MD ANDERSON Project No.

XX-XXXX MD ANDERSON PROJECT NAME

A/E Name Issue Description
A/E Project No. Mont! ""! """"
SECTION 26 08 13 ELECTRICAL SYSTEMS PREFUNCTIONAL CHECKLISTS AND START-UPS
PART 1 - GENERAL
".# RE$ATED DOC%MENTS
A. Dra&in's an( 'enera) pro*isions o+ te Contract! inc)u(in' ,enera) Con(itions an( Di*ision
"# Speci+ication Sections! app)- to tis Section.
.. Speci+ications trou'out a)) Di*isions o+ te Project Manua) are (irect)- app)ica/)e to tis
Section! an( tis Section is (irect)- app)ica/)e to tem.
".0 S%MMAR1
A. Tis Section e2pan(s on an( (e+ines responsi/i)ities o+ te Contractor re'ar(in'
Pre+unctiona) Cec3)ists an( start-up portions o+ te Commissionin' process an( a((resses
*a)i(ation o+ proper an( torou' insta))ation o+ mecanica)! p)um/in' an( +ire protection
s-stems.
.. Contractor sa)) o*ersee te Commissionin' acti*ities &it te Contractor4s Su/contractors
an( te Arcitect/En'ineer 5A/E6.
C. Contractor sa)) comp)ete)- insta))! torou')- inspect! start-up! test! a(just an( inte'rate
E)ectrica) Testin' A'enc- 5ETA6 on s-stems an( e7uipment. A)) acti*ities sa)) /e
(ocumente( on speci+ic! proce(ura) +orms (e*e)ope( +or tat purpose. Contractor sa))
noti+- A/E an( O&ner in &ritin' tat s-stems are comp)ete an( rea(- +or *eri+ication an(
8unctiona) Per+ormance Tests.
D. Comp)ete( Pre+unctiona) Cec3)ists +or a)) pieces o+ e7uipment sa)) /e su/mitte( to te
O&ner prior to 8unctiona) Per+ormance testin'.
E. Responsi/i)ities o+ te *arious parties in*o)*e( in te Commissionin' process are (e+ine( in
Section 09 ": "".
8. Re+er to Attacments A! .! C! an( D at te en( o+ tis Section +or e2amp)e +orms tat
in(icate )e*e) o+ (ocumentation re7uire( +or te Commissionin' process.
".; RE8ERENCE STANDARDS
A. Te )atest pu/)ise( e(ition o+ a re+erence sa)) /e app)ica/)e to tis Project un)ess i(enti+ie(
/- a speci+ic e(ition (ate.
.. A)) re+erence amen(ments a(opte( prior to te e++ecti*e (ate o+ tis Contract sa)) /e
app)ica/)e to tis Project.
C. A)) materia)s! insta))ation an( &or3mansip sa)) comp)- &it a)) app)ica/)e re7uirements an(
stan(ar(s.
".< S%.MITTA$S
A. Pre+unctiona) Cec3)ists! Pre+unctiona) Tests! an( Start-up (ocuments are te norma)
proce(ure o+ ensurin' tat te mecanica)! p)um/in'! an( +ire protection s-stem components
are proper)- insta))e(.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? # O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
.. Te Su/contractor in cooperation &it te A/E an( Contractor sa)) (e*e)op Pre+unctiona)
Cec3)ists an( Pre+unctiona) Tests (urin' te Construction Pase.
C. Comp)eteness o+ Pre+unctiona) Cec3)ists@ Tis Section summariAes te minimum stan(ar(
+or s-stems an( e7uipment cec3out. A recor( o+ testin' an( ac3no&)e('ement tat a
proce(ure as /een comp)ete( an( tat it cec3s out accepta/)- must /e inc)u(e( in te
Pre+unctiona) Cec3)ists. Te Pre+unctiona) Cec3)ist sa)) i(enti+- in co)umnar +ormat eac
(e*ice! )ocation! test meto(! contro) se7uence o+ operation re+erence! (e*ice co(e
reporte(! an( oter (ata as appropriate.
D. E7uipment Data Documentation@ Pro*i(e comp)ete(! as-insta))e(! speci+ic pro(uct
namep)ate (ata! pro(uct num/ers! seria) num/ers! etc. to +u))- (e+ine te asset +or O&ner4s
use in maintenance mana'ement an( asset trac3in'. Tis (ata ma- /e incorporate( &itin
te E7uipment Matri2 as (escri/e( in Di*ision "# as a sprea(seet +ormat or e)ectronic
(ata/ase. In a((ition to speci+ic manu+acturer4s name an( speci+ic pro(uct i(enti+iers suc
as mo(e) num/er! seria) num/ers! (ate o+ manu+acture! etc! te +o))o&in' in+ormation sa))
/e inc)u(e( &it te e7uipment (ata (ocumentation@
#. Capacit- (ata@ Bere app)ica/)e! use e7uipment sce(u)es on te Dra&in's as a
'ui(e)ine +or +ie)(s to /e use(.
0. $ocation i(enti+ier +ie)( +or eac o+ te tree (imensions 58)oor $e*e)! X a2is! an( 1 a2is6
usin' te Dra&in' co)umn 'ri(s as te /asis +or )ocation.
E. Su/mit te e7uipment (ata (ocumentation &it te (ra+t Pre+unctiona) Cec3)ists to te
O&ner +or appro*a). A/E an( O&ner &i)) re*ie& te Pre+unctiona) Cec3)ists an( re7uest an-
a((itiona) in+ormation re7uire( to meet te Commissionin' P)an criteria.
8. Britten Certi+ication@ Te Contractor sa)) certi+- tat te insta))ation! Start-up! Pre+unctiona)
Cec3)ist! an( initia) operation o+ te s-stem or component is in accor(ance &it te
Contract Documents! Commissionin' P)an! an( manu+acturer4s re7uirements! an( tat te
s-stem is rea(- +or 8unctiona) Per+ormance Tests. An- outstan(in' items or non-
con+ormance sa)) /e c)ear)- in(icate( an( i')i'te( on te Pre+unctiona) Cec3)ist an( an
action item sa)) a*e /een initiate(. Re+er to Di*ision "# +or speci+ic (etai)s on non-
con+ormance issues re)atin' to Pre+unctiona) Cec3)ists.
,. Re+er to Section 09 ": "" +or a((itiona) (ocumentation re7uirements.
PART 2 - PRODUCTS
".# ,ENERA$
A. A)) materia)s sa)) meet or e2cee( a)) app)ica/)e re+erence( stan(ar(s! +e(era)! state an(
)oca) re7uirements! an( con+orm to co(es an( or(inances o+ autorities a*in' juris(iction.
.. Te Pre+unctiona) Cec3)ist proce(ures (escri/e( in tis Section pro*i(e minimum
'ui(e)ines +or (e*e)opment o+ Pre+unctiona) Cec3)istsC Start-up proce(ures! an(
Pre+unctiona) Tests. Contractor sa)) prepare te Pre+unctiona) Cec3)ists usin' tese
proce(ures an( tat o+ te manu+acturer4s an(/or app)ica/)e co(es an( stan(ar(s.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? 0 O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
C. Te Pre+unctiona) Cec3)ist +orm sa)) ac3no&)e('e tat insta))ation an( Start-up proce(ures
&ere success+u))- a(ere( to an( comp)ete)- per+orme( an( sa)) (ocument re)e*ant
parameters 5pane) an( e7uipment connections! measure( *a)ues! 'roun( +au)ts! trip settin's!
etc.6. Ben in(icate( as per+ormin' a cec3out on mu)tip)e items or mu)tip)e proce(ure
items! Pre+unctiona) Cec3)ist +orms sa)) itemiAe eac in(i*i(ua) item.
