PREFUNCTIONAL TEST CHECKLIST Switchgear, Switchboards, Panel Boards, Motor Control Centers, Transformers (Swtchgr) - _________ Specification Section

1 ______ Pro!ect" __________________________________ Components incl$ded :

___disconnects, ___ fuses, ___meters, ____ other __________________

Pro!ect #o" __________

%ssociated Chec&lists" ___ _______________________ 1' S$bmittal ( %ppro)als S$bmittal' The above equipment and ! tem inte"#a$ to them a#e %omp$ete and #ead! &o# &un%tiona$ te tin"' The %he%($i t item a#e %omp$ete and have been %he%(ed o&& on$! b! pa#tie havin" di#e%t (no)$ed"e o& the event , as marked below, respective to each
responsible contractor. This prefunctional checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of orrection will be submitted upon completion of any outstanding areas. !one of the outstanding items preclude safe and reliable operation of the system. ___ "ist attached. _____________________ #lectrical ontractor _____________________ %eneral ontractor __________ $ate _____________________ __________ ontrols ontractor $ate

__________ $ate

This checklist is to be completed prior to activation by &$A$.

This checklist does not take the place of the manufacturer's recommended checkout and startup procedures or report. ontractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.

%ppro)als' This filled(out checklist has been reviewed. )ts completion is approved.
_____________________ __________ ommissioning Authority*Agent $ate ____________________ __________ +wner's ,epresentative $ate

*' a* b* %* d*

+e,$ested doc$mentation s$bmitted

&anufacturer's cut sheets: .erformance data: Se/uences and control strategies: + 0 & &anuals: -es -es -es -es * * * * !o ( date to be submitted _______ !o ( date to be submitted _______ !o ( date to be submitted _______ !o ( date to be submitted _______

PREFUNCTIONAL TEST CHECKLIST S-.TC/01%+, S-.TC/B2%+3S, P%#14 B2%+3S, M2T2+ C2#T+24 C1#T1+S, T+%#S52+M1+S +,-+. /01123+.3/ OF 4 5675OCS75I8/7+,3+.7/01123+.'5OC

PREFUNCTIONAL TEST CHECKLIST Switchgear, Switchboards, Panel Boards, Motor Control Centers, Transformers (Swtchgr) - _________ e* $ata base sheets: 6' Model 7erification Item 9anu&a%tu#e# 9ode$ Se#ia$ Numbe# 8o$ta"e-Pha e Equipment Ratin" :amp * Fu e Ratin" :amp * 4. .nstallation Chec&s No No No No No No No No No No No No No Spe%i&ied
-es * !o ( date to be submitted _______

Submitted

In ta$$ed

a1 0eneral .nstallation i1 Pe#manent $abe$ a&&i;ed6 <e ii1 Cabinet in p$a%e= no vi ib$e dama"e6 <e iii1 P#ope#$! mounted on equipment pad and an%ho#ed6 <e iv1 Inte#io# %$ean and d#!6 <e v1 Unit -equipment a%%e ib$e &o# maintenan%e-#ep$a%ement6 <e vi1 9ete#: * in ta$$ed pe# d#a)in" 6 <e vii1 5i %onne%t in ta$$ed and $abe$ed6 <e viii1 5i %onne%t a#e pad $o%(ab$e in open po ition6 <e i21 Ci#%uit b#ea(e# in ta$$ed and $abe$ed6 N-A - <e 21 Fu e in ta$$ed6 N-A - <e 2i1 Conduit in ta$$ed and %onne%ted6 <e 2ii1 Cab$e-%onduit #outin" doe not ob t#u%t a%%e 6 <e 2iii1 A 3bui$t d#a)in" updated6 <e

b* Switchgear (ser)ice entrance 1899&)a and abo)e) and Switchboards (ser)ice entrance less than 1899&)a) i1 F#ee tandin" meta$ en%$o u#e6 N-A - <e - No ii1 Coppe# bu e 6 N-A - <e - No iii1 Penet#ation to FPL vau$t pe# %ode6 N-A - <e - No %* 3istrib$tion Panel Boards and other Panel Boards i1 Tin p$ated %oppe# bu e 6 ii1 Ea%h %i#%uit identi&ied and $abe$ed6 iii1 Spa%e &o# additiona$ %i#%uit e;i t6 N-A - <e N-A - <e N-A - <e - No - No - No

