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r(C'I� PEI/RP1200-17 EMERGENCY O• SWITCH 0 OPERATION Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #: Phone #: Testing Company: I Phone #: Date: This procedure is to verify the operation of all emergency stop switches/ buttons (Estops). Each E -stop must disconnect power to dis- pensers, submersible turbine pumps (STPs) and all non -intrinsically safe electrical equipment in classified areas. Test each Estop sepa- rately. See PEI/RP1200 Section 11 for the inspection procedure. Estop Number or ID Location 1. E -stops labeled and located ❑ Yes ❑ No []Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No where easily accessible? 2. System fully powered and in ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No normal operating condition? 3. After activating E -stop, power disconnected from: 3a. All dispensing devices ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No on all islands? 3b. All STPs for all fuel ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No grades? 3c. All power, control and signal circuits assoc iat- ❑ Yes 11No ElYes ElNo ElYes ElNo ElYes ElNo ❑ Yes ❑ No ElYes ElNo ed with the dispensing devices and the STPs? 3d. All other non -intrin- sically safe electrical equipment in classified ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No areas surrounding fuel dispensing devices? 4. All intrinsically safe electri- cal equipment remains ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No energized after E -stop acti- vation? 5. After testing, E -stop has been reset and power rees- ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No tablished to normal operat- ing condition? A "No" to lines 3a -3d indicates a test failure, Test Results ❑ Pass []Fail ❑ Pass ❑ Fail []Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Comments: Tester's Name (print) 0 pei.org Tester's Signature