CRITERION TECHNOLOGY PRODUCT INFORMATION FORM GENERAL INFORMATION Date______________________ Company Name: ______________________________________________________ Company Address: ___________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Contacts: Compliance Engineer: _________________________________________ Phone: ________________ Email: ________________________ Design Engineer: _____________________________________________ Phone: ________________ Email: ________________________ TEST DESCRIPTION Debug _____ Formal (Initial) _____ Formal (Re-Verification) ______ MARKET INFORMATION (Check all that Apply) USA ____ Canada ____ European Union ____ Taiwan ____ Japan _____ New Zealand ___ Australia ___ Other ______________________________ PRODUCT INFORMATION Name __________________ Model Number __________ Serial ___________ Product Dimensions: _______________________ Weight: _______________ Product Power Source: Battery Type ________________ AC Supply Input Voltage Range(s) Phases _____________ Delta ___________ Wye ___________ Current ________________________________________________ Frequency ______________________________________________ Manufacturer ___________________________________________ Model Number ___________________________________________ Topology Linear _________ Switching Mode _________ Switching Frequency _________ Support Equipment (if used): CPU: Manufacturer ___________________________________________ Model No. ______________________________________________ Serial No. _____________________________________________ Monitor: Manufacturer ___________________________________________ Model No. ______________________________________________ Serial No. _____________________________________________ Keyboard: Manufacturer ___________________________________________ Model No. ______________________________________________ Serial No. _____________________________________________ Mouse: Manufacturer ___________________________________________ Model No. ______________________________________________ Serial No. _____________________________________________ I/O Cables - Manufacturer, P/N, Length : Serial Port ____________________________________________ Parallel Port __________________________________________ SCSI Port ______________________________________________ Other __________________________________________________ Operation Software: Name ___________________________ Version Number _____________ Operating Modes: (Please Include Cycle Time) ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Time necessary for EUT to be exercised and able to fully respond: _____________ seconds. Operation Pass/Fail Criteria: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Emissions Testing Test Type (Please check all that apply): Information Technology Equipment Class A ______ Class B ______ Oscillator/Clock Frequencies (MHz) _____________________ ________________________________________________________ Industrial, Scientific, Medical Equipment Class A ______ Class B ______ Oscillator/Clock Frequencies (MHz) _____________________ ________________________________________________________ Unintentional Radiator Class A ______ Class B ______ Oscillator/Clock Frequencies (MHz) _____________________ ________________________________________________________ Receiver Type (Regen., Superhet., Direct Conv., Homodyne) ____________________________________________ Local Oscillator Frequencies _____________________ Frequency Range __________________________________ Intentional Radiator Fundamental Frequency Range ____________________________ Local Oscillator Frequencies ___________________________ Power Output (to antenna) ______________________________ Integral Antenna (Yes/No) ______________________________ Modulation Type (AM, CM, Pulse, Spread Spectrum) _______ Control Circuits (Microprocessor/Microcontroller) ______ Oscillator/Clock Frequencies (MHz) _____________________ ____ IEC 61000-3-2, Harmonics Max Steady State Power Consumed by Product: ______ Watts ____ IEC 61000-3-3, Flicker Meter IMMUNITY TESTING Test Type (Please check all that apply): _____ EN 50082-1 -Electromagnetic Compatibility-Generic Immunity Standard, Part 1. Residential, Commercial, Light Industry _____ EN 50082-2 -Electromagnetic Compatibility-Generic Immunity Standard, Part 2.Industrial Environment _____ EN 55024 -Information Technology Equipment - Immunity Characteristics - Limits and Methods of Measurement Requirements _____ EN 60601-1-2 -Medical Electrical Equipment, Collateral Standard: EMC Requirements and Test _____ EN 61326 -Electrical Equipment for Measurement, Control and Laboratory Use -EMC Requirements EN 61000-4-2 (ESD) Number of Metallic test points touchable by equipment operator: ______________________________________________ Number of Non-Metallic test points touchable by equipment operator: ____________________________________ Is the product enclosure completely plastic? ___________ Is the product enclosure partly plastic? _______________ Are there any additional ESD voltages required for testing? If so, list herein: ___________________________ ________________________________________________________ EN 61000-4-4 (Electrical Fast Transients) How many interfacing cables are greater than 3 meter long? __________________________________________________ List each cable by name: _______________________________ ________________________________________________________ EN 61000-4-3 & ENV 50204 (Radiated Susceptibility Testing, 80 - 1000 MHz) What is the maximum time necessary for the product to respond? _______________________________________________ During normal operations, what parameter will be monitored to determine susceptibility of the product? __ ________________________________________________________ EN 61000-4-5 (Surge Testing on Power Lines) Optional: Are there any long interfacing cables to be tested? ________________________________________________ If so, how many? _______________________________________ Note: Cables must be tested at a length of 20 meters. EN 61000-4-6 (Conducted Disturbance Testing) How many interfacing cables are greater than 3 meter long? __________________________________________________ List each cable by name? _______________________________ EN 61000-4-8 (Magnetic Field Susceptibility Testing) Test is applicable to Hall Elements, Electrodynamic Microphones, Magnetic Field Sensors and CRT Monitors. Do any of these apply? _________________________________ EN 61000-4-11 (Voltage Sag and Interruptions) Comments: ______________________________________________