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TEST REPORT
IEC 6x xxx
Date of issue....................................:
Total number of pages.......................
CB Testing Laboratory...........:
Address.....................................:
Applicants name............................:
Address............................................:
Test specification:
Standard...........................................:
Test procedure..................................:
CB / CCA
N/A
IEC6xxxx_xY
Name of Originator
Master TRF......................................:
Dated
Copyright 2007 IEC System for Conformity Testing and Certification of Electrical Equipment
(IECEE), Geneva, Switzerland. All rights reserved.
This publication may be reproduced in whole or in part for non-commercial purposes as long as the IECEE is acknowledged as
copyright owner and source of the material. IECEE takes no responsibility for and will not assume liability for damages resulting from the
reader's interpretation of the reproduced material due to its placement and context.
If this Test Report Form is used by non-IECEE members, the IECEE/IEC logo and the reference to the CB
Scheme procedure shall be removed.
This report is not valid as a CB Test Report unless signed by an approved CB Testing Laboratory and
appended to a CB Test Certificate issued by an NCB in accordance with IECEE 02.
Test item description.....................:
Trade Mark.......................................:
Manufacturer....................................:
Model/Type reference.......................:
Ratings.............................................:
Page 2 of 12
Testing procedure and testing location:
CB Testing Laboratory:
Testing location/ address. :
Associated CB Test Laboratory:
Testing location/ address. :
Tested by (name + signature)......:
Approved by (+ signature)...........:
Testing procedure: TMP
Tested by (name + signature)......:
Approved by (+ signature)............:
Testing location/ address. :
Testing procedure: WMT
Tested by (name + signature)......:
Witnessed by (+ signature)...........:
Approved by (+ signature)...........:
Testing location/ address. :
Testing procedure: SMT
Tested by (name + signature)......:
Approved by (+ signature)............:
Supervised by (+ signature).........:
Testing location/ address. :
Testing procedure: RMT
Tested by (name + signature)......:
Approved by (+ signature)............:
Supervised by (+ signature).........:
Testing location/ address. :
Report No.
Page 3 of 12
Summary of testing:
Tests performed (name of test and test clause):
Testing location:
Report No.
Page 5 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
.............................................................................:
.............................................................................:
.............................................................................:
.............................................................................:
.............................................................................:
.............................................................................:
Result - Remark
Verdict
Page 6 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
Result - Remark
Verdict
TABLE:
.............................................................................:
.............................................................................:
supplementary information:
TABLE:
Comments
supplementary information:
TABLE:
.............................................................................:
.............................................................................:
.............................................................................:
.............................................................................:
supplementary information:
Page 7 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
Result - Remark
Verdict
TABLE:
result code
supplementary information:
TABLE:
.............................................................................:
.............................................................................:
Supplementary information:
Page 8 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
Result - Remark
Verdict
breakdown / flashover
(Yes/No)
TABLE:
supplementary information:
supplementary information:
surface tested
impact energy ( Nm )
comments
supplementary information:
I rated (A)
U (V)
supplementary information:
P (W)
I (mA)
Page 9 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
Result - Remark
Verdict
Up
(V)
cl (mm)
required dcr
(mm)
dcr
(mm)
supplementary information:
U r.m.s.
(V)
required di
(mm)
di
(mm)
supplementary information:
supplementary information:
impression diameter
(mm)
Page 10 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
Result - Remark
Verdict
column number
( I, II, or III)
applied torque ( Nm )
supplementary information:
operating
condition
rated voltage
(V)
test voltage
(V)
supplementary information:
National Differences for (country name)
.............................................................................:
.............................................................................:
.............................................................................:
.............................................................................:
.............................................................................:
temperature
(oC)
comments
Page 11 of 12
Report No.
IEC 6xxxx
Clause
Requirement + Test
.............................................................................:
Result - Remark
Verdict
Page 12 of 12
Report No.
Measurement /
testing
Range used
Calibration date