".0 TEST ED%IPMENT
A. Re+er to Section 09 ": "" E E)ectrica) S-stems Commissionin'.
PART 3 - EXECUTION
".# PRE8%NCTIONA$ C=EC>$IST PROCED%RES
FE(it te +o))o&in' as appropriate +or te Project@G
A. Termo'rapic Scannin'@
#. Contractor sa)) pro*i(e termo'rapic scannin' on a)) s&itc'ear an( (istri/ution
/oar(s. In 'enera)! te termo'rapic scannin' sa)) /e ma(e &en te e7uipment is ener'iAe( an( is
operatin' at its norma) capacit-. It is inten(e( tat te scan /e ma(e a+ter te e7uipment as /een in +u))
operationC o&e*er! te Contractor near te comp)etion o+ te Project &i)) (etermine te e2act time o+
con(uctin' te scan. Some scannin' +or occupant-create( )oa( sa)) /e per+orme( (urin' te Barrant-
Perio( as a De+erre( Test.
0. Test e7uipment! misce))aneous too)s! an( materia)s sa)) /e transporte( proper)-! mo*e(!
an( set up /- traine( personne). E7uipment use( in testin' sa)) /e capa/)e o+ per+ormin' a))
recommen(e( proce(ures re7uire( /- te apparatus an( re)ate( e7uipment. A)) test e7uipment sa))
a*e certi+ication o+ ca)i/ration an( /e in &or3in' or(er.
;. A)) ot spots sa)) /e mar3e(! i(enti+ie(! an( an in+rare( termo'rapic scannin' report
prepare( an( +urnise( to te O&ner.
<. Te report sa)) contain in+rare( potos o+ trou/)e spots &it temperature rea(in's.
H. Te Contractor sa)) prompt)- report a)) sources o+ eatin' pro/)ems to te O&ner +or
correcti*e action.
.. ,roun(in' S-stems@
#. Per+orm tree-point +a))-o+-potentia) test per Institute o+ E)ectrica) an( E)ectronics
En'ineers 5IEEE6 Stan(ar( :# on te main 'roun(in' e)ectro(e or s-stem. Resistance sa)) /e no
'reater tan H oms.
0. Per+orm te t&o-point meto( test per IEEE Stan(ar( :# to (etermine te 'roun(
resistance /et&een te main 'roun( s-stem an( a)) major e)ectrica) e7uipment +rames! s-stem neutra)!
an(/or (eri*e( neutra) points. Resistance sa)) /e no 'reater tan H oms.
C. AC Motors E ,enera) Across S-stems@
#. Ieri+- proper a)i'nment! insta))ation! an( rotation.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? ; O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
0. Measure te insu)ation resistance! pase /a)ance! an( resistance to 'roun(. Tis
measurement &i)) 'enera))- /e te responsi/i)it- o+ te e)ectrica) Su/contractor &o is connectin' te
motor. Correction o+ an- (e+iciencies &i)) /e te responsi/i)it- o+ te motor supp)ier. Bere te
e)ectrica) Su/contractor &ires to a sin')e point o+ a pac3a'e( (e*ice tat is sippe( &it mu)tip)e motors!
e)ectrica) Su/contractor sa)) cec3 a)) motors in te pac3a'e.
;. Ieri+- tat proper)- siAe( o*er)oa(s are in p)ace.
<. Measure *o)ta'e a*ai)a/)e to a)) pases at time o+ initia) connection an( a'ain a+ter
motor as /een p)ace( in operation un(er )oa( measure amps an( RPM.
H. Recor( a)) motor namep)ate (ata.
D. =i' Io)ta'e Primar- Ser*ice 8ee(ers@
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect un(er'roun( (uct /an3s.
/. Inspect ca/)e an( per+orm +ie)( testin' on ree)s.
c. Inspect sp)icin' an( terminations.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ E2pose( ca/)e!
compression t-pe terminations! sp)ices &ere appro*e( /- te En'ineer an( te
O&ner! an( +ire proo+in' in mano)es! ca/)e *au)ts! etc.
/. Correct co)or co(e i(enti+ication an( pasin' arran'ements.
c. Per+orm sie)( continuit- test.
(. Per+orm insu)ation resistance test on ne& an( e2istin' ca/)es.
e. Per+orm i' potentia) test on ne& ca/)es on)-.
E. =i' Io)ta'e Primar- Disconnect an( ,roun(in' S&itces@
#. ,enera)@ Pro*i(e te ser*ices o+ a +actor--traine( manu+acturer4s representati*e to
assist te Contractor in te insta))ation an( start-up ser*ice o+ te e7uipment an( to train O&nerJs
personne) as speci+ie(.
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect incomin' po&er ca/)e terminations.
/. Inspect trans+ormer connections.
c. Inspect 'roun(in'.
(. Inspect e)ectrica) inter)oc3 &irin'.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? < O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ ancorin'! 'roun(in'!
oi) )e*e)! tor7ue o+ /us an( ca/)e connections! an( mecanica) operation o+ s&itc
an( operatin' mecanisms.
/. Per+orm contact resistance test.
c. Con(uct an( re*ie& oi) samp)e tests.
(. Per+orm insu)ation resistance tests on s&itc an( contro) &irin'.
e. Per+orm e)ectrica) an( mecanica) 53e-6 inter)oc3 s-stem operations.
8. =i' Io)ta'e Trans+ormer@
#. Pro*i(e te ser*ices o+ a +actor--traine( manu+acturer4s representati*e to assist te
Contractor in te insta))ation an( start-up ser*ice o+ te e7uipment an( to train O&nerJs personne) as
speci+ie(.
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect primar- an( secon(ar- po&er connections.
/. Inspect contro) interconnections.
c. Inspect 'roun(in'.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ *i/ration iso)ation!
ancorin'! 'roun(in'! insta))ation *eri+ication usin' manu+acturer4s cec3)ist! +)e2i/)e
/us connections! tor7ue o+ /us an( ca/)e connections! an( tap can'er operation.
/. Ieri+- operation o+ temperature contro)s/a)arms.
c. Per+orm &in(in' insu)ation tests.
(. Con(uct turns ratio test.
e. Per+orm po&er +actor/(issipation test on &in(in's an( /usin's.
+. Per+orm i' *o)ta'e an( )o& *o)ta'e &in(in' an( core resistance measurements.
'. Cec3 an( con+irm percenta'e o+ impe(ance is i(entica) +or a)) tree trans+ormers
comparin' namep)ates.
,. 9""I Net&or3 Protectors/<:"I Secon(ar- Distri/ution@
#. Pro*i(e te ser*ices o+ a +actor--traine( manu+acturer4s representati*e to assist te
Contractor in te insta))ation an( start-up ser*ice o+ te e7uipment an( to train O&nerJs personne) as
speci+ie(.
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect trans+ormer connections.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? H O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
/. Inspect 9""I (isconnect connections.
c. Inspect 'roun(in'.
(. Ia)i(ate protector e)ement insta))ation 5+urnise( )oose6.
e. Ieri+- contro) interconnections.
+. Cec3 ca)i/ration/settin' o+ protecti*e (e*ices +rom s-stem coor(ination stu(-.
'. Ieri+- ca)i/ration/settin' o+ (i'ita) meterin'.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ ancorin'! 'roun(in'!
tor7ue o+ /us/ca/)e connections! operationa) cec3 o+ (ra&out mecanism!
manua)/e)ectrica) trip/c)ose operations! contact c)osure usin' s)o& c)osin' meto(!
arc cute inspection! an( insta))ation *eri+ication usin' manu+acturerJs cec3)ist.
/. Correct current trans+ormer ratios.
c. Con(uct contact resistance test.
