Equipment Malfunction Due to PQ Incident Form
Date of Incident
Time of Incident
Location / Department
Equipment Involved
Equipment Serial Number (if applicable)
Description of Malfunction
Type of PQ Incident
Voltage Sag/ Dip
Voltage Swell
Interruption
Voltage Flicker
Transient
Harmonic Distortion
Other
Details of PQ Incident
Actions Taken
Has the equipment been repaired or replaced?
Yes
No
N/A
Reported By
Additional Notes