Engineering Analysis Information Request

Customer Product Info = REQUIRED FIELDS

If there is not a current Tech Support case, call Technical Support for assistance and troubleshooting prior to filling

✆ out this form. Within the USA, call toll free: 1-888-382-1583
Outside of the USA, please visit: http://www.rockwellautomation.com/global/support/direct-dial.page

CASE INFORMATION

Active Tech Support Case # 4007835183 Related Cases (if applicable)

Product OVER 5 YEARS old must have approval of Quality prior to submitting for analysis.
STOP If there are more than 2 products involved, please complete page 5 of this document.
If a product is sent for analysis it will not be returned without being remanufactured.

PRODUCTS INVOLVED

Catalog/Part Number
Part Description Serial Number Date Code Time in Service
(including Series Letters)

80025-239-01-R FUSE,1E 4800V GOULD 5" N/A ONE WEEK

THE PROBLEM

Problem is Temperature Related When Power is Applied

Constant ✔ Intermittent Yes ✔ No ✔ Yes No

DO NOT disassemble any product.

DESCRIBE PROBLEM and APPLICATION

Include as much detail as possible so that the receiving Quality Engineer can understand and try to replicate the failure scenario. Examples of
information to include are system fault codes, LED indication, firmware levels, enviromental conditions, etc.
FUSES OF -BV_CPT1 BECOME BURNT WHEN DRIVE IS ENERGIZED
FUSES OF -BV_PT1 BECOME BURNT WHEN DRIVE IS ENERGIZED

DRIVE 6503937065-203 CAT NR 7000-D140KEND-RPDTD-S

Form 20-24A Engineering Analysis Information Request Rev. 07/2019 Page 1 of 5

Engineering Analysis Information Request

Customer Product Info = REQUIRED FIELDS

CUSTOMER FACILITY & INSTALLATION MANDATORY INFORMATION (DRIVES, MOTORS, ARMORSTARTS AND DYSCS ONLY)

Distribution Transformer VA Rating

Winding Configuration Delta-Delta Wye-Wye ✔ Delta-Wye

Secondary Voltage & Current V A

Grounding (Secondary) B – Phase Delta Ungrounded High Impedance Neutral ✔ Solidly Grounded Neutral
Power Factor ✔
Correction Capacitors Yes KVARS No

Additional Line Impedance ✔

(In Front of Drive) Yes Mhy No

Input Protection ✔ Fuses Amps 12R CLIP ON Circuit Breaker Amps

Motor Ground is Directly
Connected to PE Terminal Yes ✔ No
of Drive
Input Contactors Installed in ✔
Front of Drive Yes No

Output Contactors Installed ✔

Between Drive and Motor Yes No

Does the Drive use a ✔

Dynamic Brake Yes Ohms Watts No

Communication Type ✔ HIM Only DeviceNet Controlnet ENet other

Form 20-24A Engineering Analysis Information Request Rev. 07/2019 Page 2 of 5

Engineering Analysis Information Request

Logistics Info (To be completed by Distributor/Rockwell Automation) = REQUIRED FIELDS

RETURN INFORMATION

Return Order Number IC # / ESOTC # (International only)

Analysis then economy repair Analysis with advanced exchange

Select the return option
that applies: Analysis with consumable warranty Analysis with NPSR
Analysis ONLY (scrap after analysis)

Is this an ETO Project?

SSB/LSC LVMCC Project #
If so, please select BU

DISTRIBUTOR AND CUSTOMER INFORMATION

Distributor SAP ID Distributor PO # End Customer ID and Name

Ship to Address (If required) City State/Province Zip/Postal Code Country

CUSTOMER SITE INFORMATION (IF AVAILABLE)

Company & Plant

City, State/Province, Country

Industry

CONTACT INFORMATION
Name E-mail Phone or Cell Company
Rockwell Automation
REQUESTOR Rockwell Automation
(RA Account Manager)
CUSTOMER CONTACT
Other Technical Contact
Rockwell Automation
(RA FSE, Area Manager)
Distributor / Returns Coordinator

RA Quality Contact Rockwell Automation

Form 20-24A Engineering Analysis Information Request Rev. 07/2019 Page 3 of 5

Engineering Analysis Information Request

Material Preservation:
In order to provide the most complete product analysis possible, the condition of the unit being returned must be
preserved. Please review the following guidelines before returning a unit to Rockwell Automation for analysis:
• Material should be kept in its original state.
• Switch and jumper settings should not be changed.
• Do not attempt to disassemble, clean or repair units prior to return.
• Units should be packaged to prevent shipping damage.
• Please
 ensure that units being returned are packaged, labeled and shipped in accordance
with all federal, national and UN transportation regulations and requirements.
• Units
 contaminated with chemical, biological, or radiological contaminants must be disclosed and
brought to the attention of Rockwell Automation for instructions prior to initiating a return.
• Ensure local regulations are followed when shipping.
• Materials
 returned to Rockwell Automation may be destroyed during the
investigation to evaluate the potential product anomaly.

Instructions for Processing Your Request:

Instructions for processing your request:

1 Authorized Distributors and RA Personnel only: E-mail the completed questionnaire to:
North America: Send completed form to RA Quality Contact listed on page 3
Canada: Send completed form to RA Quality Contact listed on page 3
Latin America: Local Customer Quality and: Mexico ([email protected]),
Brazil ([email protected]), ACCA – SC-Car ([email protected])
Europe, Middle East, Africa: Technical Support at [email protected]
Asia Pacific: STO/ESOTC: Local Customer Quality Manager
Inter Company RMA (PLS Return): RACCREAP ([email protected]) and CC your Local
Customer Quality Manager

2 Do not return material until the analysis has been approved.

3 Attach Return label (see sample below) to Product and to the packing carton.

4 Include a copy of this completed Form with returned product.

5 Return product to provided address located on the RMA.

Form 20-24A Engineering Analysis Information Request Rev. 07/2019 Page 4 of 5

Engineering Analysis Information Request

STOP Fill out this section ONLY IF you need additional space to list products involved in the case.

PRODUCTS INVOLVED

Catalog/Part Number
Part Description Serial Number Date Code Time in Service
(including Series Letters)

Page 5 of 5
Form 20-24A Engineering Analysis Information Request Rev. 07/2019