Download SAFETY QUESTIONNAIRE QMF17v Issue 01

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QMF17vIssue01
17 Nov 10
SAFETY QUESTIONNAIRE
QMF17v Issue 01
RN Electronics Ltd
Arnolds Court, Arnolds Farm Lane, Mountnessing, Brentwood, Essex, CM13 1UT
Registered in England No 3051259 Registered Office Arnolds Court, Arnolds Farm Lane, Mountnessing, Brentwood Essex, CM13 1UT
Tel: +44 1277352219 Fax: +44 1277352968 E-mail: [email protected] www.RNelectronics.com
Please use Questionnaire Notes (QMF17v¹) to assist in completing this questionnaire.
Please E-Mail back to R.N. Electronics to estimate the test time required. Please complete clearly for each
item to be tested, the answers will be used within your report after Safety testing. Equipment under test should be
representative of production model. If item is sealed, putted etc. then a second open sample will be required.
1a
Contact:
1b
Company:
1c
Address:
1d
Post Code
1e
Tel No:
1f
E-mail:
1g
Order No.
1h
Quality Manager:
1i
Q.M. E-mail
2a
EUT Name:
2b
Model No:
2c
Serial Number:
Please ensure EUT is uniquely identified. If serial number is unavailable at this time please provide before test
3a
Main function / operation
of equipment
3b
Specific Use
3c
Country Of Origin
3d
Manufacturer
4a
Is support equipment required ?
4c
Please give details
4d
How many modes of operation does the unit have ?
4e
Please Describe each mode:
1
2
Y/N
4b
If YES will you supply?
Y/N
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QMF17vIssue01
17 Nov 10
SAFETY QUESTIONNAIRE
QMF17v Issue 01
3
4
Y/N
5a
Is the product IP rated?
5c
Any safety critical components present? If YES please provide details:
5d
Can you provide user manual/instructions?
5e
Are there any other guides for the EUT
5b
If YES, what is the IP rating?
Y/N
5f
Y/N
Details
please provide a copy
5g
Is the equipment mains powered? If YES, is the power supply/power adapter/transformer previously
approved. Please provide details.
6a
Is the unit one single product ?
6c
If No to above, please
give details
7a
In what position is the equipment most likely to be used ? (eg.bench, floor, etc.) :
7b
What is the equipment environmental specification ?
7c
Are there any health and safety risks associated
with the equipment? Please Detail.
8
Equipment weight and dimensions:
Height
9
mm
Power Requirements
Y/N
Width
6b
mm
Is this the most complex configuration?
(eg.temp range, humidity range etc)
Depth
Rated Voltage Range
V
Rated Frequency
Hz
mm
Weight
Rated Power
W
Current
A
Note: For testing Conducted Emissions on customer premises the EUT will require a non RCD supply.
10a List
Y/N
of ports and the maximum permissible lead length - Including AC/DC power port(s):
Lead Length (m)
Cable Type
Port Name
kg
Phase
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QMF17vIssue01
SAFETY QUESTIONNAIRE
Port Name
10b What
17 Nov 10
QMF17v Issue 01
Lead Length (m)
Cable Type
is the maximum number of inter-connecting leads the equipment could use ?
10c
How many leads may be over 3m when the equipment is installed ?
11
Is surge protection fitted to the supply or any signal ports ? (please detail below)
12a Please
Y/N
detail the Safety standard & date of issue you would like the equipment tested to; alternatively
check the box below if you would like advice about the most applicable standard(s).
12b I
would like advice about the most applicable standard(s) on test confirmation:
13
If you require a different company
name and address on the test report
please enter it here:
14
Our Quotation is based on the information supplied to us. Incorrect information may
lead to extra charges if insufficient time has been allocated to you.
Signature:
Date:
The scope of accredited work is not exhaustive. RN Electronics is not currently accredited for electrical
safety testing. Please check quotation and booking confirmation or call R.N Electronics for further
details. Our current scope is also available at www.ukas.org/testing.