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Issue Date: 2019-04-02 Page 1 of 9 Report Reference # E467376-A6002-UL Copyright © 2018 2 UL TEST REPORT AND PROCEDURE Standard: UL 62368-1, 2nd Ed, 2014-12-01 (Audio/video, information and communication technology equipment Part 1: Safety requirements) CAN/CSA C22.2 No. 62368-1-14, 2nd Ed (Audio/video, information and communication technology equipment Part 1: Safety requirements) Certification Type: Listing CCN: QQJQ, QQJQ7 (Power Supplies for Use in Audio/Video, Information and Communication Technology Equipment) Complementary CCN: N/A Product: POWER CHARGER Model: SZ-75W-PQ, 75W-PQ, 75W, SZ-75W-PQ(3), MZTPQD01, MZTPQD02, MZTPQD03, MZTPQD04, RPI-LC75, AGC0075, NPA75, M-TC-75, ZL- 75W-PD-QC, MZTPQD05 Rating: Input: 100-240Vac, 50/60Hz, 2.0A Max. Output 1 QC: 3.6Vdc-12Vdc(0.2Vdc/STEP), 3.0A Max, 18W Max. Output 2: 5Vdc, 2.4A Max. Output 3: PD: 5Vdc, 3.0A or 9Vdc, 3.0A or 12Vdc, 3.0A or 15Vdc, 3.0A or 20V, 2.25A QC: 3.6Vdc-12Vdc(0.2Vdc/STEP), 3.0A Max, 36W Max. Applicant Name and Address: SZ POWER TECHNOLOGY CO LTD A F5 BUILDING NO.0100028 XIAWEI INDUSTRIAL AREA XIAHU COMMUNITY GUANLAN LONGHUA NEW DISTRICT SHENZHEN GUANGDONG 518109 CHINA CHINA This is to certify that representative samples of the products covered by this Test Report have been investigated in accordance with the above referenced Standards. The products have been found to comply with the requirements covering the category and the products are judged to be eligible for Follow-Up Service under the indicated Test Procedure. The manufacturer is authorized to use the UL Mark on such products which comply with this Test Report and any other applicable requirements of UL LLC ('UL') in accordance with the Follow-Up Service Agreement. Only those products which properly bear the UL Mark are considered as being covered by UL's Follow-Up Service under the indicated Test Procedure. The applicant is authorized to reproduce the referenced Test Report provided it is reproduced in its entirety. UL authorizes the applicant to reproduce the latest pages of the referenced Test Report consisting of the first page of the Specific Technical Criteria through to the end of the Conditions of Acceptability. Any information and documentation involving UL Mark services are provided on behalf of UL LLC (UL) or any authorized licensee of UL. Created by UL Document Assembler 2019-04-28 04:14:42 -05:00

UL TEST REPORT AND PROCEDURE · QMFZ2 UL E59481 11-3, Magnet wire of T1 Interchangeable Interchangeable MW75, MW79, MW80, MW82, MW83, Minimum 130 degree C. OBMW2 UL 11-4. Triple insulation

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Page 1: UL TEST REPORT AND PROCEDURE · QMFZ2 UL E59481 11-3, Magnet wire of T1 Interchangeable Interchangeable MW75, MW79, MW80, MW82, MW83, Minimum 130 degree C. OBMW2 UL 11-4. Triple insulation

Issue Date: 2019-04-02 Page 1 of 9 Report Reference # E467376-A6002-UL

Copyright © 2018 2

UL TEST REPORT AND PROCEDURE

Standard: UL 62368-1, 2nd Ed, 2014-12-01 (Audio/video, information and communication technology equipment Part 1: Safety requirements)CAN/CSA C22.2 No. 62368-1-14, 2nd Ed (Audio/video, information and communication technology equipment Part 1: Safety requirements)

Certification Type: Listing

CCN: QQJQ, QQJQ7 (Power Supplies for Use in Audio/Video, Information and Communication Technology Equipment)

Complementary CCN: N/A

Product: POWER CHARGER

Model:SZ-75W-PQ, 75W-PQ, 75W, SZ-75W-PQ(3), MZTPQD01, MZTPQD02, MZTPQD03, MZTPQD04, RPI-LC75, AGC0075, NPA75, M-TC-75, ZL-75W-PD-QC, MZTPQD05

