Engineered Systems Proposal Request Form

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Engineered Systems Detailed Proposal Worksheet

This Worksheet covers the specific information required to design a New Monitoring Application or to make modifications to an Existing Monitoring Application. Please select the type (New or Existing) below for which you area requesting a proposal. Please complete a separate form for each location you want to monitor.

Please fill out the following form, including your personal information, to help us better serve you.

*Company:
*Name:
Title:
Address:
City/State/Zip:
*Phone:	*Fax:
*E-mail:
*Required

Monitoring Application

Other:

Briefly outline the specific components, use and requirements as you know them:

Location Information

Location Name:
Detector Info:	No. of Existing: No. of New: (if known)
Detector Model(s):	Use comma to separate multiple models.

Controller Conditions

Detector Conditions

Physical Location:

Indoor	Outdoor
Wall Mount	Rack Mount
Panel Mount

Controller Temperature (indicate F° or C°):

Minimum:

Maximum

Controller Humidity: RH

Condensing

Non-Condensing

Available Electrical at Controller:

Volts AC:

Volts DC:

Controller Hazard Rating:

Hazardous	Non Hazardous
Restricted Access

Explosion Rating:

	Division 1	Division 2
	Class I	Class II
	Group A	Group B
	Group C	Group D

Local Conditions At Controller:

Dust/Mists	Corrosives
Vibration	Splash/Washdown

Interferences:

Radio (RFI)

EMI

Controller Special Requirements:
Operate other equipment?
If Yes, What?

(ie. Fans, Alarms, Service or Proccess)

Replace Existing Equipment?
If Yes, where there problems we should try to work around?

Type of Alarm at Controller:

Visual	Audible
Alarm Delay
Relays Req.
Warn	Fault
Mid	High

Physical Location:

Indoor	Outdoor
Wall Mount	Duct Mount
Mount Equipment

Detector Temperature (indicate F° or C°):

Minimum:

Maximum

Detector Humidity: RH

Condensing

Non-Condensing

Available Electrical at Detector:

Volts AC:

Volts DC:

Detector Hazard Rating:

Hazardous	Non Hazardous
Restricted Access

Explosion Rating:

Division 1		Division 2
Class I		Class II
Group A		Group B
Group C		Group D

Local Conditions at Detector:

Dust/Mists	Corrosives
Vibration	Splash/Washdown

Interferences:

Radio (RFI)

EMI

Detector Special Requirements:
Operate other equipment?
If Yes, What?

(ie. Fans, Alarms, Service or Proccess)

Replace Existing Equipment?
If Yes, where there problems we should try to work around?

Type of Alarm at Detector:

Visual	Audible
Alarm Delay
Relays Req.
Warn	Fault
Mid	High

Options & Accessories:
Back-up Power	Repeater Display	Installation
Data Logging	Spare Parts	Calibration Kit
Training	Startup Service	Service Contract

If possible, fax a rough sketch (Applications Worksheet Grid) of the area noting dimensions and key components, such as machinery, major exits, stairs, pits, etc., and fax it to us at 810-774-2780; Attention: Fixed Systems Application Engineer for review and evaluation. You may also complete a less detailed form by going to Quick Start.

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