Copyright © 2007-2010 Eaton Corporation. All Rights Reserved.
IPN 997-00012-52D July 2010
101
Equipment Incident Report
EQUIPMENT INCIDENT REPORT
Please enter as much information as you can. Send the completed form, together with the item for repair to your nearest
authorized service agent. NOTE: Only one fault to be recorded per form.
For further information contact your local Eaton dc product supplier or Eaton (see contact details on page
). Or
email: [email protected]
Date: ________________
Customer Information
Company: _______________________________________________________________________
Postal Address: _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Return Address:
(Not PO Box) _______________________________________________________________________
Telephone: _______________
Fax: _______________ Email:
_________________
Contact Name: _______________________________________________________________________
Location of Failure
Product code: ___________
Serial number: __________ Document
number:
_____________
System type installed in: _________________________
Serial number: _____________
Site name or location: __________________________________________________________
Fault discovered
Delivery
Unpacking
Installation
Initial test
Operation after _____ years
Other _______________
Failure source
Design
Manufacturing
Documentation
Transportation Installation
Handling
______________
Effect on system operation
None Minor Major _______________________
INFORMATION (fault details, circumstances, consequences, actions)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Internal use only.
Reference No: __________ RMA: __________ NCR: __________ Signature: _________________ Date: _______________
