Appendix D: Gross Serror Report

DOE-STD-1054-93

A PPEN D IX D

GROS S ERROR REPORT

FORM NO.

Plant

Facility Name

Instrument #

SR#

Manufacturer

Model #

Calibration Date

Previous Calibration Date

Ranges Affected

% Error

Ranges Affected

% Error

This instrument was involved in activities associated with the attached list of equipment

and/or jobs. Based on a review of the out-of-calibration condition and the affected list of

equipment, the checked action is required.

No Action Required:

instrument was not used during period (no list)

affected range(s) was not used

the error did not cause any test result/calibration to exceed equipment

allowable tolerances.

instrument would not function and failure time and cause were known,

providing reasonable assurance that the instrument was in calibration

prior to failure

other

D-3