Rating:

Input: 100-240Vac, 50/60Hz, 2.0A Max. Output 1 QC: 3.6Vdc-12Vdc(0.2Vdc/STEP), 3.0A Max, 18W Max.Output 2: 5Vdc, 2.4A Max.Output 3: PD: 5Vdc, 3.0A or 9Vdc, 3.0A or 12Vdc, 3.0A or 15Vdc, 3.0A or 20V, 2.25A QC: 3.6Vdc-12Vdc(0.2Vdc/STEP), 3.0A Max, 36W Max.

Applicant Name and Address:

SZ POWER TECHNOLOGY CO LTDA F5 BUILDING NO.0100028XIAWEI INDUSTRIAL AREA XIAHU COMMUNITYGUANLAN LONGHUA NEW DISTRICTSHENZHENGUANGDONG 518109 CHINACHINA

This is to certify that representative samples of the products covered by this Test Report have been investigated in accordance with the above referenced Standards. The products have been found to comply with the requirements covering the category and the products are judged to be eligible for Follow-Up Service under the indicated Test Procedure. The manufacturer is authorized to use the UL Mark on such products which comply with this Test Report and any other applicable requirements of UL LLC ('UL') in accordance with the Follow-Up Service Agreement. Only those products which properly bear the UL Mark are considered as being covered by UL's Follow-Up Service under the indicated Test Procedure.

The applicant is authorized to reproduce the referenced Test Report provided it is reproduced in its entirety.

UL authorizes the applicant to reproduce the latest pages of the referenced Test Report consisting of the first page of the Specific Technical Criteria through to the end of the Conditions of Acceptability.

Any information and documentation involving UL Mark services are provided on behalf of UL LLC (UL) or any authorized licensee of UL.

Created by UL Document Assembler 2019-04-28 04:14:42 -05:00

Page 2: UL TEST REPORT AND PROCEDURE · QMFZ2 UL E59481 11-3, Magnet wire of T1 Interchangeable Interchangeable MW75, MW79, MW80, MW82, MW83, Minimum 130 degree C. OBMW2 UL 11-4. Triple insulation

Issue Date: 2019-04-02 Page 2 of 9 Report Reference # E467376-A6002-UL

Copyright © 2018 2

Prepared By: Polly Wang / Project Handler Reviewed By: Jack Jia / Reviewer

Supporting Documentation

The following documents located at the beginning of this Procedure supplement the requirements of this Test Report:

A. Authorization - The Authorization page may include additional Factory Identification Code markings.

B. Generic Inspection Instructions -

i. Part AC details important information which may be applicable to products covered by this Procedure. Products described in this Test Report must comply with any applicable items listed unless otherwise stated in the body of this Test Report.

ii. Part AE details any requirements which may be applicable to all products covered by this Procedure. Products described in this Test Report must comply with any applicable items listed unless otherwise stated in the body of each Test Report.

iii. Part AF details the requirements for the UL Certification Mark which is not controlled by the technical standard used to investigate these products. Products are permitted to bear only the Certification Mark(s) corresponding to the countries for which it is certified, as indicated in each Test Report.

Product DescriptionThe apparatus are Class II Power charger (desk-top type) used for audio/video, information and communication technology equipment; electrical components are mounted on PWB, housed in plastic enclosure and then sealed by ultrasonic.

Model DifferencesAll models are identical to each other except for model name.

Test Item ParticularsClassification of use by Ordinary person

Children likely to be presentSupply Connection AC MainsSupply % Tolerance +10%/-10%Supply Connection – Type pluggable equipment type A -

appliance couplerConsidered current rating of protective device as part of building or equipment installation

20 A;building;

Equipment mobility movabletransportable

Over voltage category (OVC) OVC IIClass of equipment Class IIAccess location N/APollution degree (PD) PD 2Manufacturer’s specified maximum operating ambient

25 °C

IP protection class IPX0Power Systems TNAltitude during operation (m) 2000 m or lessAltitude of test laboratory (m) 2000 m or less Mass of equipment (kg) 0.222 kgTechnical Considerations

