AFCI Unwanted Tripping Report

Please complete as many areas below as possible. Areas identified with red asterix are mandatory. Use text boxes to describe in detail the situation you are encountering with your AFCI and what you believe is causing the unwanted trip condition.

Please take a moment to enter the characters in the security field below into the adjacent data entry box. This helps to protect the integrity of the data being forwarded to the AFCI manufacturers from NEMA. Once completed, the data entered into the form will be automatically forwarded to the manufacturer you select.

AFCI Data Entry Security Field *:

Contact Information:

Last Name:		First Name * :
Address:		City:
State:		Zip:

Daytime Telephone * :
Evening Telephone:
E-mail Address * :

AFCI Product Information at your installation

Select the Manufacturer/Brand Name of AFCI * :
	Cutler Hammer (Eaton)		Siemens
	GE (General Electric)		Square D (Schneider Electric)
	Murray

Select Amperage of AFCI		Select Poles of AFCI
	15A		1 Pole (120V)
	20A		2 Pole (120/240V)

AFCI Installation Location:

		Date format must be: MM/DD/YYYY
Same as address above	Date of Occurrence:
Different location	Date of Installation:
If checked different location, please provide address

Address:
City:
State:		Zip:

Individual Reporting (select one) *:

	Homeowner		Remodeler
	Electrical Contractor		Other (please specify)
	Electrical Inspector

Describe The Tripping Incident * :
Example: When power to equipment is turned on, the fan is operated, the AFCI trips when....

What Equipment Is Connected To The Circuit That Is Tripping The AFCI?

Appliance Description * :
Appliance Manufacturer Name:
Appliance Model Number:
Other Appliances On The Circuit: (please describe)

Type of Residence/Room Affected

Please select residence type:		Please describe room(s) affected by trip
	House (Single Family)		Bedroom	Kitchen
	Townhome		Living room	Basement
	Apartment/Condo		Dining room	Hallway
	Multifamilly Home		Family Room	Other (Specify)
	Other (Specify)		Home Office

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NEMA is the leading trade association in the U.S. representing the interests of electroindustru manufacturers of products used in the generation , transmission and distribution , control, and end-use of electricity.