(. Per+orm operationa)/+unctiona) tests o+ protecti*e re)a-in'.
e. Per+orm operationa)/+unctiona) tests o+ (i'ita) meterin'.
+. Per+orm e)ectrica) an( mecanica) 53e-6 inter)oc3 s-stem operationa) tests.
'. Con(uct operationa) *o)ta'e testin' &it )ine *o)ta'e +rom trans+ormer on)- an(/or
source +ee(er /rea3er open.
=. 9""I Disconnect S&itces/<:"I Secon(ar- Distri/ution@
#. Pro*i(e te ser*ices o+ a +actor--traine( manu+acturer4s representati*e to assist te
Contractor in te insta))ation an( Start-up ser*ice o+ te e7uipment an( to train O&nerJs personne) as
speci+ie(.
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect protector an( /us(uct connections.
/. Inspect 'roun(in'.
c. Ieri+- contro) interconnections.
(. Cec3 insta))ation o+ &arnin' namep)ates.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ ancorin'! 'roun(in'!
tor7ue o+ /us/ca/)e connections! an( mecanica) operation o+ s&itc an( operatin'
mecanisms.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? 9 O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
/. Con(uct insu)ation resistance tests on s&itc an( contro) &irin'.
c. Con(uct contact resistance test.
I. 9""I Ser*ice S&itc'ear/<:"I Secon(ar- Distri/ution@
#. Pro*i(e te ser*ices o+ a +actor--traine( manu+acturer4s representati*e to assist te
Contractor in te insta))ation an( Start-up ser*ice o+ te e7uipment +or a perio( o+ tree 5;6 &or3in' (a-s
in tree 5;6 *isits an( to train O&nerJs personne) as speci+ie(.
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect connections to main /rea3ers.
/. Inspect 'roun(in'.
c. Inspect +ee(er connections to /us&a-s an( ca/)es.
(. Inspect insta))ation o+ main! tie an( +ee(er /rea3er e)ements.
e. Inspect contro) an( a)arm interconnections.
+. Cec3 ca)i/ration/settin' o+ trip (e*ices usin' s-stem coor(ination stu(-.
'. Ieri+- ca)i/ration/settin' o+ (i'ita) meterin'.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ ancorin'! 'roun(in'!
tor7ue o+ +ee(er an( incomin' /us (uct connections! +ee(er ca/)e an( inte'ra) main
/us connections! s&itc'ear section a)i'nments! e)ectrica) c)earances! mecanica)
operation o+ /rea3er/+use (ra&out e)ements an( operatin' mecanisms! manua) trip
+unction! main /us sa+et- sutters! an( insta))ation *eri+ication usin' manu+acturerJs
cec3)ist.
/. Cec3 current an( potentia) instrument trans+ormer ratios.
c. Con(uct insu)ation resistance an( o*er potentia) tests on eac t-pe o+ eac
/rea3er e)ement contacts! s&itc'ear contro) &irin'! /rea3er e)ement contro) &irin'
an( eac /us section.
(. Con(uct resistance test trou' s&itc'ear /us joints.
e. Con(uct current test usin' primar- or secon(ar- current injection.
+. Con(uct pasin' test on trip)e-en(e( s&itc'ear.
'. Con(uct contact resistance test on eac t-pe /rea3er e)ement.
. Con(uct 'roun( resistance test.
i. Con(uct operationa)/+unctiona) tests o+ protecti*e re)a-in'. Time-current tests
sa)) /e con(ucte( an( trip points sa)) /e set per Arcitect/En'ineer4s (irection.
j. Con(uct operationa)/+unctiona) tests o+ (i'ita) meterin'.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? ? O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
3. Per+orm e)ectrica) an( mecanica) 53e-6 inter)oc3 s-stem operationa) tests on
'enerator an( ser*ice s&itc'ear.
J. 9""I 8ee(er an( Su/+ee(ers/<:"I Secon(ar- Distri/ution@
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect ca/)e terminations.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ )ar'e junction an( pu))
/o2es! supports o+ race&a-s an( ca/)e /us! an( compression t-pe terminations.
/. Correct i(enti+ication an( pasin' arran'ements.
c. Con(uct continuit- test o+ eac +ee(er.
(. Con(uct insu)ation resistance test o+ eac +ee(er.
>. 9""I Motor Contro) Centers / <:"I Secon(ar- Distri/ution
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect ca/)e terminations.
/. Cec3 insta))ation an( settin' o+ o*er)oa( re)a-s.
c. Inspect contro) interconnections.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ ancorin'! 'roun(in'!
tor7ue o+ +ee(er an( incomin' connections! e)ectrica) c)earances! starter an( +ee(er
unit (ra&out mecanisms! an( cec3 insta))ation usin' manu+acturerJs cec3)ist.
/. Per+orm test o+ o*er)oa( re)a-s +or eac siAe starter usin' primar- current injection
meto(s.
c. Con(uct operationa) tests o+ starters trou' )oca)/remote contro)s.
(. Con(uct insu)ation resistance test on MCC /usin'! eac t-pe motor starter unit
5e2cept +or *aria/)e +re7uenc- (ri*es6! an( eac contro) circuit.
e. Con(uct contact resistance an( insu)ation resistance test o+ mo)(e( case main
an( +ee(er circuit /rea3ers.
$. Distri/ution Trans+ormers/<:"I Secon(ar- Distri/ution@
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect &irin' connections.
/. Insure taps are a(juste(.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? : O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
c. Inspect 'roun(in'.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ mountin'! 'roun(in'!
e)ectrica) c)earances! an( > +actor an(/or iso)atin' trans+ormers are insta))e( &ere
re7uire(.
/. Per+orm insu)ation resistance! turns ratios! an( po)arit- tests on eac t-pe /siAe o+
trans+ormer.
M. Distri/ution an( .ranc Circuit Pane)/oar(s/<:"I Secon(ar- Distri/ution@
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect &irin' connections.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ mountin'! separate
'roun( an( neutra) connections per circuit! comp)ete( circuit (irectories! e)ectrica)
c)earances! >AIC ratin's o+ pane)/oar( an( /rea3ers.
/. Correct sur'e suppression (e*ices insta))e(.
c. Re*ie& current rea(in's +or eac pane)/oar( to ensure )oa(s are /a)ance(.
(. Con(uct insu)ation resistance tests.
N. 9""I .ranc Circuits/<:"/0":/#0"I Secon(ar- Distri/ution@
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect &irin' connections.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ )ar'e junction an( pu))
/o2es! supports o+ race&a-s! an( compression t-pe terminations.
/. Correct i(enti+ication an( pasin' arran'ements.
c. Per+orm ran(om continuit- test o+ an- /ranc circuit.
(. Receptac)e Po)arit- Test@ Test e*er- receptac)e insta))e( or reconnecte( un(er tis
Contract &it a receptac)e circuit tester. Tester sa)) test +or open 'roun(! re*erse
po)arit-! open ot! open neutra)! ot an( 'roun( re*erse(! ot or neutra) an( ot
open. Re&ire receptac)es &it +au)ts an( retest.
e. ,roun(-8au)t Receptac)e Circuit Interrupter Tests@
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MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? K O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
#6 Test eac receptac)e or /ranc circuit /rea3er a*in' 'roun(-+au)t circuit
protection to assure tat te 'roun(-+au)t circuit interrupter &i)) not operate &en
su/jecte( to a 'roun(-+au)t current o+ )ess tan < mi))iamperes an( &i)) operate
&en su/jecte( to a 'roun(-+au)t current e2cee(in' 9 mi))iamperes.
06 Per+orm testin' usin' an instrument speci+ica))- (esi'ne( an( manu+acture(
+or testin' 'roun(-+au)t circuit interrupters. LTESTL /utton operation &i)) not /e
accepta/)e as a su/stitute +or tis test.
