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Sr.No.:-
Date:-
Questionnaire for Failure Investigation
*Strike off whichever is not applicable.
GENERAL DETAILS
Application Engg./Perfomance Comp.Case No. :
Customer Name :
Address :
Code :
Telephone :
Contact Person :
Telefax :
Designation :
Fax :
EQUIPMENT DETAILS
Supply :Direct/Aid
AID Name :
Machine Description :
Manufacturer :
Drive :
(Direct /Belt-pulley driven)
Rpm :
Use Period :
Code :
Kw :
OPERATING DATA
Bearing Details :
1)Markings On The Bearing :
 Inner Ring :_________________________________________ Country ___________
 Outer Ring :
Of Origin :
2)No. Of Rolling Elements :
3)Cage Type :
Steel/Brass/Polyamide(Plastic)/Textile
4)Cage Guidance : Inner/Outer/Rolling Element
LOAD DETAILS
1)Radial(Kg Or N) :
2)Axial(Kg Or N) :
3)Type Of Load : Constant/Variable/Vibratory/Intermittent/Periodic
Note: Provide matrix where necessary.(load x time)
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OTHER DETAILS
1)Speed(Rpm) :
Variable/Constant
Note: If variable than give min/max value or matrix.
2)Fits :
Shaft Fits :
3)Sealing Arrangement :
Felt/Oil Seal/Labyrinth/Double Lip/O Ring/Others
Housing Fits :
LUBRICATION DETAILS
1)Grease/Oil :____________________________________
Brand
:____________________________________
2)Specification :
 Viscosity At 40/100ºC :____________________
 NLGI Class
:___________________
 Speed Parameter(N.dm) :____________________
 Operating Temperature Range(Min/Max) :
Min :______________ Max :_________________
Note :Refer manufacturer’s manual.
3)Relubrication Interval(Hr/days) :
4)If Oil Lubrication :
Oil Sump/Oil Circulation/Oil Mist
5)Relubrication Quantity :
6)Relubrication Method :
OPERATING TEMPERATURE
1)Min/Max/Stabilized(Measured Values) : _____________________
_____________________
_____________________
2)Measured At : Inner Ring/Outer Ring/Mating Parts
VIBRATION LEVEL
1)Instrument Used :____________________________
Type : _______________________________________
Make : _______________________________________
2)How Many Measurements Are Taken :__________
Measured at :________________________________
3)Recorded Values :
Velocity(mm/sec)
: _____________________
Acceleration(mm/sec² ) : _____________________
Displacement(mm)
: _____________________
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SURROUNDING CONDITIONS
1)Atmospheric Temperature : (ºC / ºF ) :
Min:
2)Contamination Level : High/Moderate/Low
3)Type Of Contamination : Solid/Liquid/Gas
Give brief inf about the source of Contamination:
Max:
HISTORY OF FAILURE
1)Nature Of Failure :
2)Any Observations Before Failure Notice :
Audible/High Vibrations/High Temperature/High
Current/Change In Machine Efficiency/High Consumption
Of Lubricant,etc.
3)Outcome Of Previous 3 Failures :
I.Date : __________ Symptoms :_________________
II.Date :___________Symptoms :_________________
III.Date :___________Symptoms :_________________
4)Changes Made In Past Before Failure:
Electrical
:________________________________
Mechanical :_________________________________
Lubricant :_________________________________
Functional/ Basic configuration(other electrical &
mechanical changes to improve the output): :
_____________________________________________
PRELIMINARY OBSERVATION
1)Condition Of The Failed Bearing :
2)Observation Of The Mating Components :
3)Seals If Any : Internal/External
4)Cage Condition :
5)Lubricant :
Prepared by: __________________________ Person responsible : ___________________________
at FAG Vadodara
Date
: ______________
Date: _______________
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