Test Configuration/Product Information Form

Official Product Name (as you want it to appear in the report and on the Declaration of Conformity):

Test Unit Model No.:
Test Unit Serial No.:
Product Description (include Manufacturer Product Literature Sheet if available): Attach file:

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What is the primary market for your product:
Medical Industrial Commercial Military
Other:

What type of approval do you want (check all that apply):
FCC (US EMC) CE (Europe EMC) EDA (US Medical) MIL-Spec (Military) CSA (Canada EMC) UL (Safety)
Other:

Enclosure Type:
Painted Metal All Plastic Combination of Metal and Plastic
Other:

Input Power Range:
Volts: Hz: Amps: Number of Phases:

Environmental Range of Operation:
to Temperature (min/max degrees Centigrade)
to Humidity (min/max % RH)

Software Programs Used (diagnostics, special, etc., list current revision):

How does the software exercise the device while testing:

Power Line Filters Used (list Manufacturer, Model and Part Number):

Power Supplies Used (list Manufacturer, Model, Part Number):

List ALL Crystal and/or Clock Frequencies used in the device under test:

List ALL cables (note: during testing ALL connectors/ports MUST be connected to a typical cable regardless if the port is active or not):

Cable Name	Connector Type	Shield Type	Shield Termination	Length (meters)

List ALL associated equipment and components (auxillary PCs, monitors, etc.):

Description	Manufacturer	Model #	Serial #	FCC ID #

Describe how the device will be monitored for proper operation, describe pass/fail conditions:

System Warm-Up Time:

Preferred testing sequence (such as ESD last and Emissions first):

System Start-Up Procedure:

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Are there any safety considerations for our employees to observe:

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Special comments or concerns:

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General notes for testing:

The EUT must be fully operating during testing. If there are different modes of operation each mode should be able to be activated for testing to determine the worst case for emissions testing.
If the EUT requires auxiliary equipment to be cabled to it but is not to be tested, the interconnecting cables need to be approximately 15 feet in length to reach to the shielded area. This length will provide attachment to auxiliary equipment from the EUT at the Emissions test position (from the underground pit area to the turntable) as well as during Immunity testing (from the test chamber to the control room area)
Power connection to the EUT from the test areas is supplied using a standard three prong plug (except for three phase equipment and other special arrangements.) The power cable must be adaptable to the tests required. If Immunity testing includes EN61000-4-6 (Conducted Immunity) the power cord and plug must be no longer than 12 inches. If testing includes EN61000-4-4 (Electric Fast Transients/Bursts) the power cable must be .5 meter or less.
I/O cables: It is required that all ports/connectors be occupied with a typical installation cable (type and length). It is recommended that all cables be properly terminated into an actual typical load device or a terminator simulator for testing. If the EUT is marketed with specific cables, those cables must be installed for the testing. If the manufacturer of the EUT does not specify cable length, it will be assumed that the cable could exceed 3 meters in length. Shielded cables are subject to direct injection of signals which require that the cable insulating jacket be removed so that an electrical connection can be made directly onto the shield.
If special utilities are required for the EUT to operate (compressed air, water, batteries for DC devices, etc.) please notify the Lab prior to your arrival.

Please include a sketch of the entire system configuration (including auxiliary equipment) that will be used for testing (include all cables and associated equipment):
Attach file:

The field below are required

First Name:

Last Name:

Company:

Daytime Phone:
( ) -
Email:

Local: 320.864.4444 | Fax: 320.864.6611 | Toll free: 1.888.286.6888