Smart-UPS VT / AIS 3000 Breck dwon Site Form

APC SERVICE REPRESENTATIVE: Company: Service Request Number: Company Address: Service Engineer: City: State: Date of Service: Service Start Time: Service End Time: # Hours On Site Total Travel Time: LOCATION OF THE SYSTEM: Unit Type: Serial Number: Company Name: Telephone: Street Address: City: State: U.P Zip Code: Location: Contact Name: Alt. Cont. Name: INSTALLING ELECTRICIAN: Company Name: Electrician Name: Telephone : SERVICE BULLETINS: List all Service Bulletins completed during this Site Visit.

AUTHORIZATION TO SERVICE/TEST UPS: Customer Signature APC Signature: SYSTEM CONFIGURATION INFORMATION: Service Bypass Panel Batteries: Internal Batteries: External Batteries: Battery amount: Yes yes No

Date: Date:

SBP type: no

yes

Record the Product Number/Serial Number for each component along with its Current Firmware Version in the table below. Product Number/Serial Number Current Firmware Revision

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ENVIRONMENT: 1. The system environment is suitable for operation. 2. There is sufficient clearance around the system for service. 3. Control wiring for the EPO, MBP, and XR Battery Enclosures is correct. 4. There is no sign of damage to the system. 5. DC disconnect breaker on the XR battery enclosure is closed. 6. Alarms and any shutdown software have been disabled. CORRECTIVE ACTION (PRELIMINARY): 1. Record the Visual observations present upon arriving on site: 12V-26 AH 4 NOS EXIDE MAKE SMF BATTERY FAULTY ,NEED TO BE REPLACED

Yes/No

2. In which mode of operation was the system in at time of visit? (Normal, Battery, Dead, Bypass) 3. Record the Normal Input Voltage and Input Frequency. 4. Record the System Output Voltage. 5. Record the UPS PowerView log, as well as any active alarms below: UPS: Alarms:

6. Using Tera Term, capture the Request Event Log content. 7. Using Tera Term, Clear the Event Log contents. 8. Using Tera Term, capture the Battery Monitor Statistics dump.

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CORRECTIVE ACTION (COMPLETION):

2. Identify the type of failure: Assembly/ Workmanship/Component Failure/Misuse/Module Failure/Revision Change/Transport/Upgrade/Other:

3. List of all parts removed from the Smart-UPS VT / AIS 3000: Reason for Removal: Part No. Part Description Serial Number Rev. No. Yr/Wk Warranty Upgrade Worn-out Defect

4. List of all parts replaced in the Smart-UPS VT / AIS 3000: Reason for Replacement: Part No. Part Description Serial Number Rev. No. Yr/Wk Warranty Upgrade Worn-out Defect

FINAL INSPECTION: 1. Ensure that the interior and exterior of the system clean and free from debris. 2. Ensure that the system functions properly on all modes of operation. 3. Verify that the correct settings are present (UPS and Customer needs). 4. Review ALL diagnostic parameters (UPS PowerView) ensuring ALL subsystems are on and OK. 5. If entire event log has been recorded and reviewed, clear the log before leaving site. 6. Note additional comments on the space below if necessary:

Yes/No

Document any issues for APC Issues and Assignments db: Region (e.g. LAM): Product family (e.g. Silcon): Strategic Initiative: UNKNOWN Issue/assignment title: Recommended priority: Nature of problem & effects: Recommended solution:

Date: Customer signature: APC signature:

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