;6 Rep)ace receptac)es tat (o not suto++ po&er &it H/#""" o+ an ampere
&itin #/<"t o+ a secon( an( retest. Su/mit test report si'ne( /- Test En'ineer
&o per+orme( tis test.
O. $i'tin' 8i2tures an( $i'tin' Contro)s / 0?? / #0"I $i'tin'@
#. Pro*i(e te ser*ices o+ a +actor--traine( manu+acturer4s representati*e to assist te
Contractor in te insta))ation an( Start-up ser*ice o+ te )i'tin' contro) s-stem an( train O&nerJs
personne) as speci+ie( /e)o&. Representati*e &i)) con+irm te proper insta))ation an( operation o+ a))
s-stem components.
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Ensure a)) )a/e)in' is a++i2e( an( accurate.
/. Ieri+- 7uantit-! t-pe an( )ocation o+ +i2tures.
c. Ieri+- t-pe an( )ocation o+ s&itces.
(. Ensure a)) terminations are ti't.
e. Cec3 sensor p)acement is a(e7uate +or re7uire( (ut-.
+. Ensure a(e7uate access is pro*i(e( to a)) pane)s an( tat (ocumentation o+ tat
pane) is pro*i(e( in it.
'. Ensure a)) circuits +or te )oa(s are ener'iAe( an( rea(- +or testin'.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Test! ca)i/rate! an( set a)) (i'ita) an( ana)o' sensin'! an( actuatin' (e*ices.
#6 Ca)i/rate eac instrumentation (e*ice /- ma3in' a comparison /et&een te
'rapic (isp)a- an( te rea(in' at te (e*ice! usin' an instrument tracea/)e to
te Nationa) .ureau o+ Stan(ar(s! &ic sa)) /e at )east t&ice as accurate as
te (e*ice to /e ca)i/rate( 5e.'.! i+ +ie)( (e*ice is M/-".H percent accurate! test
e7uipment sa)) /e M/-".0H percent accurate o*er same ran'e6.
06 Recor( te measure( *a)ue an( (isp)a-e( *a)ue +or eac (e*ice in te
Pre+unctiona) Cec3)ist.
;6 Cec3 eac (i'ita) contro) point /- ma3in' a comparison /et&een te
contro) comman( at te contro) pane) an( te status o+ te contro))e( (e*ice.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? #" O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
<6 Cec3 eac (i'ita) input point /- ma3in' a comparison o+ te state o+ te
sensin' (e*ice an( te OI (isp)a-.
H6 Recor( te resu)ts +or eac (e*ice in te .ui)(in' Automation S-stem Start-
up cec3)ist.
/. Ieri+- operation o+ )i'tin' contro)s 5(immin'! poto-contro)! re'u)ar s&itcin'6.
c. Cec3 )oa(s on a)) /rea3ers to ensure tat te /rea3er is proper)- siAe(.
(. Enter a)) sce(u)es per occupant4s (irection.
e. 8or Operator Inter+aces@ Ieri+- a)) e)ements on te 'rapics are +unctiona) an(
proper)- /oun( to p-sica) (e*ices an(/or *irtua) points an( tat ot )in3s or pa'e
jumps are +unctiona) an( )o'ica).
+. Output a)) speci+ie( reports +or re*ie& an( appro*a).
'. Ieri+- te a)arm printin' an( )o''in' is +unctiona) an( per re7uirements.
. Ia)i(ate a)) inter+aces &it oter s-stems on a point /- point /asis.
P. $i'tnin' Protection S-stem@
#. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Inspect &irin' connections.
0. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Iisua))- an( mecanica))- inspect to inc)u(e te +o))o&in'@ air termina) mountin's!
/on(in' connections o+ roo+ mounte( =IAC e7uipment! (o&n )ea(s routin'/roo+
penetrations! an( 'roun(in'.
/. Re*ie& %$ test certi+ication.
c. Cec3 +or receipt o+ %$ master )a/e).
D. 8ire A)arm E7uipment / 8ire A)arm an( Detection S-stem@
#. Pro*i(e te ser*ices o+ a 7ua)i+ie( +ire a)arm specia)ist to super*ise te insta))ation!
ma3e a(justments! an( per+orm tests on te +ire a)arm s-stem an( to train O&nerJs personne).
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up.
a. Ensure a)) )a/e)in' is a++i2e( an( accurate.
/. Ensure a)) terminations are ti't.
c. Ensure a(e7uate access is pro*i(e( to a)) pane)s an( tat (ocumentation o+ tat
pane) is pro*i(e( in te pane).
(. Re*ie& tat a)) +ire a)arm (e*ices as so&n on te construction Dra&in's an(
Sop Dra&in's are insta))e(.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? ## O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
e. Re*ie& ei't an( )ocations o+ pu)) stations an( *isua) a)arms to comp)- &it ADA.
+. Re*ie& tat smo3e an( (uct (etectors are insta))e( accor(in' to N8PA K"A.
'. Cec3 tat +ire a)arm s-stem contro) pane) is c)ear &it no trou/)e or 'roun( +au)ts.
. Sprin3)er +)o& an( tamper s&itces a*e /een a(juste(.
i. Cec3 &ire super*ision on a)) (e*ices.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Cec3 )ocation o+ a)) sensors an( s&itces to ensure con+ormance &it
re7uirements.
/. Cause acti*ation o+ a)) (e*ice! assure a)arms are initiate( an( resu)tin' response
is per te re7uirements.
c. Ieri+- inter+aces &it a)) oter inter-re)ate( s-stems or e7uipment inc)u(in'
/ui)(in' automation s-stem 5.AS6! soun( s-stems! securit- s-stems! =IAC
s-stems! *ertica) (e)i*er- s-stems! etc. on a point /- point /asis +or a)) points
(. Ia)i(ate a)) output (e*ices 5spea3ers an( stro/es6 meet te co(e criteria 5K9 (.a
at #" +eet an( ##? can(e)a at pea36.
e. Acti*ate i' temperature (etectors in te e)e*ator macine room. Ieri+- a))
se7uences inc)u(in' e)e*ator sunt o++! e)e*ator reca)) inc)u(in' a)ternate +)oors
&en main +)oor is in a)arm.
+. Acti*ate a)) sprin3)er +)o& s&itces. Ia)i(ate tat appropriate Aone enunciates an(
a)arms soun(.
'. Ieri+- au(io aspects o+ te s-stem +unction as re7uire(. Ieri+- pa'in' messa'es
can /e ear( trou'out te /ui)(in'.
. 8or annunciator pane)s! *a)i(ate correct 'rapic an( correct i(enti+ication o+ a))
Aones. Test te action an( inter)oc3s o+ a)) o*erri(e s&itces as appropriate
i. 8or Operator Inter+aces@
#6 Ieri+- a)) e)ements on te 'rapics are +unctiona) an( proper)- /oun( to
p-sica) (e*ices an(/or *irtua) points an( tat ot )in3s or pa'e jumps are
+unctiona) an( )o'ica).
06 Output a)) speci+ie( reports +or re*ie& an( appro*a).
;6 Ieri+- te a)arm printin' an( )o''in' is +unctiona) an( per re7uirements.
j. Ia)i(ate a)) inter+aces &it oter s-stems on a point /- point /asis.
R. ,roun(in'/.ui)(in' ,roun(in' S-stem@
#. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? #0 O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
a. Con(uct +a)) o+ potentia) 'roun( resistance tests per IEEE Stan(ar( :# at eac test
&e)) an( at ser*ice e7uipment.
/. Con(uct insu)ation resistance! sort circuit! an( 'roun( tests o+ eac motor.
