Copyright © 2019 Eaton Corporation. All Rights Reserved.
IPN March 2019
159
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 161). Or
email: DCInfo@eaton.com
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: _______________
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