Industrial Customer PQ Incident Inquiry Step 1 of 5 20% Customer InformationCompany*Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact Name* First Last Telephone #:*Email Address* Please Answer the Following:Have you contacted anyone at Bluewater Power about this event(s) before?* Yes No If Yes, enter the name of the person you contacted:* Details of the Event:Date of Event:* YYYY slash MM slash DD Time* : Hour Min AM PM AM/PM Last Known Occurrence:* MM slash DD slash YYYY Please tell us how often the event or anomaly occurs:*Once a WeekOnce a MonthOnce a QuarterOnce a YearIs the same equipment affected each time a power quality event occurs?* Yes No Please tell us what power equipment is effected by the event(s):*Computer Type EquipmentVariable Speed DrivesOther Please tell us if any were applicable at the time of event:New Equipment installed at your site?* Yes No Changes in processes (i.e. increase load) at your site? Yes No Changes in operations / business cycle (i.e. daily to 24 hour shifts) at your site?* Yes No Other: On the following scale, tell us how much the events(s) impact your business:Time to restore operation after business:* 1 (No Impact) 2 3 4 (Severe Impact) Impact to restore operation after event:* 1 (No Impact) 2 3 4 (Severe Impact) Effect on health, safety, or environment:* 1 (No Impact) 2 3 4 (Severe Impact) Other Impacts:* 1 (No Impact) 2 3 4 (Severe Impact) Please describe other:Would you like a copy of this form emailed to you?* No Yes Which e-mail should we send it to?*