SEWS 8.1.2 (1 of 4) Sheet 1 of \_\_\_\_\_\_

+------------------------------------+----------------+---------------+
| **SCREENING EVALUATION WORK SHEET  |                |               |
| (SEWS)**                           |                |               |
+------------------------------------+----------------+---------------+
| **Equipment ID No.:**              | **Equipment    |               |
|                                    | Class: Motor   |               |
|                                    | Control        |               |
|                                    | Centers**      |               |
+------------------------------------+----------------+---------------+
| Equipment description:             |                |               |
+------------------------------------+----------------+---------------+
| Equipment Location: Bldg.          | Floor El.      | Room,         |
|                                    |                | Row/Col.      |
+------------------------------------+----------------+---------------+
| Manufacturer, model, etc.:         |                |               |
+------------------------------------+----------------+---------------+
| Weight of each Cabinet:            |                |               |
+------------------------------------+----------------+---------------+
| Drawing No.:                       | Performance    |               |
|                                    | Category:      |               |
+------------------------------------+----------------+---------------+
| ***Functionality Requirement***    |                |               |
+------------------------------------+----------------+---------------+
| q Contact Lead Relay Reviewer to   |                |               |
| determine if item contains         |                |               |
| Essential Relays                   |                |               |
|                                    |                |               |
| q For components whose function or |                |               |
| structural integrity is required,  |                |               |
| complete all sections of this      |                |               |
| form.                              |                |               |
|                                    |                |               |
| q For all other components, only   |                |               |
| anchorage evaluation is required.  |                |               |
+------------------------------------+----------------+---------------+
| ***Seismic Capacity vs. Demand     |                |               |
| (Chapter 5)***                     |                |               |
+------------------------------------+----------------+---------------+
| 1\. Seismic Capacity based on:     |                |               |
|                                    |                |               |
| q Reference Spectrum               |                |               |
|                                    |                |               |
| q GERS                             |                |               |
|                                    |                |               |
| q Existing documentation           |                |               |
|                                    |                |               |
| 2\. Elevation where equipment      |                |               |
| receives seismic input             |                |               |
|                                    |                |               |
| Seismic Demand Spectrum (SDS)      |                |               |
| based on:                          |                |               |
|                                    |                |               |
| q In-structure response spectrum   |                |               |
| (IRS) per DOE-STD-1020             |                |               |
|                                    |                |               |
| q Other in-structure response      |                |               |
| spectrum (determine appropriate    |                |               |
| experience data                    |                |               |
|                                    |                |               |
| scale factor)                      |                |               |
|                                    |                |               |
| q Design basis earthquake (DBE)    |                |               |
| per DOE-STD-1020                   |                |               |
|                                    |                |               |
| q Other                            |                |               |
|                                    |                |               |
| Scale Factor (SF) Experience Data  |                |               |
| Factor (F~ED~)                     |                |               |
|                                    |                |               |
| Does capacity exceed demand? Y N U |                |               |
|                                    |                |               |
| Reference:                         |                |               |
+------------------------------------+----------------+---------------+
| ***Caveats (Section 8.1.2)***      |                |               |
+------------------------------------+----------------+---------------+
| *Reference Spectrum* (Identify     |                |               |
| with an asterisk (\*) those        |                |               |
| caveats which are met by intent    |                |               |
| without meeting the specific       |                |               |
| wording of the caveat rule and     |                |               |
| explain the reason for this        |                |               |
| conclusion in the COMMENTS section |                |               |
| below)                             |                |               |
+------------------------------------+----------------+---------------+
| 1\. Equipment is included in       |                |               |
| earthquake experience equipment    |                |               |
| class Y N U N/A\                   |                |               |
| 2. 600 V rating or less Y N U N/A\ |                |               |
| 3. Adjacent cabinets which are     |                |               |
| close enough to impact, or         |                |               |
| sections\                          |                |               |
| of multi-bay cabinets, are bolted  |                |               |
| together if they contain\          |                |               |
| essential relays Y N U N/A\        |                |               |
| 4. Attached weight (except         |                |               |
| conduit) less than about 100 lbs   |                |               |
| per\                               |                |               |
| cabinet assembly Y N U N/A\        |                |               |
| 5. Externally attached items       |                |               |
| rigidly anchored Y N U N/A         |                |               |
+------------------------------------+----------------+---------------+