S. %ninterrupti/)e Po&er S-stems 5%PS6@
#. Pro*i(e te ser*ices o+ a manu+acturer certi+ie( specia)ist to super*ise te insta))ation!
ma3e a(justments! an( per+orm tests on te %PS an( to train O&nerJs personne).
T. Automatic Trans+er S&itces@
#. Pro*i(e te ser*ices o+ a manu+acturer certi+ie( specia)ist to super*ise te insta))ation!
ma3e a(justments! an( per+orm tests on te automatic trans+er s&itces an( to train O&nerJs personne).
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Iisua))- inspect te s-stems.
/. Ensure te terminations are ti't an( a)) anci))ar- e7uipment comp)ete)- insta))e(.
c. Ensure a)) o*er)oa(s are in p)ace.
(. Measure contact resistance.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Ener'iAe S&itc.
/. Cec3 positi*e inter)oc3 /et&een s-stems.
c. Set/Ca)i/rate Io)ta'e sensin' re)a-! trans+er time (e)a-s 5in /ot (irections6! an(
s-ncroniAation re)a-s.
(. Measure insu)ation resistance an( resistance to 'roun(.
e. Cec3 manua) /-pass operation.
%. Emer'enc- Po&er En'ine ,enerators an( Distri/ution S-stems@
#. Pro*i(e te ser*ices o+ a manu+acturer certi+ie( specia)ist to super*ise te insta))ation!
ma3e a(justments! an( per+orm tests on te en'ine 'enerators an( emer'enc- po&er s&itc'ear an( to
train O&nerJs personne).
0. Start-up cec3)ists@ Per+orm te +o))o&in' +ina) cec3s /e+ore Start-up@
a. Iisua))- inspect te s-stems.
/. Ensure te terminations are ti't on po&er an( contro) &irin'.
c. Ieri+- a)) anci))ar- e7uipment comp)ete)- insta))e(.
(. Ensure a)) o*er)oa(s are in p)ace.
e. Ieri+- tat 'enerator is set in p)ace.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? #; O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
+. Ieri+- +ue) connections.
'. Ieri+- ra(iator connections.
. Ieri+- /atter- connection.
i. Ieri+- e2aust connections.
j. Ieri+- /)oc3 or oi) eater connection.
3. Cec3 an( recor( en'ine oi) )e*e)! ra(iator &ater )e*e)! an( /atter- e)ectro)-te
)e*e).
). Pipin' S-stem Tests@ Comp)ete s-stem test in accor(ance &it te respecti*e
section.
m. Inspect te insta))ation an( access/c)earance +or ser*ice an( maintenance to
ensure it meets te Project an( manu+acturer4s re7uirements.
n. Cec3 )u/ricatin' oi) +or )u/ricate(-t-pe e7uipment.
o. Cec3 +or proper seismic restraints.
p. Cec3 tat sa+et- *a)*es a*e correct settin'C 'reater tan compressor (iscar'e
pressure! /ut not 'reater tan pressure ratin' o+ s-stem components.
7. Cec3 tat a)) operatin' contro)s are set +or initia) sa+e operation.
;. Startin' Proce(ures@ 8o))o& te manu+acturerJs &ritten proce(ures an( te +o))o&in' as
a minimum@
a. Test 'enerator at H"! ?H! #""! #0H percent )oa( capacit- usin' )oa( /an3s at #""
percent po&er +actor.
/. Run )oa( test at a)) )oa(s e2cept #0H percent +or ;" minutes recor(in' en'ine an(
a)ternator rea(in's at te start! at #H minutes an( at ;" minutes. #0H percent )oa( to
/e run +or #H minutes recor(in' rea(in's at te start an( en( o+ test.
c. Simu)ate operation o+ a)) 'enerator sa+eties suc as i' oi) pressure! )o& oi)
pressure! i' temperature! o*er spee(! etc. O/ser*e +unction o+ sa+eties un(er
actua) ma)+unction situation.
(. Cec3 +or e2cessi*e *i/ration an( noise.
".0 ACCEPTANCE CRITERIA
A. Acceptance criteria +or tests are in(icate( in te Speci+ication Sections app)ica/)e to te
s-stems /ein' teste(. %n)ess in(icate( oter&ise! acceptance criteria &i)) /e speci+ie( &it
te in(i*i(ua) s-stem! e7uipment! component! or (e*ice.
".; TRAININ,
A. Trainin' re7uirements are speci+ie( in Di*ision "# Speci+ications an( in Section 09 ": "" -
E)ectrica) S-stems Commissionin'.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? #< O8 <
MD ANDERSON Project No. XX-XXXX MD ANDERSON PROJECT NAME
A/E Name Issue Description
A/E Project No. Mont! ""! """"
END OF SECTION 26 08 13
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
E$ECTRICA$ S1STEMS PRE8%NCTIONA$ C=EC>$ISTS AND
START-%PS
09 ": #;
MS#0#:"? #H O8 <
REQUEST FOR START-UP/FUNCTIONAL PERFORMANCE TEST
5Cec3 app)ica/)e re7uest /e)o&6
Re7uest +or Initia) Startup NNNNNN Re7uest +or O&ner4s Demonstration NNNNNN
P!"#$%@ NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN P!"#$% O@NNNNNNNNNNNNNNNNNNNNN
Identification of Equipment or System: NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
$ocation o+ E7uipment or S-stem@ NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Speci+ication Section@ NNNNNNNNNNNNNNNNNNNN Detai)/Dra&in' Num/er@ NNNNNNNNNNNNNNN
Manu+acturer / Supp)ier@ NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
This Date: NNNNNNNNNNNNNNNNNN Inspection Requested for (Date): NNNNNNNNNNNNNNNNNN

CONTRACTOR&S CERTIFICATION OF PERFORMANCE'

I hereby certify that the above described equipment or system, has been energized, operated, adjusted,
and balanced in accordance with the requirements of the Contract Documents and the manufacturer's
recommendations for a sufficient period to confirm that operation complies in all respects with the
Contract Requirements
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN
!rinted "ame Date
I()%*++,(- S./$!(%*$%!'
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN
!rinted "ame Date
M*(.0*$%.#&) R#1#)#(%*%,2#' I hereby certify that I have been personally and actively involved
with energizing, operational chec#out, adjustments, and balancing of the above described equipment or
system$ and that such has been accomplished in accordance with the manufacturer's recommendations
and is operating correctly
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN
%ignature & 'anufacturer's Representative !rinted "ame Date
((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
((
CONFIRMATION ! COMMENTS 0!3 MD ANDERSON'
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
N
Resu)ts o+ Test Accepta/)eP NNNN1ES NNNNNO Re-Test Re7uire(P NNNN1ES NNNNNO
Punc $ist@ NNNNAttace( NNNNTo 8o))o& NNNNN/A
S-stem Accepta/)e +or L%ser Trainin'LP NNNN1es NNNNNo
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN
%ignature)s* + 'D ,"D-R%." +/acility 'anager !rinted "ame)s* + 'D ,"D-R%." Date
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN
%ignature)s* + 'D ,"D-R%." + !roject 'anager !rinted "ame)s* + 'D ,"D-R%."
