Attachment_5-Assessment_Input_Template.pdf

Assessment Input US Army Corps of Engineers

Power Response Team Facility Information

1. Mission Number:

2. Facility and building use:

3. Address:

4. City:

5. State: 6. County:

7a. Latitude: 7b. Longitude:

8. Site Amperage (Amp): 9. Site Power (kW):

10. Site Voltage (V): 11. Site Phase:

12. Site POC:

13. Office Phone: 14. Cell Phone:

15. Fax:

Assessment - Assessor Information

16. Assessor Name:

17. Assessor Qualification:

18. Assessor State Qualification:

19. Assessor Qualification Date:

20. Assessment Completed Date Time:

Assessment - Facility Power Information

21. Calculated Load: 22. Voltage:

23. Output Phase: 24. Configuration:

25. Amperage (Amp):

Load Cable Information

26. Cable Size: 27. Cable runs per phase:

28. Neutral Runs: 29. Neutral Runs:

30. Total Cable Length (ft):

Ground Cable Information

31. Ground Cable Size: 32. Ground Cable Runs:

33. Bare Copper Length (ft): 34. Total Ground Rods:

ATTACHMENT 5 - Assessment Input Template

Assessment Input US Army Corps of Engineers

Power Response Team

On-Site Generator

Does this facility have an existing on-site backup generator?

Can an alternate generator be connected via this hookup?

Critical Load Data

37a. Latitude: 37b. Longitude:

38. Output Phase: 39. Configuration:

40. Calculated Load: 41. Voltage:

42. Amperage (Amp):

Assessment - Onsite Generator

43a. Latitude: 43b. Longitude:

44. Output Phase: 45. Configuration:

46. Calculated Load: 47. Voltage:

48. Fuel Type: 49. Fuel Capacity:

50. Amperage (Amp): 51. Meter Reading (hrs):

Remarks

52. Generator Remarks:

53. Directions/Remarks:

Assigned Date

Tasking Received by Action Officer Date Time:

Date and Time tasking received by Mission Manager:

Date and Time tasking passed to the 249th:

Inspection Team:

ATTACHMENT 5 - Assessment Input Template