SEWS 8.1.2 (2 of 4) Sheet 2 of \_\_\_\_\_\_

+------------------------------------+---------------------------------+
| **SCREENING EVALUATION WORK SHEET  |                                 |
| (SEWS) (Cont.)**                   |                                 |
+------------------------------------+---------------------------------+
| **Equipment ID No.:**              | **Equipment Class: Motor        |
|                                    | Control Centers**               |
+------------------------------------+---------------------------------+
| Equipment description:             |                                 |
+------------------------------------+---------------------------------+
| ***Caveats (Cont.)***              |                                 |
+------------------------------------+---------------------------------+
| 6\. General configuration similar  |                                 |
| to NEMA standards Y N U N/A\       |                                 |
| 7. Cutouts in lower half less than |                                 |
| 6 in. wide and 12 in. high Y N U   |                                 |
| N/A\                               |                                 |
| 8. All doors secured by latch or   |                                 |
| fastener Y N U N/A\                |                                 |
| 9. Have you looked for and found   |                                 |
| no other adverse concerns? Y N U   |                                 |
| N/A\                               |                                 |
| \                                  |                                 |
| Is the intent of all the caveats   |                                 |
| met for Reference Spectrum? Y N U  |                                 |
| N/A                                |                                 |
+------------------------------------+---------------------------------+
| *GERS* (Identify with an asterisk  |                                 |
| (\*) those caveats which are met   |                                 |
| by intent without meeting the      |                                 |
| specific wording of the caveat     |                                 |
| rule and explain the reason for    |                                 |
| this conclusion in the COMMENTS    |                                 |
| section below)                     |                                 |
+------------------------------------+---------------------------------+
| 1\. Equipment is included in       |                                 |
| generic seismic testing equipment  |                                 |
| class Y N U N/A\                   |                                 |
| 2. Meets all Reference Spectrum    |                                 |
| caveats Y N U N/A\                 |                                 |
| 3. Floor-mounted cabinet Y N U     |                                 |
| N/A\                               |                                 |
| 4. Average weight per section less |                                 |
| than 800 pounds Y N U N/A\         |                                 |
| 5. Base anchorage utilizing MCC    |                                 |
| base channels Y N U N/A\           |                                 |
| 6. Adequate strength and stiffness |                                 |
| in load transfer path from\        |                                 |
| anchorage to base frame (only for  |                                 |
| \"function after\" GERS) Y N U     |                                 |
| N/A\                               |                                 |
| 7. Essential relays have GERS \>   |                                 |
| 4.5g (only for \"function\         |                                 |
| during\" GERS) Y N U N/A\          |                                 |
| 8. Able to reset starters (only    |                                 |
| for \"function after\" GERS) Y N U |                                 |
| N/A\                               |                                 |
| 9. Adjacent cabinets which are     |                                 |
| close enough to impact, or         |                                 |
| sections of\                       |                                 |
| multi-bay cabinets, are bolted     |                                 |
| together. Y N U N/A\               |                                 |
| \                                  |                                 |
| Is the intent of all the caveats   |                                 |
| met for GERS? Y N U N/A            |                                 |
+------------------------------------+---------------------------------+
| ***Anchorage (Chapter 6)***        |                                 |
+------------------------------------+---------------------------------+
| 1\. Type of anchorage:             |                                 |
|                                    |                                 |
| q expansion anchor                 |                                 |
|                                    |                                 |
| q cast-in-place bolt or headed     |                                 |
| stud anchor                        |                                 |
|                                    |                                 |
| q cast-in-place J-bolt             |                                 |
|                                    |                                 |
| q grouted-in-place bolt            |                                 |
|                                    |                                 |
| q welds to embedded steel on       |                                 |
| exposed steel                      |                                 |
|                                    |                                 |
| q lead cinch anchors               |                                 |
|                                    |                                 |
| q Other                            |                                 |
|                                    |                                 |
| q N/A (no further anchorage        |                                 |
| considerations)                    |                                 |
|                                    |                                 |
| 2\. Appropriate characteristics    |                                 |
| for anchorage type checked         |                                 |
|                                    |                                 |
| (size, location, equipment         |                                 |
| characteristics) Y N U             |                                 |
|                                    |                                 |
| 3\. Gap at threaded anchor less    |                                 |
| than 1/4 inch Y N U N/A            |                                 |
|                                    |                                 |
| 4\. Base stiffness and no          |                                 |
| significant prying action          |                                 |
| requirements met Y N U             |                                 |
|                                    |                                 |
| 5\. Equipment base strength and    |                                 |
| structural load path adequate Y N  |                                 |
| U                                  |                                 |
|                                    |                                 |
| 6\. Embedment steel and pads       |                                 |
| requirements met Y N U N/A         |                                 |
|                                    |                                 |
| 7\. Embedment length requirements  |                                 |
| met Y N U                          |                                 |
|                                    |                                 |
| 8\. Anchor spacing requirements    |                                 |
| met Y N U                          |                                 |
|                                    |                                 |
| 9\. Edge distance requirements met |                                 |
| Y N U                              |                                 |
|                                    |                                 |
| 10\. Concrete strength             |                                 |
| requirements met Y N U             |                                 |
+------------------------------------+---------------------------------+