Date
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QAR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; A
MS"#"#"? # O8 #
EXAMPLE - PREFUNCTIONAL CHECKLIST
S4,%$5-#*6 P*(#+/!*7)6 M!%! C!(%!+ C#(%#)6 T*()0!3#)
P!"#$%@ NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN P!"#$%
O@NNNNNNNNNNNNNNNNNNNNN
Identification of Equipment or System:
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
$ocation o+ E7uipment or S-stem@
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Speci+ication Section@ NNNNNNNNNNNNNNNNNNNN Detai)/Dra&in' Num/er@ NNNNNNNNNNNNNNN
Manu+acturer / Supp)ier@
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
This Date: NNNNNNNNNNNNNNNNNN Inspection Requested for (Date): NNNNNNNNNNNNNNNNNN

Pre+unctiona) Cec3)ist Num/er@ NNNNNNNNNNNNNNNNNN

Components Inc)u(e(@ NNNNDisconnects NNNN8uses NNNNMeters NNNNOter
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Associate( Pre+unctiona) Cec3)ists@NNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNN
#. ,enera)@
a. Te a/o*e s-stems an( components inte'ra) to tis e7uipment are comp)ete an( rea(- +or
8unctiona) Per+ormance Tests. Te Pre+unctiona) Cec3)ist items are comp)ete an( a*e
/een cec3e( o++ on)- /- parties a*in' (irect 3no&)e('e o+ te e*ent ! as in(icte( /e)o&!
respecti*e to eac responsi/)e contractor. Tis Pre+unctiona) Cec3)ist is su/mitte( +or
appro*a) an( is su/ject to te attace( )ist o+ outstan(in' items not comp)ete( success+u))-.
Su/mit a De+icienc- 8orm upon comp)etion o+ an- outstan(in' or (e+icient items. None o+
te outstan(in' items prec)u(e sa+e an( re)ia/)e +unctiona) tests /ein' per+orme(.
/. NNN De+icienc- 8orm attace(.
c. Tis Pre+unctiona) Cec3)ist (oes not ta3e te p)ace o+ te manu+acturer4s recommen(e(
cec3out an( Start-up proce(ures or report.
(. Contractors assi'ne( responsi/i)it- +or sections o+ te Pre+unctiona) Cec3)ist sa)) /e
responsi/)e to ensure tat teir su/contractors comp)ete an( cec3 o++ teir Cec3)ist items.
e. Pre+unctiona) Cec3)ist items sa)) /e comp)ete( as part o+ Start-up an( initia) cec3out!
preparator- to +unctiona) testin'.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT Q.R TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; .
MS"#"#"? # O8 H
C!(%*$%!/E(%,%8 C!31*(8 A//#2,*%,!(
MD An(erson Sta++ MD ANDERSON
Arcitect/En'ineer A/E
,enera) Contractor / Construction
Mana'er
,C
Mecanica) Contractor MC
E)ectrica) Contractor EC
.ui)(in' Automation S-stem
Pro*i(er
.AS
Test! A(just! an( .a)ance 8irm TA.
Commissionin' Consu)tant CA
0. Re7ueste( Documentation Su/mitte(@
S1#$,0,#7 R#9.,#3#(% Y#) N! D*%# %! /#
S./3,%%#7
a6 Manu+acturer4s Pro(uct Data inc)u(in' Per+ormance Data an(
Sop Dra&in's! as appro*e( /- Arcitect/En'ineer
/6 Re7uire( Test Reports an(/or Certi+ications
c6 Insta))ation an( Start-up Manua) an( P)an
(6 Birin' Dia'rams! Contro) Scematics an( Se7uences
e6 Operatin' an( Maintenance Manua) Content +or App)ica/)e
S-stem
+6 E7uipment Matri2
;. E7uipment Ieri+ication@
I%#3 S1#$,0,#7 S./3,%%#7 I()%*++#7
Manu+acturer
Mo(e) Num/er
Seria) Num/er
Ser*ice
E7uipment Ratin' 5amps6
Io)ta'e/Pase
<. Insta))ation Cec3s@
*: U(,% *(7 G#(#*+ I()%*++*%,!( Y#) N! C!33#(%)
#. Permanent )a/e)s a++i2e(
0. P-sica) con(ition accepta/)e! no *isi/)e (ama'e! ca/inets
in p)ace
;. Proper)- mounte( on e7uipment pa( an( ancore(
<. Maintenance access accepta/)e
H. Interior c)ean an( (r-
9. Meter5s6 insta))e( per Contract Documents
?. Disconnects insta))e( an( )a/e)e(
:. Disconnects are pa( )oc3a/)e in open position
K. Circuit /rea3ers insta))e( an( )a/e)e(
#". 8uses insta))e(
##. Con(uits insta))e( an( connecte(
#0. Ca/)e/con(uit routin' (oes not o/struct access
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT Q.R TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
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09 ": #; .
MS"#"#"? 0 O8 H
*: U(,% *(7 G#(#*+ I()%*++*%,!( Y#) N! C!33#(%)
#;. E7uipment room proper)- *enti)ate(! air-con(itione(!
eate(! +ire/smo3e &a)) separate(! +ire/smo3e (ampere(!
+ire sprin3)ere(! +ire a)arme( an( i))uminate( 5norma)!
emer'enc- an( /atter- /ac3e(-up +i2tures6
#<. As-/ui)t (ra&in's up(ate(
/: S4,%$5-#* ;)#2,$# #(%*($# 1<00=>A *(7 */!2#: *(7
S4,%$5/!*7) ;)#2,$# #(%*($# +#)) %5*( 1<00 =>A:
Y#) N! C!33#(%)
#. 8ree stan(in' meta) enc)osure
0. Co//er /uses
;. Penetration to uti)it- ser*ice area an( e7uipment per co(e
$: D,)%,/.%,!( P*(#+/!*7) *(7 !%5# P*(#+/!*7) Y#) N! C!33#(%)
#. Tin p)ate( copper /uses
0. Eac circuit i(enti+ie( an( )a/e)e(
;. Space +or a((itiona) circuits e2ist
7: M!%! C!(%!+ C#(%#) Y#) N! C!33#(%)
#. Tin p)ate( copper /uses
0. Main /rea3ers insta))e( an( )a/e)e(
;. Eac circuit i(enti+ie( an( )a/e)e(
#: T*()0!3#) Y#) N! C!33#(%)
#. Dr- t-pe insta))e(
0. %nit proper)- )a/e)e( an( i(enti+ie(
0: E+#$%,$*+ *(7 C!(%!+) Y#) N! C!33#(%)
#. Pane) (e*ices )a/e)e( an( &irin' ta''e( per Contract
Documents
0. I/O (e*ices )a/e)e( an( &irin' ta''e( per Contract
Documents
;. Di'ita) inputs an( outputs operationa)
<. A)) e)ectrica) connections ti't
H. Proper 'roun(in' insta))e( +or te e)ectrica) s-stem!
e7uipment! components! an( unit
9. Sa+eties in p)ace an( opera/)e
?. Sensors! transmitters! 'a'es! etc.! insta))e(
:. Sensors ca)i/rate( 5see /e)o&6
K. Contro) s-stem inter)oc3s oo3e( up an( +unctiona)
#". A)) contro) (e*ices an( &irin' comp)ete
##. $i'tnin' protection insta))e(
#0. Sur'e protection insta))e(
-: F,(*+ Y#) N! C!33#(%)
#. Start-up report comp)ete( an( attace( &it tis
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT Q.R TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; .
MS"#"#"? ; O8 H
-: F,(*+ Y#) N! C!33#(%)
Pre+unctiona) Cec3)ist
0. Sa+eties an( sa+e operatin' ran'es +or tis e7uipment a*e
/een re*ie&e( an( accepte(
;. S-stem is rea(- +or 8unctiona) Per+ormance Test

H. Operationa) Cec3s@
a. Tese cec3s supp)ement te manu+acturer4s )ist. Tis is not te 8unctiona) Per+ormance
Test.
O1#*%,!(*+ C5#$=) Y#) N! C!33#(%)
#. Associate( Pre+unctiona) Cec3)ists are comp)ete an(
accepte(
0. 8uses are 'oo(
;. Resistance cec35s6 comp)ete &it resu)ts attace(
<. Disconnect s&itc operates smoot)- &it +u)) contact
H. Speci+ie( point-to-point cec3s a*e /een comp)ete( an(
(ocumentation recor( su/mitte( +or tis s-stem
9. Sensor an(/or Actuator Ca)i/ration@
a. A)) +ie)(-insta))e( temperature sensors! pressure sensors! meters! an( 'a'es! an( a))
actuators an( *a)*es on tis piece o+ e7uipment sa)) /e ca)i/rate(. Sensors insta))e( in te
unit at te +actor- &it ca)i/ration certi+ication pro*i(e( are not re7uire( to /e +ie)( ca)i/rate(.
