Work Order #	Customer Name	Date

Sales Person & Territory

NAME PLATE DATA MUST BE COMPLETLY FILLED IN

Original MFG		HP / Size		Full Load Current
Speed (RPM)		Voltage		Serial Number
Date of Manufacturer

VISIBLE INSPECTION OF MOTOR (DONE PRIOR TO ANY TEAR DOWN) TAKE PICTURES

Items Sent With Motor:

NONE

Pump

Cable

Adapter

Bonnet

Bonnet Bolts

Skid

Pallet

Crate

Sensors

Mercury Sealing Cap

Re-Use	Yes	No
Replace	Yes	No

**MARK CREATE OR PALLET WITH CUSTOMERS NAME AND NUMBER**

COUPLING

Straight	Two PC	Motor Half	Pump Half
Coupling Key	Motor Side	None
Spiral Lock Ring	Coupling Pin	Alignment Jig & Bolts

Comments (Record All Observations Prior to Begining the T.I.R Process)

CONSTRUCTION TYPE:

Painted Standard:	Stainless Steel	Bronze	Other
Balance Tube or Fitting Damage	YES	NO	NONE
Motor Sealed on Arrival	YES	NO
Mercury Present	YES	YES	NONE
Mercury Seal Capped	YES	NO	NONE

*If Mercury is Present - Move to Mercury Pit for Tear Down

Are Part Missing:

YES

NO

Comments (Identify any Missing Parts)

Exterior Condition:

RUST

PITTING

Damage:

Dissassembled When Received:	YES	NO
Motor is Leaking:	YES	NO

Megger Reading with 500 Volt Tester:

Megger Reading with 1000 Volt Tester:

Power cable Sent With Motor:	YES	NO
Damage to Cable Sent:	YES	NO	N/A

*Discribe Any Damage to Cable:

Drop Cable:	YES	NO	SIZE:	Length:
Condition:	GOOD	BAD
Type of Motor Leads:	PLUG-IN	CONTINUOUS

Wire Size: AWG

Meg Test Leads:

YES

NO

Voltage Rating:

Passed:

YES

NO

Motor has Sensor:	YES	NO
Motor has Sensor Leads:	YES	NO
Sensor Lead Cable Condition:	GOOD	BAD
Single Sensor With 6 Wires:
Multi Sensor With 12 Wires:

Length of Sensor Cable: FT.

Sensors Readings in OHMS:

T1

T2

T3

T4

DIMENSIONAL DATA: TO BE RECORDED "PRIOR" TO ANY DISSASSEMBLY OF MOTOR MEASURE ALL DIAMETERS, SHAFT STICK UP'S AND ACCURATE RADINGS

Motor Register Size: IN.

End Float Clearance: IN.

Register Condition:

GOOD

BAD

Machined:

NO

Deteriorated:

Pitted

Shaft Height: IN.

With Button: IN.

Without Button: IN.

Continuous Lead Length or Pin Projection: IM./FT.

DISASSEMBLY OF MOTOR *TAKE PICTURE OF DISASSEMBLY AT EACH STEP

Seal Carrier Condition:

GOOD

BAD

REUSE

REPLACE

Material:

Stainless Steel

Bronze

Other:

Comments :

Pressure Test:

YES

NO

Results of Test:

Passed

Failed

*MAXIMUM PRESSURE 35 PSI FOR MECHANICAL SEALS - 5 PSI FOR LIP SEALS

Pressure:

Describe Where Air Leaks Were found :

Vent Plug Tight:	YES	NO
Received Drained:	YES	NO
Drain Plug Tight:	YES	NO
Balance Assy. Plugged:	YES	NO	N/A
Balance Tube & Fittings:	YES	NO	REUSE	REPLACE

Internal Fluid:	YES	NO	COLOR:	SMELL:
	YES	NO	COLOR:	SMELL:
	YES	NO	GALLONS:

DISASSEMBLY

Motor has Sand Slinger:	YES	NO	Slinger Material:
Slinger Tight:	YES	NO
Slinger Condition:	GOOD	BAD	REUSE:	REPLACE:
Motor Turns Freely:	YES	NO

DISASSEMBLY

Outer Seal Condition:	Good	Bad	Replace
Seal Type:	LIP	TYPE 1 OR 2	METAL BELLOWS	BURGAMAN

Comments on Seal :

Rubber Components:	Good	Bad
Spring Condition:	GOOD	BAD
Spring Length Compressed:	Uncompressed:

Rotating Face:	GOOD	BAD
(Mech. Seals Only)	GOOD	CRACKED	OXIDIZED	GROOVED	WORN
Stationary Face:	GOOD	BAD
Mech.Seal Condition:	GLAZED	CRACKED	OXIDIZED	GROOVED	WORN
Stationary Face Tight in Housing:	YES	NO

DISASSEMBLY

Inner Seal Condition:	Good	Bad	Replace
Seal Type:	LIP	TYPE 1 OR 2	METAL BELLOWS	BURGAMAN

Comments on Seal :

Rubber Components:	GOOD	BAD
Spring Condition:	GOOD	BAD
Rotating Face:	GOOD	BAD
(Mech. Seals Only)	GOOD	CRAKED	OXIDIZED	GROOVED	WORN
Stationary Face:	GOOD	BAD
Mech. Seal Condition:	GLAZED	CRACKED	OXIDIZED	GROOVED	WORN
Stationary Face Tight in Housing:	YES	NO

DISASSEMBLY

Internal Leads:
GOOD CONDITION:	YES	NO
RE-LEAD MOTOR:	YES	NO

DISASSEMBLY

Lower End of Motor:
Expansion Bag:	GOOD	BAD	NONE
Strainer / Filter Contents:	YES	NO
Chips	Grindings	Mercury	N/A

Comment:

Thrust Assembly:
Type:	PIVOT	SOLID	CLEAN	DIRTY	RUSTY
Shoe Material:	STEEL	HARDENED S/S	RUBBER
Shoe Condition:	SCRATCHED	GUALED	STAINED
Repairable/ Relap	YES	NO	REPLACE	DESTROYED

Lower End Housing Condition:

GOOD

BAD

SANDBLAST AND CLEAN

REPLACE

Driver Condition:

GOOD

STAINED

CRACKED

WORKED

HARDENED

SLIGHTLY WORN

WORN

SCRATCHED

RE-GRIND AND RE-USE

REPLACE

DESTROYED

Upthrust:

GOOD

STAINED

CRACKED

WORKED

HARDENED

SLIGHTLY WORN

WORN

SCRATCHED

RE-GRIND AND RE-USE

REPLACE

DESTROYED