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Issue Date: 2019-04-02 Page 3 of 9 Report Reference # E467376-A6002-UL

2

The product was submitted and evaluated for use at the maximum ambient temperature (Tma) permitted by the manufacturer’s specification of : __25__°C

The product is intended for use on the following power systems : TN Considered current rating of protective device as part of the building installation (A) : 20 Mains supply tolerance (%) or absolute mains supply values : +10%/-10% The equipment disconnect device is considered to be : Appliance inlet The following circuit locations (with circuit/schematic designation) were investigated as a limited power

source (LPS) : Output terminal The following are available from the Applicant upon request : Installation (Safety) Instructions / Manual

Additional InformationN/A

Additional StandardsThe product fulfills the requirements of: N/A

Markings and Instructions

Clause Title Marking or Instruction Details

Class II Equipment without Functional Earth

Symbol for Class II construction

(IEC 60417-5172)

Equipment identification marking – Manufacturer identification

Listees or Recognized companys name, Trade Name, Trademark or File Number

Equipment identification marking – model identification

Model Number

Equipment rating marking –ratings

"Input Ratings (voltage, frequency/dc, current/power)", "Output Ratings (voltage, frequency/dc, current/power)"

Fuses – replaceable by skilled person

(component ID: F1), "Ratings (T3.15A 250V)", located on or adjacent to fuse or fuseholder or in service manual.

LPS marking (Optional) Limited Power Source or LPS or L.P.S.

Special Instructions to UL Representative[X] For transformer test - When the tests are conducted at other location, inspect test record and specification sheet provided by the component manufacturer. Verify the specification sheet indicates 100% routine test specified in Production-Line Testing Requirements be conducted at the component manufacturer.

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Issue Date: 2019-04-02 Page 4 of 9 Report Reference # E467376-A6002-UL

1

BD1.0 TABLE: Production-Line Testing RequirementsBD1.1 Electric Strength Test Special Constructions – Refer to Generic Inspection Instructions,

Part AC for further information.Model Component Removable parts Test probe

locationTest V rms Test V

dcTest

Time, sAll models T1,T2 N/A Primary to

Secondary4000Vpk 4000Vd

cMin. 1s

Earthing Continuity Test Exemptions – This test is not required for the following models:BD1.2All models

Electric Strength Test Exemptions – This test is not required for the following models:BD1.3None

Electric Strength Test Component Exemptions – The following solid-state components may be disconnected from the remainder of the circuitry during the performance of this

test.

BD1.4

--

BE1.0 Sample and Test Specifics for Follow-Up Tests at ULModel Component Material Test Sample (s) Test Specifics

-- -- -- -- -- --

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Issue Date: 2019-04-02 Page 5 of 9 Report Reference # E467376-A6002-UL

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4.1.2 TABLE: List of critical components Pass

Object / part No. Manufacturer/trademark

Type / model Technical data Product Category CCN(s)

Mark(s) of conformity

Supplement ID

01. Plastic enclosure

CHI MEI CORPORATION

PC-6610 Minimum 2.2mmthickness, rated V-0,115 degree C, secured by ultrasonic welding. See supplement 07-01 for details.

QMFZ2 UL E56070

02. AC inlet ZHEJIANG LECI ELECTRONICS CO LTD

DB-8 5A, 250VAC,105 degree C

AXUT2 UL E302229

02a. AC inlet Dongguan HUACONN Electronics Co., Ltd

HC-88 5A, 250VAC, 105 degree C

AXUT2 UL E340249

03. PWB Interchangeable Interchangeable V-0,130 degree C.

ZPMV2 UL

04. Fuse (F1) Conquer Electronics Co., Ltd.

MST T3.15AL, 250Vac JDYX2 UL E82636

04a. Fuse (F1) (Alternate)

LITTELFUSE WICKMANN WERKE

392 T3.15AL, 250Vac JDYX2 UL E67006

04b. Fuse (F1) (Alternate)

Dongguan Reomax Electronics Technology Co., Ltd.

MFS T3.15AL, 250Vac JDYX2 ULE340427

04c. Fuse (F1) (Alternate)

Dongguan Reomax Electronics Technology Co., Ltd.