/. A)) test instruments a*e a( a certi+ie( ca)i/ration &itin te )ast #0-monts@ 1 / N
c. Sensor/Actuator Ieri+ication Ta/)e
S#()! ! A$%.*%! C!#$%
L!$*%,!(
;Y/N:
;1:
T5#3!3#%# !
G*-# >*+.#
?AS >*+.#
;2:
I()%.3#(%
M#*).#7
>*+.# ;3:
P*)) ;Y/N:
#6 Termometer/,a'e rea(in' is te rea(in' o+ te permanent)- mounte( instrument on te
e7uipment.
06 .AS is te .ui)(in' Automation S-stem. Instrument S testin' instrument.
;6 A)) sensors are ca)i/rate( &itin re7uire( to)erances NNN 1ES NNN NO
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MD An(erson Cancer Center
ATTAC=MENT Q.R TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; .
MS"#"#"? < O8 H
FINAL SIGN-OFF
C!(%*$%!) *%%#)% %5*% %5# */!2# ,%#3) 5*2# /##( 2#,0,#7 *(7 3##% %5# #9.,#3#(%) !0 %5#
C!(%*$% D!$.3#(%) #@$#1% *) (!%#7 !( %5# *%%*$5#7 D#0,$,#($8 0!3A
,enera) Contractor@ Print Name@
Si'nature@
Tit)e@
Date@
E)ectrica) Su/contractor Print Name@
Si'nature@
Tit)e@
Date@
Oter Su/contractor@ Print Name@
Si'nature@
Tit)e@
Date@
P#0.($%,!(*+ C5#$=+,)% #$#,2#7 *(7 #2,#4#7 0! $!31+#%#(#)) /8 MD ANDERSON
#1#)#(%*%,2#)A F.($%,!(*+ P#0!3*($# T#)% $*( 1!$##7A
MD ANDERSON@ Print Name@
Si'nature@
Tit)e@
Date@
MD ANDERSON@ Print Name@
Si'nature@
Tit)e@
Date@
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT Q.R TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; .
MS"#"#"? H O8 H
EXAMPLE - PREFUNCTIONAL CHECKLIST
E3#-#($8 P!4# S8)%#3
P!"#$%@ NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN P!"#$%
O@NNNNNNNNNNNNNNNNNNNNN
Identification of Equipment or System:
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
$ocation o+ E7uipment or S-stem@
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Speci+ication Section@ NNNNNNNNNNNNNNNNNNNN Detai)/Dra&in' Num/er@ NNNNNNNNNNNNNNN
Manu+acturer / Supp)ier@
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
This Date: NNNNNNNNNNNNNNNNNN Inspection Requested for (Date): NNNNNNNNNNNNNNNNNN

PREFUNCTIONAL CHECKLIST NUM?ER' NNNNNNNNNNN

Components Inc)u(e(@
NNN Prime Mo*er! NNN ,enerator! NNN 8ue) S-stem! NNNCoo)in' S-stem! NNN.atter- S-stem!
NNN E2aust S-stem! NNN ATS! NNN %PS
Associate( Pre+unctiona) Cec3)ists@
NNNPipin'! NNN Pump! NNN E2aust 8an! NNNOterNNNNNNNNNNNNNNNN
#. ,enera)@
a. Te a/o*e s-stems an( components inte'ra) to tis e7uipment are comp)ete an( rea(- +or
8unctiona) Per+ormance Tests. Te Pre+unctiona) Cec3)ist items are comp)ete an( a*e
/een cec3e( o++ on)- /- parties a*in' (irect 3no&)e('e o+ te e*ent! as in(icte( /e)o&!
respecti*e to eac responsi/)e contractor. Tis Pre+unctiona) Cec3)ist is su/mitte( +or
appro*a) an( is su/ject to te attace( )ist o+ outstan(in' items not comp)ete( success+u))-.
Su/mit a De+icienc- 8orm upon comp)etion o+ an- outstan(in' or (e+icient items. None o+
te outstan(in' items prec)u(e sa+e an( re)ia/)e +unctiona) tests /ein' per+orme(.
/. NNN De+icienc- 8orm attace(.
c. Tis Pre+unctiona) Cec3)ist (oes not ta3e te p)ace o+ te manu+acturer4s recommen(e(
cec3out an( Start-up proce(ures or report.
(. Contractors assi'ne( responsi/i)it- +or sections o+ te Pre+unctiona) Cec3)ist sa)) /e
responsi/)e to ensure tat teir su/contractors comp)ete an( cec3 o++ teir Cec3)ist items.
e. Pre+unctiona) Cec3)ist items sa)) /e comp)ete( as part o+ start-up an( initia) cec3out!
preparator- to +unctiona) testin'.
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QCR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; C
MS"#"#"? # O8 9
Contractor/Entit- Compan- A//re*iation
MD An(erson Sta++ MD ANDERSON
Arcitect/En'ineer A/E
,enera) Contractor / Construction
Mana'er
,C
Mecanica) Contractor MC
E)ectrica) Contractor EC
.ui)(in' Automation S-stem
Pro*i(er
.AS
Test! A(just! an( .a)ance 8irm TA.
Commissionin' Consu)tant CA
0. Re7ueste( Documentation Su/mitte(@
Speci+ie( Re7uirement 1es No Date to /e
Su/mitte(
a6 Manu+acturer4s Pro(uct Data inc)u(in' Per+ormance Data an(
Sop Dra&in's! as appro*e( /- Arcitect/En'ineer
/6 Re7uire( Test Reports an(/or Certi+ications
c6 Insta))ation an( Start-up Manua) an( P)an
(6 Birin' Dia'rams! Contro) Scematics an( Se7uences
e6 Operatin' an( Maintenance Manua) Content +or App)ica/)e
S-stem
+6 E7uipment Matri2
;. E7uipment Ieri+ication@
Item Speci+ie( Su/mitte( Insta))e(
Manu+acturer
Mo(e) Num/er
Seria) Num/er
Ser*ice
SiAe/Ratin' 53B /
continuous or stan(/-6
8ue) T-pe
Io)ta'e/Pase
<. Insta))ation Cec3s@
a6 %nit an( ,enera) Insta))ation 1es No Comments
#. Permanent )a/e)s a++i2e(
0. P-sica) con(ition accepta/)e
;. Proper)- mounte( &it *i/ration iso)ators
<. 8actor- a)i'nment appears correct
H. 8ie)( a)i'nment comp)ete
9. Maintenance access accepta/)e
?. 8ue) pipin' an(/or prime mo*er e2aust s-stem are proper)-
supporte( 5in(epen(ent o+ prime mo*er an(/or 'enerator6
:. As-/ui)t (ra&in's up(ate(
K. E7uipment c)ean
#". E7uipment room proper)- *enti)ate(! air-con(itione(!
eate(! +ire/smo3e &a)) separate(! +ire/smo3e (ampere(!
+ire sprin3)ere(! +ire a)arme( an( i))uminate( 5norma)!
