Large Breaker Survey Form

Name (required)

Company (required)

Company Address (required)

City (required)

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Telephone (required)

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Facility Name

Facility Location (required)

Panel #

Panel Location:

Building Name:

Fig. A) Center Column: Raised or flush with panel front?
raisedflush

Fig. B) Distance from center line to handle in the off position?

Fig C) Distance from edge of breaker to handle in off position?

Fig D) Distance between breaker center lines?

Fig E) Distance between breaker and raised center column?

Fig. F) Distance between breaker and edge of panel?

Fig G) If rail will be installed "outside" the breaker column, what is the distance from the rail location to the breaker handle in the off position (closer is better)?

Fig H) Distance between surface of breaker and the surface of the panel?

Fig I) Number of breakers on the left?

Fig J) Number of breakers on the right?