MTS T3.15AL, 250Vac JDYX2 ULE340427

05. Varistor (MOV) Hongzhi Enterprises Ltd.

HEL10D471K 300Vac, 105 degree C, minimum coating V-1

VZCA2 UL E324904

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Issue Date: 2019-04-02 Page 6 of 9 Report Reference # E467376-A6002-UL

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05a. Varistor (MOV) (Alternate)

CERGLASS MFG INC

10D471K 300Vac, 85 degree C minimum coating V-1

VZCA2 UL E317616

06. X-capacitor (CX1)

Dain Electronics Co., Ltd.

MPX Max. 0.33uF±10%, min. 275Vac, 100 degree C, X2 type

FOWX2 UL E147776

06a. X-capacitor (CX1) (Alternate)

SHANTOU HIGH-NEW TECHNOLOGY DEVELOPMNT ZONE SONGTIAN ENTERPRISE CO LTD

MPX Max. 0.33uF±10%,, min. 275Vac, 110 degree C, X2 type

FOWX2 UL E208107

07. Line Choke (LF1)

DONGGUANG LETENG ELECTRONIC TECHNOLOGY CO., LTD

LT2018-004 1000uH, 130 degree C, see supplement 04-03 for details.

-- --

07-1.Core of LF1 -- -- Ferrite, Overall approximately OD approx.14.5 mm, ID approx.8.5 mm, width approx.7.5 mm.

-- --

07-2. Magnet Wire of LF1

Interchangeable Interchangeable Rated 130 degree C OBMW2 UL

07-3. Triple insulation wire of LF1

FURUKAWA ELECTRIC CO.,LTD

TEX-E Rated 130 degree C OBJT2 ULE206440

08. Line Choke (LF2)

DONGGUANG LETENG ELECTRONIC TECHNOLOGY CO., LTD

LT2018-005 15mH, 130 degree C, see supplement 04-04 for details.

-- --

08-1.Core of LF2 -- -- Ferrite, Overall approximately OD approx.14.5 mm, ID approx.8.5 mm, width approx.7.5 mm.

-- --

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Issue Date: 2019-04-02 Page 7 of 9 Report Reference # E467376-A6002-UL

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08-2. Magnet Wire of LF2

Interchangeable Interchangeable Rated 130 degree C OBMW2 UL

09. Y-capacitor (CY1, CY2)

GCE (Dongguan) Electronics Co., Ltd

GY1 Min. 400Vac, max. 1000pF, Y1 type, 125 degree C

FOWX2 UL E464834

09a. Y-capacitor (CY1, CY2) (Alternate)

Shantou High-New Technology Developmnt Zone Songtian Co., Ltd.

CD Min. 400Vac, max.1000pF, Y1 type, 125 degree C

FOWX2 UL E208107

10. Optical isolator (U2, U8)

CT Micro International Corporation

CT1018 Isolators, providing 5000 Vac isolation, minimum 110 degree C

FPQU2 UL E364000

10a. Optical isolator (U2, U8) (Alternate)

Everlight Electronic (China)Co.,Ltd.

EL1018H Isolators, providing 5000 Vac isolation, minimum 125 degree C

FPQU2 UL E214129

10b. Optical isolator (U2, U8) (Alternate)

Everlight Electronics Co., Ltd

EL817 Isolators, providing 5000 Vac isolation, minimum 110 degree C

FPQU2 UL E214129

11. Transformer (T1)

Dongguan Leteng Electronic Technological Co., Ltd.

RM10(6+0) Class B . See supplement 04-01 for details.

-- --

11-1. Insulated system of T1

Dongguan Leteng Electronic Technological Co., Ltd.

SW-130-2 Class B OBJY2 UL E355144

11-2, Bobbin of T1 Chang Chun Plastics Co., Ltd.

T375J Phenolic, rated V-0, 150 degree C, Minimum 0.8mm thickness.

QMFZ2 UL E59481

11-3, Magnet wire of T1

Interchangeable Interchangeable MW75, MW79, MW80, MW82, MW83, Minimum 130 degree C.

OBMW2 UL

11-4. Triple insulation wire of T1

Totoku Electric Co. Ltd.

