Information
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This equipment is being energized at the request of those people identified in this report, who agree to accept care, custody, control and responsibility of the equipment from this date forward. Staff Electric is removing all lockouts/tag outs, as required. Our understanding is that all site specific procedures and OSHA regulations will be followed by the parties requesting energization. Staff Electric will no longer be involved with the equipment described in this report, except for the contractual guarantees and warranties.
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EQUIPMENT ENERGIZATION & START UP - (Enter equipment name)
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Client / Site
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Conducted on
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Prepared by
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Location
Equipment Description and Location
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Enter equipment description: ( e.g. generators, transfer switches, UPS systems, motors, fire pumps, air handlers, VFD's, utility service, etc)
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Enter equipment location:
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Enter equipment number:
Participants
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Staff Electric Foreman/Superintendent
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Select date
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Staff Electric Start Up Personnel
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Select date
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General Contractor Representative
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Select date
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Owner Representative
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Select date
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Mechanical Start Up Personnel
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Select date
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Factory Start Up Personnel
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Select date
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Additional Personnel
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Select date
Voltage Verified
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Input Voltage Verified?
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Input Voltage:
- 120V
- 208V
- 277V
- 480V
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Input Phase:
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Output Voltage Verified?
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Output Voltage:
- 120V
- 208V
- 277V
- 480V
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Out out Phase:
As Left Conditions
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Rotation checked:
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Are switches & breakers left in proper positions?
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Monitoring checked?
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Proper breaker/overload settings?
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Point to point wiring verified?
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Owner training completed?
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Enter owner training date.
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Additional factory start up report included?
Comments
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Enter additional comments
