Doc ID: Document1

Rev. 1.5, 12/22/08

PROJECT INFORMATION FORM

1Applicant (Client) information

Company: / Address:
City: / Country: / Postal code:
P.O. Box: / Tel.: / Fax:
Responsible: / Mobile: / E-mail:
Representative: / Mobile: / E-mail:

2Test and Certification requirements

Requirements: / Standards / Approvals/ marks / Target dates
EMC
Radio
Product Safety
Environmental
Telecom

3Description of equipment under test

Short description:
Manufacturer: / Test item(s): / Software release:
Model: / Trademark: / Hardware version:
EUT classification: / Please choose HouseholdIndustrialITELaboratory, measurement and controlMedicalMilitaryRadioTelecom (wired)Other / EUT condition: / Please chooseNewRevised modelPrototypeProduction model / Serial number:
Dimensions: / (H)mm / (W) mm / (D) mm / Weight: / kg

3.1EUT operating modes

Describe different operating modes and/or configurations applicable to product, such as different operating voltages/frequencies, heat/ cool/ fan modes, bit rates and hardware configurations, charger modes, etc.

# / Operating mode description / Configuration

3.2Power supply

Power supply / Voltage (V) / Current (A)/ Power (W) / Frequency (Hz)
type / Min / Nominal / Max / Min / Nominal / Max / Min / Nominal / Max
Please chooseMains powered (Single)Mains powered (3-phase Y)Mains powered (3-phase D)DC PoweredBattery powered (AAA)Battery powered (AA)Battery powered (Li)Battery powered (Ni-Me)Battery powered (Lead acid)Other

3.3Ports and lines

List all external ports except intended for debugging, initial adjustment and maintenance

Port type / Port description / Connected / Quantity / Cable type / Cable / Indoor /
From / To / length, m / outdoor
Please choosePowerSignalTelecomControl / Please chooseEthernetPSTNUSBRS-232RS-485ConsoleE1/T1E3/T3AntennaIFVideoAudio / Please chooseUnshieldedShieldedSTPUTPFTPFiber opticCoaxTwisted / IndoorOutdoor
Please choosePowerSignalTelecomControl / Please chooseEthernetPSTNUSBRS-232RS-485ConsoleE1/T1E3/T3AntennaIFVideoAudio / Please chooseUnshieldedShieldedSTPUTPFTPFiber opticCoaxTwisted / IndoorOutdoor

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Doc ID: Document1

Rev. 1.5, 12/22/08

PROJECT INFORMATION FORM

4EMC investigation

4.1Operating frequencies

List in the table below all the EUT internally generated or used frequencies, including radio and intermittent frequencies (RF and IF), local oscillator/s (LO), baseband, clocks, bus frequencies etc.

Source / Frequency, MHz
Please choose source typeLOClockTxRxInternal generator
Please choose source typeLOClockTxRxInternal generator

4.2EUT modules and sub-assemblies

In case your product includes removable modules/sub-assemblies please identify and describe briefly each of them (e.g. telecom interface cards installed inside a cage).

Description / Manufacturer / Model or P/N / Hardware rev. / Serial number / Slot

4.3Support and test equipment

List in the table below all support and test equipment to be used during the tests to provide and check the EUT proper operation.

Description / Manufacturer / Model number / Serial number

4.4Performance/ Acceptance criteria / Essential Performance (EMC Immunity tests)

Specify acceptance criteria which describe how the EUT performance and normal operation are monitored. For medical equipment please provide risk analysis with essential performance description and explain how the EUT performance and normal operation are monitored

4.5Test configuration

Draw block diagram of test setup including EUT, all simulators and loads. In the EMC tests the EUT shall be within the test site and auxiliary equipment shall be out of the test site, 12 meters cables required to interconnect them.

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.

Safety investigation

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

Document / Remarks
Installation and operating instructions / Instructions shall specify temperature range, supply voltages, etc.
Schematics and block diagram
Parts list/ Bill of materials / Safety critical components should be identified on that list. The list should include 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 / 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.
Risk analysis, software validation, biocompatibility / Only when required for the project. Always required for medical devices.
System in a full load mode
Fuses rating and fans speed information

Telecom investigation

1Wire interfaces

Analog two-wire (POTS) e.g. terminal equipment, central office equipment

E1/T1 Unframed, Framed, ISDN PRI

E3/T3

10/100/1000 Base-T ethernet

Other: ______

Contract requirements met / Tests finished / Report/ application finished / Project completed
Sign,Name
Date

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