TIW-3X$, TIW-E, 3S-ETFE

Rated 155 degree C OBJT2 ULE166483

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Issue Date: 2019-04-02 Page 8 of 9 Report Reference # E467376-A6002-UL

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11-5. Varnish of T1 JOHN C DOLPH CO

BC-359 Rated 130 degree C. OBOR2 UL E317427

11-6. Insulation Tape of T1

JingJiang Yahua Pressure Sensitive Glue Co., Ltd.

PZ* (b) Rated 130 degree C. OANZ2 UL E165111

11-7. Tube of T1 Great Holding Industrial Co., Ltd.

TFT 200 degree C, VW-1 YDPU2 UL E156256

11-8, Core of T1 -- -- Ferrite, Measured overall approx.23.7mm by 17.5mm by 14.8mm.

-- --

12. Transformer (T2)

Dongguan Leteng Electronic Technological Co., Ltd.

RM10(5+0) Class B. See supplement 04-02 for details.

-- --

12-1. Insulated system of T2

Dongguan Leteng Electronic Technological Co., Ltd.

SW-130-2 Class B OBJY2 UL E355144

12-2, Bobbin of T2 Chang Chun Plastics Co., Ltd.

T375J Phenolic, rated V-0, 150 degree C, Minimum 0.8mm thickness.

QMFZ2 UL E59481

12-3, Magnet wire of T2

Interchangeable Interchangeable MW75, MW79, MW80, MW82, MW83, Minimum 130 degree C.

OBMW2 UL

12-4. Triple insulation wire of T2

Totoku Electric Co. Ltd.

TIW-3X$, TIW-E, 3S-ETFE

Rated 155 degree C OBJT2 ULE166483

12-5. Varnish of T2 JOHN C DOLPH CO

BC-359 Rated 130 degree C. OBOR2 UL E317427

12-6. Insulation Tape of T2

JingJiang Yahua Pressure Sensitive Glue Co., Ltd.

PZ* (b) Rated 130 degree C. OANZ2 UL E165111

12-7. Tube of T2 Great Holding Industrial Co., Ltd.

TFT 200 degree C, VW-1 YDPU2 UL E156256

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Issue Date: 2019-04-02 Page 9 of 9 Report Reference # E467376-A6002-UL

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12-8, Core of T2 -- -- Ferrite, Measured overall approx.17.6mm by 16.3mm by 9.9mm.

-- --

13. Thermistor (NTC)

Interchangeable Interchangeable 25 degree C, 5A XGPU2 UL

14. MOSFET (Q1, Q3)

-- -- Rated minimum 600V, minimum 7A.

-- --

15. Bridge Rectifier (DB1)

-- -- Rated minimum 600V, minimum 2.0A.

-- --

16. Electrolytic capacitors (EC2, EC3)

-- -- Rated minimum 400V, rated 68uF minimum 105 degree C

-- --

17. Electrolytic capacitors (EC1)

-- -- Rated minimum 400V, rated 47uF minimum 105 degree C

-- --

18. Current-limiting resistor (RS1, RS2, RS3)

-- -- 1.2Mohms, 1/4W -- --

19. Current-limiting resistor (RS4, RS5)

-- -- 0.75ohm, 1/4W -- --

20. Heat sink on Q1, Q3

-- -- Aluminum, see supplement 7-02 for details.

-- --

21. ICX (U1, U4) DIODES INCORPORATED

AP3108L series 100-240V~ (Tested for 90-265V~), 50-60Hz (Tested for 47-63Hz) (For circuit input), Associated discharge resistor 20k ohm, Associated X-capacitor 0.1uF – 2.31uF.

-- --

22. Resistors (R1, R2, RA, RB)

-- -- Each 10K ohm, 1/4W -- --

23. Diode (D1, D2) Interchangeable Interchangeable 1KV, 1A -- --

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Issue Date: 2019-04-02 Page 10 of 9 Report Reference # E467376-A6002-UL

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24. Marking Label Interchangeable Interchangeable Rated Minimum 80 degree C, suitable for use on plastic material.

PGDQ2 or PGJI2 UL

24a. Marking Label (Alternate)

-- -- Required markings are moulded in enclosure or permanently silk-screened or laser carved on plastic enclosure.

-- --

25. Heat sink on Q2, Q4

-- -- Aluminum, see supplement 7-03 for details.

