SAFETY QUESTIONNAIRE QMF17v Issue 01
Contents
1. Any safety critical components present If YES please provide details Sea 5d Can you provide user manual instructions Y N Se Are there any other guides for the EUT Y N Details please provide a copy Is the equipment mains powered If YES is the power supply power adapter transformer previously approved Please provide details Ooo O 6a Is the unit one single product Y N 6b Is this the most complex configuration Y N 6c If No to above please give details 7a In what position is the equipment most likely to be used eg bench floor etc fs 7b What is the equipment environmental specification eg temp range humidity range etc 7c Are there any health and safety risks associated with the equipment Please Detail 8 Equipment weight and dimensions Height e mm Width m Depth m 9 Power Requirements Rated Voltage Range V Rated Power W Rated Frequency Hz Current A Phase Note For testing Conducted Emissions on customer premises the EUT will require a non RCD supply 10a List of ports and the maximum permissible lead length Including AC DC power port s Lead Length m Cable Type Page 3 of 3 QMF17vlssue01 17 Nov 10 SAFETY QUESTIONNAIRE QMF17v issue 01 ead Length m Cable Type 10b What 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 prote2. Page 1 of 3 QMF17vlssue01 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 anurag RNelectronics com www RNelectronics com Please use Questionnaire Notes QMF17v 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 Contact Company Address Post Code Tel No E mail Order No Quality Manager Q M E mail EUT Name Model No Please ensure EUT is uniquely identified If serial number is unavailable at this time please provide before test Main function operation of equipment Specific Use Country Of Origin Manufacturer Is support equipment required 4b If YES will you supply Y N How many modes of operation does the unit have Please Describe each mode ad 2 O Page 2 of 3 QMF17vlssue01 17 Nov 10 Ee oS O ASEOS O 5a Is the product IP rated Y N 5b If YES what is the IP rating 5c
3. ction fitted to the supply or any signal ports please detail below Cd 12a Please detail the Safety standard amp 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 PO O 12b would like advice about the most applicable standard s on test confirmation e If you require a different company 13 name and address on the test report please enter it here 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 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
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