PREFUNCTIONAL TEST CHECKLIST S-.TC/01%+, S-.TC/B2%+3S, P%#14 B2%+3S, M2T2+ C2#T+24 C1#T1+S, T+%#S52+M1+S +,-+. /01123+.3. OF 4 5675OCS75I8/7+,3+.7/01123+.'5OC

PREFUNCTIONAL TEST CHECKLIST Switchgear, Switchboards, Panel Boards, Motor Control Centers, Transformers (Swtchgr) - _________ d* Motor Control Centers i1 Tin p$ated %oppe# bu e 6 N-A - <e - No ii1 9ain b#ea(e# in ta$$ed and $abe$ed6 N-A - <e - No iii1 Ea%h %i#%uit identi&ied and $abe$ed6 N-A - <e - No e* Transformers i1 5#! t!pe in ta$$ed6 &* 1lectrical and Controls i* Pane$ devi%e $abe$ed and )i#in" ta""ed pe# d#a)in" 6 ii* I-O devi%e $abe$ed and )i#in" ta""ed pe# d#a)in" 6 iii* 5i"ita$ input and output ope#ationa$6 iv* A$$ e$e%t#i%a$ %onne%tion ti"ht6 v* P#ope# "#oundin" in ta$$ed &o# %omponent and unit6 vi* Sa&etie in p$a%e and ope#ab$e6 vii* Sen o# = t#an mitte# = "a"e = et%'= in ta$$ed6 viii* Sen o# %a$ib#ated : ee be$o)* 6 i;* Cont#o$ ! tem inte#$o%( hoo(ed up and &un%tiona$6 ;* A$$ %ont#o$ devi%e and )i#in" %omp$ete6 ;i* Su#"e p#ote%tion in ta$$ed6 ;ii* Li"htnin" p#ote%tion in ta$$ed6 "* Final i* ii* iii* iv* 5. a* b* c1 d1 e1 ' N-A - <e
<e <e <e

- No
- No - No - No

<e <e
<e

- No - No
- No

<e
<e

- No
- No

<e
<e

- No
- No

<e <e

- No - No

Sta#tup #epo#t: * %omp$eted )ith thi %he%($i t atta%hed6 <e - No Sa&etie and a&e ope#atin" #an"e &o# thi equipment have been #evie)ed and a%%epted6 <e - No
Room venti$ated p#ope#$!6 S! tem i #ead! &o# &un%tiona$ te tin"6 <e <e - No - No

2perational Chec&s
Associated prefunctional checklists are completed and accepted: 3uses are good: !*A * -es * !o -es * !o

5i %onne%t )it%h ope#ate mooth$! )ith &u$$ %onta%t6 Re i tan%e %he%(: * %omp$ete )ith #e u$t atta%hed6

<e <e

- No - No

Spe%i&ied point3to3point %he%( have been %omp$eted and do%umentation #e%o#d ubmitted &o# thi ! tem6 N-A - <e - No

Sensor and(or 0age Calibration

All field(installed temperature sensors, 4relative humidity sensors5, meters and gages on this piece of e/uipment shall be calibrated. Sensors installed in the unit at the factory with calibration certification provided need not be field calibrated. All test instruments have had a certified calibration within the last 67 months: -*!______.

PREFUNCTIONAL TEST CHECKLIST S-.TC/01%+, S-.TC/B2%+3S, P%#14 B2%+3S, M2T2+ C2#T+24 C1#T1+S, T+%#S52+M1+S +,-+. /01123+.3, OF 4 5675OCS75I8/7+,3+.7/01123+.'5OC

PREFUNCTIONAL TEST CHECKLIST Switchgear, Switchboards, Panel Boards, Motor Control Centers, Transformers (Swtchgr) - _________
Sensor*%age 8erification Table

Sen o# o# >a"e

Lo%ation OK :<-N*

Sen o# o# >a"e 8a$ue

?9S 8a$ue

In t#ument 9ea u#ed 8a$ue

Pa

:<-N*

The#momete#->a"e #eadin" @ #eadin" o& the pe#manent in t#ument on the equipment' ?9S @ bui$din" mana"ement ! tem' In t#ument @ te tin" in t#ument' All sensors/gages are calibrated within required tolerances
-- 1#3 25 S1CT.2#-PREFUNCTIONAL TEST CHECKLIST S-.TC/01%+, S-.TC/B2%+3S, P%#14 B2%+3S, M2T2+ C2#T+24 C1#T1+S, T+%#S52+M1+S +,-+. /01123+.34 OF 4 5675OCS75I8/7+,3+.7/01123+.'5OC

___ YES ___ NO