-- --

26. Output connecter

Interchangeable Interchangeable Min. V-1 QMFZ2 UL

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Issue Date: 2019-04-02 Page 11 of 9 Report Reference # E467376-A6002-UL

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EnclosuresType Supplement Id Description

Photographs 03-01 Overall view 1

Photographs 03-02 Overall view 2

Photographs 03-03 Terminal view

Photographs 03-04 Internal view

Photographs 03-05 Top view of transformer (T1)

Photographs 03-06 Bottom view of transformer ( T1 )

Photographs 03-07 Top view of transformer (T2)

Photographs 03-08 Bottom view of transformer (T2)

Photographs 03-09 PWB components side view

Photographs 03-10 PWB trace side view

Diagrams 04-01 T1 spec.

Diagrams 04-02 T2 spec.

Diagrams 04-03 LF1 spec.

Diagrams 04-04 LF2 spec.

Schematics + PWB 05-01 PCB layout 1

Schematics + PWB 05-02 PCB layout 2

Miscellaneous 07-01 Enclosure spec.

Miscellaneous 07-02 Heat sink on Q1,Q3

Miscellaneous 07-03 Heat sink on Q2,Q4

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Issue Date: 2019-04-02 Page 1 of 1 Report Reference # E467376-A6002-UL

Test Record No. 1

--The customer submitted sample of production Power charger, Model VSZ-75W-PQ, 75W-PQ, 75W, SZ-75W-PQ(3), MZTPQD01, MZTPQD02, MZTPQD03, MZTPQD04, RPI-LC75, AGC0075, NPA75, M-TC-75, ZL-75W-PD-QC, MZTPQD05, for investigation. -- All tests were considered not necessary based upon previous evaluation under CB Scheme. Test Certificate Ref. No. DK-82042-UL, dated 2019-03-29, and Test Report Ref. No. ES180925040S, dated 2019-03-28, were issued by UL (Demko), Borupvang 5A DK-2750 Ballerup, DENMARK. --Any information and documentation involving UL Mark services are provided on behalf of UL LLC (UL) or any authorized licensee of UL.

The following supplements are provided as a part of this Test Record. NOTE: These supplements are only available to the Applicant via the CDA system.

Type Supplement Id DescriptionAttachment 02-01 CRD

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Project No. 4788820363 File E467376 Page 1Compliance Review Conducted by: Polly Wang Polly Wang Date 2019-03-13

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CONSTRUCTION COMPLIANCE REVIEW RECORD

Sample Identification -

Sample Card No.

Date Received

Sample No. Manufacturer, Product Identification and Ratings

2131144 2019-03-11 2131144-1

SZ Power Technology Co Ltd POWER CHARGER;SZ-75W-PQInput: 100-240Vac, 50/60Hz, 2.0A Max. Output 1 QC: 3.6Vdc-12Vdc(0.2Vdc/STEP), 3.0A Max, 18W Max.Output 2: 5Vdc, 2.4A Max.Output 3: PD: 5Vdc, 3.0A or 9Vdc, 3.0A or 12Vdc, 3.0A or 15Vdc, 3.0A or 20V, 2.25A QC: 3.6Vdc-12Vdc(0.2Vdc/STEP), 3.0A Max, 36W Max.

Measurement Instrument Information -

Inst. ID No. Instrument Type Function/Range Last Cal. Date Next Cal. DateGUZ-LE-MG023 Caliper 0~150mm 2018-07-18 2019-07-17

The following additional information is required when using client’s or rented equipment, or when a UL ID Number for an instrument number is not used. The Inst. ID No. below corresponds to the Inst. ID No. above.

Inst. ID No. Make/Model/Serial Number/Asset No.-- --

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CONSTRUCTION COMPLIANCE REVIEW:

The sample was reviewed for compliance with the construction requirements in the following Standard and compliance with applicable construction requirements is noted below.

Standard

CSA C22.2 No. 62368-1-14, 2nd Edition - Audio/video, Information and Communication Technology Equipment - Part 1: Safety Requirements

Edition/ Revision Date 2nd Edition / --

For clause Verdict see in BBP.

