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General Information
EUT Information
EMC
Safety
Telecom

HL price proposal*:

HL sales representative*:

1.1. CLIENT INFORMATION

Responsible*

First name:	Last name:	Phone:	Mobile:	Email:

Representative

First name:	Last name:	Phone:	Mobile:	Email:

1.2. ESTIMATED TESTS START DATES

EMC:		Radio:
Product Safety:		Environmental:
Telecom:

1.3. DESCRIPTION OF EQUIPMENT UNDER TEST

Short Description*:

Manufacturer*:

Test item(s)*:

Model*:

Trademark:

EUT condition:

EUT Classification:

Software release:

Hardware version:

Serial number:

Dimensions (mm):

H
W
D

Weight (kg):

2.2. EUT OPERATING MODES

#	Operating mode description	Configuration
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2.3. POWER SUPPLY

Power Supply type

Voltage (V)

Current (A)/ Power (W)

Frequency (Hz)

MIN
RATED
MAX

MIN
RATED
MAX

MIN
RATED
MAX

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2.4. PORTS AND LINES

Port type	Port description	Connected		Quantity	Cable type	Cable length, m	Location
Port type	Port description	From	To	Quantity	Cable type	Cable length, m	Location
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3.1. Operating frequencies

Source	Frequency, MHz
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3.2. EMC MODULES AND SUB-ASSEMBLIES

Description	Manufacturer	Model or P/N	Hardware rev.	Serial number	Slot
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3.3. SUPPORT AND TEST EQUIPMENT

Description	Manufacturer	Model number	Serial number
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3.4. PERFORMANCE/ACCEPTANCE CRITERIA / Essential Performance (EMC Immunity tests)

3.5. TEST CONFIGURATION

Note: An input/output unit of a system that feeds data into and/or receives data from the central processing unit of a personal computer, connected either internal or external and intended for use within residential environment (class B), deems personal computer peripheral device and must be tested in minimum configuration consisting of the EUT, personal computer, keyboard, mouse, monitor, serial and parallel port terminations and relevant terminations/ simulators for other PC ports, all the mentioned devices must be placed within a test site.

(file up to 5 MB)

The following documentation is to be provided prior to safety investigation initiation

	Document	Remarks
	Factory details	Name and address of all manufacturing locations, contact details
	Installation and operating instructions	Instructions shall specify temperature range, supply voltages, indoor or outdoor installation, IP rating (if applicable), special safety requirements, etc.
	Schematics and block diagram	Block diagram (for complicated systems), schematics of safety critical parts (AC power distribution, ac/dc and dc/dc power supplies, battery charge and protection circuits, TNV circuits, SELV interfaces showing power limiting components)
	Parts list/ Bill of materials	Safety critical components should be identified on that list. For these components, the list should include rating, manufacturer, model number and UL/CSA/other file number, where applicable.
	Data sheets for safety critical components	Examples of safety critical components: appliance inlet, batteries, circuit breaker, fuse holder, fan, indicator, interlock, laser, mains connector, motor, motor capacitor, main switch, optocoupler, overvoltage protector, plugs/terminals, power supply, power cord (set), fuse, PCB material, plastic covers, plastic large components, RFI capacitor/choke/filter, safety interlock, solid state relay, thermal protector, terminal block, transformer, voltage selector, power wires, etc (other components will be decided on case-to-case basis), motherboard, monitor, external connectors.
	Rating/marking plate/label example
	Mechanical drawings/equivalent specifications	Only when required for the project. Information should be provided about: dimensions, vents size and location, fans size and location. Rack mechanical drawings are required.
	PCB layouts of all layers	Only when required for the project.
	Description of all hazard sources other than electrical	Only when required for the project. Including but not limited to mechanical hazard, laser, light, UV, acoustic noise and the like
	Risk analysis, software validation, biocompatibility, sterilization	Only when required for the project. Always required for medical devices.
	System in a full load mode
	Fuses rating and fans speed information