Tripping Form

NUISANCE TRIPPING REPORT

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THINGS TO LOOK FOR IN ADVANCE OF SUBMITTING A REPORT:

Refer to manufacturer's instructions or website for additional troubleshooting information.

Ensure that furniture is not on or pushing against plug, causing electrical wires to be pinched

Ensure that the receptacle is installed correctly (is not loosely mounted within wall, is not recessed compared to mounting plate, does not have other visible damage)

Ensure that test/reset function of dual AFCI/GFCI or AFCI-only receptacle is operating correctly

Ensure that plugs, cords, wires and plug strips (if applicable) are installed and/or attached correctly, and are not damaged in any way

Ensure light bulbs are correctly installed and tight in lamp sockets

Ensure light bulbs match with lamp sockets sized to accept the matching base of the bulb

Ensure that the branch circuit is not overloaded - contact a qualified electrician

Ensure that connected appliances or products are FCC Part 15 compliant (confirms suitability to operate in a residential RFI/EMI environment)

Ensure that connected appliances or products are operating correctly for the appropriate purpose, and are not damaged or misused in some way

If device trips with no load or a variety of loads connected contact a qualified electrician.

NOTE: * Indicates required information

Contact Information

First Name *
Last Name *
Address
City
State *
Zip
Daytime Telephone *
Evening Telephone
E-mail Address*
Individual Reporting

AFCI Receptacle Information at your installation

Select Type of AFCI Receptacle product
Select the Manufacturer/Brand Name of AFCI *
Amperage of AFCI Receptacle

AFCI Installation

Date of Occurrence *

Date format must be: MM/DD/YYYY

Date of Installation

Date format must be: MM/DD/YYYY

Location
Address
City
State
Zip
Is the Dual Function or AFCI-only Receptacle Accessible for test/reset?
Describe the Nuisance Trip Incident:
Describe any Corrective Actions Taken up to now to Address Nuisance Trip Incident
Please describe room(s) affected by trip

What Equipment is Connected to the Circuit that is Tripping the AFCI?

Description of Equipment *
Name of Appliance or Equipment Manufacturer
Catalog Number (if visible/available)
Serial Number on product (if visible/available)
Additional or Adjacent Items on the Circuit Exhibiting the Dual Function or AFCI-only Nuisance Tripping
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