Automatic Transfer Switch
Automatic Transfer Switch
Automatic Transfer Switch
Campus Facilities
University of Missouri-Columbia 117 General Services Building
Columbia, MO 65211-3200
PROJECT:
PHONE (573) 882-1133
FAX (573) 882-1175
Date:
Date:
Building:
Location:
Submittal / Approvals
Submittal. The above equipment and systems integral to them are complete and ready for functional
testing. The checklist items are complete and have been checked off only by parties having direct
knowledge of the event, as marked below, respective to each responsible contractor. This construction
checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed.
A Statement of Correction will be submitted upon completion of any outstanding areas. None of the
outstanding items preclude safe and reliable functional tests being performed. ___ List attached.
Construction checklist items are to be completed as part of startup & initial checkout, preparatory to
performing test procedures.
• This checklist does not take the place of the manufacturer’s recommended checkout and startup
procedures or report.
• If this form is not used for documenting, one of similar rigor shall be used.
• Contractors assigned responsibility for sections of the checklist shall be responsible to see that
checklist items by their subcontractors are completed and checked off.
Approvals. This filled-out checklist has been reviewed. Its completion is approved with the exceptions
noted below.
Panel Information
Panel Tag Panel Location
System / Equip 208-120 or 480-277 Normal or Emergency
Manufacturer Model Number
Serial Number Short Circuit Capacity
Volts/Phase Rating Amperage Rating
Service Area
Comments:
Associated Checklists
Emergency Generator Panels Other
Comments:
Comments:
Operational Checks
Check if Acceptable; Provide comment if unacceptable NA Comment
Specified sequences of operation and operating schedules have been
provided with all variations documented
Specified point-to-point checks have been completed and
documentation record submitted for this system
Sensor or Actuator Tag Location 1st Gage or Instrument Final Gage or Pass
& Location OK BAS Value Measured Value BAS Value Y/N
Comments: