ANNEXURE-I

PRO FORMA TO BE SUBMITTED ALONG WITH

COMPREHENSIVE AUDIT REPORT

1.1 General information-

Branch-

Zone-

Sr. Details
01 Type of Branch (Metro/Urban/Semi-Urban/Rural)
02 Staff strength details of branch Officer-
Clerk-
Sub Staff-
03 Name of designated branch security officer with contact no.
04 Name of Electrical Auditor and contact no.

1.2 Last Audit-

Sr. Date of last electric audit Electric risk rating Compliance date Closure date
Start on Complete (High/Medium/Low)
date

1.3 Electric Supply Details-

Sr. Electric supply Sanction Load Maximum Average Load Any Penalty (in
company/Dept. Load(in last (in last one last one year)
one year) year)
A.P.D.C.L. 382.35 KVA

1.4 Details of Electrical Equipment-

Sr. Equipments Make and Model Quantity Rating (AMP or

KVA or core x sq.
mm or watt)
01 UPS
02 Batteries
03 D.G. Set Kirloskar 1 250 KVA
04 Miniature Circuit Breaker (MCB) Schneider Electric 262 + 16 A – 63 A
05 MCCB (Moulded Case Circuit Merlin Gerin & 37 32 A – 800 A
Breaker) Schneider electric
& L&T
06 ELCB (Earth leakage circuit None
breaker)
07 RCCB (Residual current circuit
breaker)
08 SFU/HRC fuse 8 32 A
09 Electric Wire
a) 1.5 sq. mm
b) 2.5 sq. mm
c) 04 sq. mm
d) 06 sq. mm

1.5 UPS and Batteries-

AMC vendor & expiry Proper electric Auto timer Adequate rating MCB
date (if any) connection with (functional/non- /fuse or ACs
compressor contactor, functional) (if provided) unit(Yes/No)
relay and capacitor

Any chemical rust or Whether Unwanted material Any overheating in

loose connection on ventilation/cooling is inside kept inside UPS wire/fuse/MCB/switches
battery terminal/lug provided in UPS room & Battery room etc. (Yes/No) (if yes give
(yes/no)(if yes give (Yes/No) (Yes/No) (if yes give reason/details)
reason/details) details)
Yes Yes No No

No. of batteries (more than 3 years old) & having Last date of battery back-up test on full load &
capacity below 80% of full capacity have any deformity (give details)

1.6 AC Units-

AMC Vendor & expiry Proper electric Auto timer Adequate rating
date (if any) connection with (functional/non- MCB/fuse for ACs unit
compressor contactor, functional) (if provided) (Yes/No)
relay and capacitor
1.7 Diesel Generator-

AMC vendor & expiry Date of last engine oil All gauges like temp. Any deformity noise,
date (if any) and filter replacement meter, voltmeter, leakage, fuel,
(not more than 6 month ammeter, wattage, consumption rate and
or 250 running hrs) KWH, hour meter etc. spark in exhaust system
are working properly (yes/no) (if yes give
(yes/no) (if no give reason/details)
reason/details)

1.8 Details of other electrical equipment-

Sr. Equipments Make and model Quantity Details

01 Computers
02 Printers
03 Passbook printers
04 Cash counting machine
05 Split ACs/Window ACs
06 Fans
07 Router
08 Fire alarm and burglar alarm
09 CCTV

1.9 Electric supply (single phase/three phase) (please tick)-

Phase-I Phase-II Phase-III

1.10 Electric load distribution(in volt)-

R-Phase(R-N) Y-Phase(Y-N) B-Phase(B-N)

2.1 Earthing system-

Sr. Separate earthing for UPS and Type of earthing Earth resistance Earth pit identified
Raw power (Yes/No) (chemical/normal) (in ohm) (Yes/No)
No
2.2 Heating of wire/panels-

Sr. Thermography of electric wire Locations/spots Details of heating Reason

and panel (Yes/No) thermo-graphed equipment (attach
thermography
image & system
generated report)
Yes LT Metering Panel MCCB outgoing Loose connection.
cable joint.

2.3 Other Electrical Risk-

Sr. Electrical Risk Category Reason/details and

(High/medium/low) recommendation (For
high only)
01 Any hanging electrical wire/temporary High
electric connection etc. in premises
02 Any multi pin plug or extension cable/board
use in premises
03 Any dangling/loose electric connection or
portion of live wire with damage
jacket/insulation
04 Flammable combustible material damped
near electric panel (those electrical
equipment run on 24x7 basis)
05 Voltage fluctuation
06 Any MCB /Fuse etc. by pass from the electric
system
07 Any other electrical risk

2.4 ATM/E-gallery (only for on-site)-

No. No. Auto timer for UPS & Thermography Any loose Any other
of of AC ACs available batteries of wire and connection/multi electrical
kiosk units (yes/no) & Auto (working/non- panel (yes/no) pin plug etc. in observation
timer working) (attach report ATM/E-gallery in ATM/E-
(functional/non- giving (yes-no) gallery
functional) location/spots)
1 1

2.5 Risk Rating-

Overall electric risk category (High/medium/low) Reason

2.6 Summary-

Sr. Observations Rating Recommendation

(High/medium/low) (Strictly specify details
of electrical
equipment/wire etc.
only) (e.g. – 01 MCB of
16 amp of UPS incomer
replace)

(Signature of electrical auditor)