The document outlines a sales maintenance services form for performing insulation resistance tests, including essential client and circuit information. It collects details such as the test number, client information, circuit specifics, ambient conditions, and test results. The form is prepared by DCNC Sales & Service Corp and requires technician and client signatures.

1. 1SALES MAINTENANCE SERVICES AUTOMATION AUDIO/VISUAL INSTRUMENTATION&CONTROL SAFETY&SECURITY MEP WORKS
A.C. Cortes Ave., Cambaro, Mandaue City 6014, Cebu Philippines; Contact No.: 092 2953 9333 or 0928 613 6306; LL : 032 340 0805
Email add: dcncsalesservices@gmail.com
INSULATION RESISTANCE TEST DATA FORM
GENERAL INFORMATION:
Date:_____________ Test No.:________________
Client: ______________________________________ Ref. PO No.: __________________________________
Technician:______________________ Company:______________________ Circuit ID/Name:_____________
Circuit Information: __________________________________________________________________________
Phase Conductor Size:_____________________ Circuit Install Date/Age:_________________________
Neutral Conductor Size:_____________________ Conductor Rated Voltage:_______________________
Ground Conductor Size:_____________________ Circuit Length:________________________________
Wire/Cable : Conduit/Duct Size
Manufacturer:_____________________________ and Type:_____________________________
Wire/Cable Type:_________________________ Installation: ☐ Indoor ☐ Outdoor
Buried: ☐ Yes ☐ No
Wire Insulation Type:________________________ Concrete-Encased: ☐ Yes ☐ No
Wire Insulation Number and
Thickness:_____________________________ Type of Splices: ______________________________
Shielded: ☐ Yes ☐ No
Testing Conditions:
Ambient
Temperature:________________________ Meter Manufacturer:___________________________
Relative Humidity:_______________________ Meter Model:__________________________
Test Voltage (DC):_______________________ Meter Serial:__________________________
Wire Grounding
Time Prior to Test:_______________________
Were adjacent conductors (within same conduit/cable) grounded during test? ☐ Yes ☐ No

2. 2SALES MAINTENANCE SERVICES AUTOMATION AUDIO/VISUAL INSTRUMENTATION&CONTROL SAFETY&SECURITY MEP WORKS
A.C. Cortes Ave., Cambaro, Mandaue City 6014, Cebu Philippines; Contact No.: 092 2953 9333 or 0928 613 6306; LL : 032 340 0805
Email add: dcncsalesservices@gmail.com
Date:_____________ Circuit ID/Name:______________________ Test No.:_______________
Test Results: Where a circuit does not contain a neutral conductor, Test time of 60sec or 1-min @ 250VDC
Resistance in ☐ MΩ ☐ GΩ
SN Circuit no. / Description
Test Connection
L1-GND L2-GND L1 – L2 REMARKS
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Notes and Remarks (note any circumstances which may affect test results):
Client:
Noted by:
Prepared by:
DCNC Sales & Service
Corp. Technician
DCNC Sales & Service Corp
Supervisor
Client representative