SEWS 8.1.2 (3 of 4) Sheet 3 of \_\_\_\_\_\_

+-------------------------------+-----------------------------+-------+
| **SCREENING EVALUATION WORK   |                             |       |
| SHEET (SEWS) (Cont.)**        |                             |       |
+-------------------------------+-----------------------------+-------+
| **Equipment ID No.:**         | **Equipment Class: Motor    |       |
|                               | Control Centers**           |       |
+-------------------------------+-----------------------------+-------+
| Equipment description:        |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Anchorage (Cont.)***       |                             |       |
+-------------------------------+-----------------------------+-------+
| 11\. Concrete crack           |                             |       |
| requirements met Y N U        |                             |       |
|                               |                             |       |
| 12\. Equipment with essential |                             |       |
| relays requirements met Y N U |                             |       |
| N/A                           |                             |       |
|                               |                             |       |
| 13\. Installation adequacy    |                             |       |
| requirements met Y N U N/A    |                             |       |
|                               |                             |       |
| 14\. No other concerns Y N U  |                             |       |
|                               |                             |       |
| Does anchorage capacity       |                             |       |
| exceed demand? Y N U          |                             |       |
|                               |                             |       |
| Reference:                    |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Interaction Effects        |                             |       |
| (Chapter 7)***                |                             |       |
+-------------------------------+-----------------------------+-------+
| 1\. Soft targets free from    |                             |       |
| impact by nearby equipment\   |                             |       |
| or structures Y N U N/A       |                             |       |
|                               |                             |       |
| 2\. If equipment contains     |                             |       |
| sensitive essential relays,   |                             |       |
| equipment free\               |                             |       |
| from all impact by nearby     |                             |       |
| equipment or structures Y N U |                             |       |
| N/A                           |                             |       |
|                               |                             |       |
| 3\. Attached lines have       |                             |       |
| adequate flexibility Y N U    |                             |       |
| N/A                           |                             |       |
|                               |                             |       |
| 4\. No collapse of overhead   |                             |       |
| equipment, distribution       |                             |       |
| systems,                      |                             |       |
|                               |                             |       |
| or masonry walls Y N N/A      |                             |       |
|                               |                             |       |
| 5\. Equipment is free from    |                             |       |
| credible and significant      |                             |       |
|                               |                             |       |
| seismic-induced flood and     |                             |       |
| spray concerns Y N N/A        |                             |       |
|                               |                             |       |
| 6\. No credible               |                             |       |
| seismic-induced fire concerns |                             |       |
| Y N N/A                       |                             |       |
|                               |                             |       |
| 7\. No other "two over one"   |                             |       |
| concerns as defined in        |                             |       |
| DOE-STD-1021 Y N N/A          |                             |       |
|                               |                             |       |
| 8\. No other concerns Y N U   |                             |       |
| N/A                           |                             |       |
|                               |                             |       |
| Is equipment free of          |                             |       |
| interaction effects? Y N U    |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Comments***                |                             |       |
+-------------------------------+-----------------------------+-------+
|                               |                             |       |
+-------------------------------+-----------------------------+-------+

SEWS 8.1.2 (4 of 4) Sheet 4 of \_\_\_\_\_\_

+-------------------------------+-----------------------------+-------+
| **SCREENING EVALUATION WORK   |                             |       |
| SHEET (SEWS) (Cont.)**        |                             |       |
+-------------------------------+-----------------------------+-------+
| **Equipment ID No.:**         | **Equipment Class: Motor    |       |
|                               | Control Centers**           |       |
+-------------------------------+-----------------------------+-------+
| Equipment description:        |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Comments (Cont.)***        |                             |       |
+-------------------------------+-----------------------------+-------+
| Screening Walkdown(s):        |                             |       |
|                               |                             |       |
| [Date]{.underline}            |                             |       |
| [Time]{.underline} [Team      |                             |       |
| Members]{.underline}          |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Recommend Resolution***    |                             |       |
+-------------------------------+-----------------------------+-------+
| q Maintenance action:         |                             |       |
|                               |                             |       |
| q Further evaluation:         |                             |       |
|                               |                             |       |
| q Retrofit design:            |                             |       |
|                               |                             |       |
| q Other:                      |                             |       |
|                               |                             |       |
| q No further action required. |                             |       |
| Equipment is seismically      |                             |       |
| adequate.                     |                             |       |
+-------------------------------+-----------------------------+-------+
| All aspects of the            |                             |       |
| equipment\'s seismic adequacy |                             |       |
| have been addressed.          |                             |       |
|                               |                             |       |
| Evaluation by: Date:          |                             |       |
|                               |                             |       |
| (All team members)            |                             |       |
+-------------------------------+-----------------------------+-------+