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StandardSCC Requirements and Guidance – Product Certification Body Accreditation Program

Edition/Revision Date 2016-04-06

ComplyClause/Par. Reference and Construction Requirement Yes No N/A Comments/Measurements

Inst. ID No.

9.2.3 CBs shall include dual language safety labeling within their product certification requirements, if so required by the standard or by the authority having jurisdiction. The manufacturer has confirmed they have the ability to include English and French safety labeling exactly as specified in the product standard; or, if NOT specified in the product standard, the ability to include English and French safety labelling consisting of markings associated with the signal words DANGER, WARNING, and CAUTION when required.

N/A The ability of the manufacturer to include these markings was verified by either (1) visual inspection of the markings on the actual product or (2) draft of labels thatwill be applied to the product or (3) written confirmation from the c u s t o m e r o f t h e markings that will appear on the product.If the product standard provides the exact t r a n s l a t i o n , t h e evidence must match the exact translation.If the product standard does NOT provide the exact translation, the evidence must simply i n c l u d e b o t h t h e English and French text (no verification of t r a n s l a t i o n i s required).

N/A

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ComplyClause/Par. Reference and Construction Requirement Yes No N/A Comments/Measurements

Inst. ID No.

Manufacturer has a method to manage distribution of products, IF all products with the Canadian certification mark are NOT going to include the dual language.

N/A Evaluation staff are to only verify that the manufacturer has a method to control distribution. Evaluation staff do not have to record the method of control nor are the evaluation staff expect e d t o v e r i f y t h e effectiveness of the method of control. This requirement to verify that a method exists will be noted in the FUS Procedure. The UL Field Engineer will verify the method during surveillance.If the manufacturer is going to include the dual language on all products with the Canadian certification mark, then this item is N/A; no further action required.

N/A

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Issue Date: 2019-04-02 Page 1 of 2 Report Reference # E467376-A6002-UL

2

ENERGY SOURCE IDENTIFICATION AND CLASSIFICATION TABLE:

(Note 1: Identify the following six (6) energy source forms based on the origin of the energy.)(Note 2: The identified classification e.g., ES2, TS1, should be with respect to its ability to cause pain or injury on the body or its ability to ignite a combustible material. Any energy source can be declared Class 3 as a worse case classification e.g. PS3, ES3.

Electrically-caused injury (Clause 5):(Note: Identify type of source, list sub-assembly or circuit designation and corresponding energy source classification)Example: +5 V dc input ES1

Source of electrical energy Corresponding classification (ES)

All circuits except for output circuits ES3

X capacitor connected between L and N ES3

Output terminal ES1

Electrically-caused fire (Clause 6):(Note: List sub-assembly or circuit designation and corresponding energy source classification)Example: Battery pack (maximum 85 watts): PS2Source of power or PIS Corresponding classification (PS)

All primary circuits and secondary circuits inside the equipment enclosure

PS3 , Arching PIS, Resistive PIS

Output terminal PS2

Injury caused by hazardous substances (Clause 7)(Note: Specify hazardous chemicals, whether produces ozone or other chemical construction not addressed as part of the component evaluation.)Example: Liquid in filled component Glycol

Source of hazardous substances Corresponding chemical

N/A N/A

Mechanically-caused injury (Clause 8)(Note: List moving part(s), fan, special installations, etc. & corresponding MS classification based on Table 35.)Example: Wall mount unit MS2

Source of kinetic/mechanical energy Corresponding classification (MS)

Equipment mass MS1

Sharp edges and corners MS1

Thermal burn injury (Clause 9)(Note: Identify the surface or support, and corresponding energy source classification based on type of part, location, operating temperature and contact time in Table 38.)Example: Hand-held scanner – thermoplastic enclosure TS1 Source of thermal energy Corresponding classification (TS)

Internal parts/circuits TS3

Accessible surfaces TS1

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2

ENERGY SOURCE IDENTIFICATION AND CLASSIFICATION TABLE:

Radiation (Clause 10)(Note: List the types of radiation present in the product and the corresponding energy source classification.)Example: DVD – Class 1 Laser Product RS1Type of radiation Corresponding classification (RS)

LED indicator RS1

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ENERGY SOURCE DIAGRAM

Indicate which energy sources are included in the energy source diagram. Insert diagram below

ES PS MS TS RS

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