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QCR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; C
MS"#"#"? 0 O8 9
a6 %nit an( ,enera) Insta))ation 1es No Comments
emer'enc- an( /atter- /ac3e(-up +i2tures6
##. A)) e7uipment proper)- i(enti+ie( an( )a/e)e(
/6 Prime Mo*er 1es No Comments
#. %nit a/)e to run on (iese) +ue) or a com/ination o+ natura)
'as an( (iese) +ue)
0. Air c)eaner an( oi) +i)ter5s6 insta))e(
;. Ii/ration iso)ators acti*e
<. Proper oi) t-pe use(! &it )e*e) correct
H. E2aust (uct insta))e( &it proper insu)ation an(
si)encer/mu++)er
9. E2aust s-stem (iscar'es to outsi(e
?. Con(ensa/)es a/)e to /e remo*e( +rom e2aust s-stem an(
(iscar'e( proper)-
:. Com/ustion an(/or *enti)ation air )ou*ers insta))e( correct)-
K. Coo)in' &ater ra(iator (ucte( to in)et )ou*er

c6 ,enerator 1es No Comments
#. .earin's )u/ricate(
0. Rotor an( stator in proper con(ition
;. Io)ta'e re'u)ator insta))e(
<. Main /rea3er insta))e(! rate( at +u)) )oa( capacit-
H. Instrument pane) is mounte( on unit
9. Remote annunciator pane) insta))e(
?. ,enerator au2i)iar- pane) 5(e(icate( to 'enerator room
e7uipment/)i'tin'6 is insta))e(

(6 8ue) S-stem 1es No Comments
#. Pipin' Pre+unctiona) Cec3)ist comp)ete an( accepte(
0. Da- tan3 insta))e(! &it e)ectric pump! an( pump! an(
/-pass pipin'/*a)*es
;. A/o*e 'roun( +ue) tan3 insta))e(! &it pump5s6
<. Monitorin' s-stem insta))e(
H. MD ANDERSON En*ironmenta) re*ie&s comp)ete an(
accepte(
e6 .atter- Car'er an( .atteries 1es No Comments
#. .atteries insta))e( in a nonmeta))ic rac3 5&a)) mounte(6
a(jacent to te prime mo*er
0. .atter- e)ectro)-te )e*e) is correct
;. Automatic tric3)e /atter- car'er is insta))e( 5&a)) mounte(6
a(jacent to /atter- /an3
<. .atter- ca/)e connections are ti't! termina)s are c)ean
+6 Automatic Trans+er S&itc 1es No Comments
#. ATS rate( +or operation at te same output as te
emer'enc- 'enerator! capacit- is 'reater tan tota) s-stem
trans+erre( )oa(
0. Trans+erre( )oa(s i(enti+ie( at pane)! a'rees &it )iste( )oa(s
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QCR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; C
MS"#"#"? ; O8 9
+6 Automatic Trans+er S&itc 1es No Comments
;. ATS insta))ation is comp)ete
'6 E)ectrica) an( Contro)s 1es No Comments
#. Pane) (e*ices )a/e)e( an( &irin' ta''e( per Contract
Documents
0. %nit mounte( instrument pane) inc)u(es@
AC *o)tmeter
Ammeter
I-a se)ector s&itc
8re7uenc- meter
Runnin' time meter
Io)ta'e a(justin' reostat
E2citer o*er)oa( protection
Barnin' )i'ts an( a)arms
;. .atteries pro*i(e( &it e)ectronic sensin' (e*ice +or remote
noti+ication o+ /atter- con(itions
<. I/O (e*ices )a/e)e( an( &irin' ta''e( per Contract
Documents
H. Di'ita) inputs an( outputs operationa)
9. A)) e)ectrica) connections ti't
?. Proper 'roun(in' insta))e( +or te e)ectrica) s-stem!
e7uipment! components! an( unit
:. Sa+eties in p)ace an( opera/)e
K. Sensors! transmitters! 'a'es! etc.! insta))e(
#". Sensors ca)i/rate( 5see /e)o&6
##. Contro) s-stem inter)oc3s oo3e( up an( +unctiona)
#0. A)) contro) (e*ices an( &irin' comp)ete
#;. $i'tnin' protection insta))e(
6 8ina) 1es No Comments
#. Start-up report comp)ete( an( attace( &it tis
Pre+unctiona) Cec3)ist
0. $ist o+ items/s-stems ser*e( /- te emer'enc- po&er
s-stem is attace(
;. 8ue) tan35s6 +u))
<. Sa+eties an( sa+e operatin' ran'es +or tis e7uipment a*e
/een re*ie&e( an( accepte(
H. Se7uence o+ operation a(e7uate)- in(icates a)) in+ormation
9. S-stem is rea(- +or 8unctiona) Per+ormance Test
H. Operationa) Cec3s@
+. Tese cec3s supp)ement te manu+acturer4s )ist. Tis is not te 8unctiona) Per+ormance
Test.
Operationa) Cec3s 1es No Comments
#. Associate( Pre+unctiona) Cec3)ists are comp)ete an(
accepte(
0. ATS operates correct)-
;. Resistance cec35s6 comp)ete &it resu)ts attace(
<. 8ue) s-stem operates correct)-
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QCR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; C
MS"#"#"? < O8 9
Operationa) Cec3s 1es No Comments
H. I'nition an( /atter- s-stems operate correct)-
9. Coo)in' s-stem operates correct)-
?. Speci+ie( point-to-point cec3s a*e /een comp)ete( an(
(ocumentation recor( su/mitte( +or tis s-stem
9. Sensor an(/or Actuator Ca)i/ration@
'. A)) +ie)(-insta))e( temperature sensors! pressure sensors! meters! an( 'a'es! an( a))
actuators an( *a)*es on tis piece o+ e7uipment sa)) /e ca)i/rate(. Sensors insta))e( in te
unit at te +actor- &it ca)i/ration certi+ication pro*i(e( are not re7uire( to /e +ie)( ca)i/rate(.
. A)) test instruments a*e a( a certi+ie( ca)i/ration &itin te )ast #0-monts@ 1 / N
S#()!/A$%.*%! >#,0,$*%,!( T*/+#
Sensor or Actuator Correct
$ocation
51/N6
5#6
Termometer or
,a'e Ia)ue
.AS Ia)ue
506
Instrument
Measure(
Ia)ue 5;6
Pass 51/N6
#. Termometer/,a'e rea(in' is te rea(in' o+ te permanent)- mounte( instrument on te
e7uipment.
0. .AS is te .ui)(in' Automation S-stem. Instrument S testin' instrument.
;. A)) sensors are ca)i/rate( &itin re7uire( to)erances NNN 1ES NNN NO
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QCR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; C
MS"#"#"? H O8 9
FINA SI!N"#FF
C!(%*$%!) *%%#)% %5*% %5# */!2# ,%#3) 5*2# /##( 2#,0,#7 *(7 3##% %5# #9.,#3#(%) !0 %5#
C!(%*$% D!$.3#(%) #@$#1% *) (!%#7 !( %5# *%%*$5#7 D#0,$,#($8 0!3A
,enera) Contractor@ Print Name@
Si'nature@
Tit)e@
Date@
E)ectrica) Su/contractor Print Name@
Si'nature@
Tit)e@
Date@
Oter Su/contractor@ Print Name@
Si'nature@
Tit)e@
Date@
P#0.($%,!(*+ C5#$=+,)% #$#,2#7 *(7 #2,#4#7 0! $!31+#%#(#)) /8 MD ANDERSON
#1#)#(%*%,2#)A F.($%,!(*+ P#0!3*($# T#)% $*( 1!$##7A
MD ANDERSON@ Print Name@
Si'nature@
Tit)e@
Date@
MD ANDERSON@ Print Name@
Si'nature@
Tit)e@
Date@
Te %ni*ersit- o+ Te2as
MD An(erson Cancer Center
ATTAC=MENT QCR TO E$ECTRICA$ S1STEMS PRE8%NCTIONA$
C=EC>$ISTS AND START-%PS
09 ": #; C
MS"#"#"? 9 O8 9