Yes

  No

  N/A

• 2.6.. Verified all TRAFFIC LIGHTS - RED ON SECURED/CLOSED/UP Position are functional during EFO/E-UP, If applicable.

  Yes

  No

  N/A

• 2.7. Verified all TRAFFIC ARMS - ARM in the DOWN POSITION when Barrier is in the SECURED/CLOSED/UP Position are functional during EFO/E-UP, If applicable.

  Yes

  No

  N/A

• Enter any corrective actions that WILL NEED to be undertaken

3. Sequence of Operations - SPECIAL MODE

• Fill in any Special Sequence of Operations requirements and Authorized END-User MUST SIGN.

• AUTHORIZED END-USER APPROVAL AND ACCEPTANCE FOR SPECIAL SEQUENCE

  Sign

APPROVAL and ACCEPTANCE AUTHORIZED SIGNATURES (must be signed and date for Warranty)

• On Site Representative (GC/Customer)

  Sign

• End-User Representative

  Sign

• NASATKA Representative

  Sign

Signature Acknowledgement

• ELECTRONIC SIGNATURE ACKNOWLEDGE, I AGREE THAT MY ELECTRONIC SIGNATURE <br>IS A LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. WHENEVER I <br>EXECUTE AN ELECTRONIC SIGNATURE, IT HAS THE SAME VALIDITY AND MEANING AS <br>MY HANDWRITTEN SIGNATURE. I WILL NOT AT ANY TIME IN THE FUTURE, REPUDIATE <br>THE MEANING OF MY ELECTRONIC SIGNATURE OR CLAIM THAT MY ELECTRONIC SIGNATURE <br>IS NOT LEGALLY BINDING.

  Yes

  No

  N/A

ANY MODIFICATIONS OR ALTERATIONS BY ANYONE OTHER THAN "NASATKA" OR A "NASATKA AUTHORIZED PERSONNEL" WILL RENDER THE NASATKA WARRANTY HEREIN "NULL" AND "VOID".