COMPONENT DATA SHEET INFORMATION / UEL File #: / Date:
Company: / Product / Model

Please fill in the following form and provide it with the sample prior to testing. The information shown here will be used as part of the test report and to assist in determining test requirement applicability.

Components to be listed are parts where a failure of such component or part may cause a safety related hazard, such as fire, electrical shock, explosion and so forth. The first column provides the various categories to help identify what components or parts are considered "safety critical". Insert additional lines or delete column categories as necessary.

ELECTRICAL COMPONENT INFORMATION

Unique Component Reference or Location / Application / Function / Manufacturer / Type / Model / Technical Info – temperature ratings, volts, current, AWG, etc. / Recognitions
(UL, CSA, VDE, TUV, etc.) / Datasheet enclosed
Fuse F1 / arrestors / etc.
Fuseholder
Varistors / Arrestors / etc.
Lasers / LEDs
Internal / external wiring
heat-shrink/sleeves
Enclosures / covers / Doors / Gaskets / seals
Opto-isolators
Relays
AC filters, X/Y capacitors
Connectors, screw terminals, jacks
Plugs
Battery Pack / Cell
Switches
Motors / fans / blowers
Plastics, enclosure or decorative parts
PCB or PWB information
Transformers T1, T2, etc.
Ethernet Transformer T3
Diodes / rectifiers / bridging resistors
On/off switches, components
Power supplies, AC adapter, etc.

BATTERY CHARGING CIRCUIT COMPONENT LIST:

Charging IC
Reverse Polarity diode
Current limit resistor
Management IC
  • USE ADDITIONAL SHEETS IF NECESSARY, INSERT ADDITIONAL LINES OR ATTACH SEPARATE DOCUMENTS.

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SAFETY CHECKLIST FOR CE MARK, UL OR CSA LISTING, QPS OR CB SCHEME)Date: ______

This checklist is for documentation and paperwork for EUT safety approvals, and should be followed as closely as possible to avoid delays in obtaining the required safety marks and/or CE mark.

Place a check beside each of the items as applicable. Include the documents where applicable.

Electrical Ratings: / Voltage Range: / Current Rating:
Frequency (or DC): / Power (W or VA):
Approved Power Supply?
(Very Important) / Yes – Datasheet enclosed
Yes – CB report enclosed
Schematics and BOM:
(Required) / Schematics Provided
BOM Provided
Manual provided? / Users Service Installation
Label and Markings / Actual label is on sample
Photograph or drawing attached / Approved Label material? / Yes - Datasheet Enclosed
Construction Review: / Rated for outdoor use?
IP Rating:
Wall-Mountable
Rack-mountable
Lifting / carrying handles
Weight: / On-board battery
Type: (i.e. lithium)
Has Antenna/RF Port
Has Telecom/Ethernet Ports

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