Technical Investigation Information Request Form SINAMICS Perfect Harmony GH180 Cells Innomotics A Siemens Business

Technical Investigation Request Form Revision: 3 Page 1 

Technical Investigation 

Information Request Form

Investigations require factory approval before proceeding

Date:

Project Name* 

Site Name* 

General Information

Customer* 

Date of Failure* 

Product & Part Information 

Component Part #* Serial #* Replacement Serial # Sales Order/WBS ID* Description (Cell, 

Board, Module, etc.) 

Description of Failure or Fault Observed* A Fault Reference MUST be provided here - Customer shall review their 

Innomotics System / Operation and Diagnostics Manual and indicate reference in manual 

Containment Action Taken to Address Failure*

Equipment Condition at Time of Failure* Indicate one of the three Failure Status choices. 

1 - Not Powered 2 - Powered, no drive operation 3 - Powered, in drive operation 

Information Required for Failure Analysis

Providing an effective root cause analysis requires gathering information from the customer’s site. To help achieve this 

goal, the following information is requested. An effective root cause analysis is dependent on a detailed response. It is 

essential to provide as much specific information as possible. All forms that are incomplete will be returned for 

completion. Logs, Field Service Reports, Description of Failure or Fault Observed, Containment Action Taken to Address 

Failure, and Equipment Condition at Time of Failure are all required. 

*One completed Technical Investigation Request Form is required for each (one) part returned.

**Factory Approval and a customer PO (Purchase Order) will be required along with this completed form to begin the 

root cause analysis process. 

Download this form, complete & click Save. The Save function WILL NOT work in a browser.

Technical Investigation Request Form Revision: 3 Page 2 

Yes Digital Pictures (Show As Much Detail As Possible)* Not Available 

Author: 

Date: 

Additional 

Comments: 

Drive Information For Larger Projects with Multiple Drives, provide Information below if applicable

Drive Number: 

VFD (A, B, C, etc.): 

Building: 

Cell Location in VFD 

(A1, B3, etc.): 

Pre-failure Customer Site & Equipment Operation Information 

c. Air Quality

d. Is the unit in a temperature￾controlled room?

Yes No 

1. What is the normal operating environment of the unit?

a. Temperature

b. Humidity

2. What is the unit being used for?

a. What is the load?

b. Percent of output during normal operations

c. What is the duty cycle?

3. What is the Unit’s layout? In particular:

a. List any unique set-up or layout designs at site:

b. Lengths of the input /output connecting wires:

4. Please describe the drive’s Operational History.

a. Drive’s total operational run-time

b. List previous fault or problem history including any repairs or rework history

c. Maintenance history

Failure Information:

5. Are any monitoring equipment measurements available? (please attach)

6. What is the quality of the Electric Utility Company’s input voltage? (normally high, soft or variable)

Fault

Additional Attachments Requested Please provide where possible – indicate what is attached here 

Event*

Field / Site Service Report* Yes Not Applicable

LOGS Provided – The Event Log is REQUIRED History

Technical Investigation Request Form Revision: 3 Page 3 

7. At the time of the unit failure were there any other equipment failures at the site?

8. Describe the conditions at the time of the failure – Please give AS MUCH detail as possible!

a. Drive/unit run-state leading up to the failure. (i.e. speeding up, ramping down).

b. List any unique circumstances leading up to (or at the time of) the failure.

c. Please describe the environmental conditions at the time of the failure including any weather disturbances or

temperature conditions.

d. Please describe the failure in detail. Include any additional information not previously given.

e. Was there damage to the system / drive other than the failed unit? (if so describe)

How to submit this form: 

Save this form and attach to the RMA Form Submittal Email along with the relevant logs, pictures, reports and any 

other documentation.

The Root Cause Analysis can not begin until this form, the failed parts, additional attachements, and a Purchase Order 

Number (if required) are provided (returned). 

The current version of this form can be found at usa.siemens.com/lda-tiir-form.