LISN Type/Inductance:

# of Line/Neutral Conductors:

LISN Description:

Test Lead Selection Mechanism (check all that apply):

Local Switch

Remote Switch

N/A

Other

If the LISN is equipped with any features, such as an RF filter, transient limiter or attenuation pad that can be enabled/disabled via a switch or other means, please check all that apply below:

High Pass/Low-Pass/Band-Pass Filter

Transient Limiter

Attenuation Pad

SECTION C -CALIBRATION INFORMATION

Calibration Standard(s) (check all that apply):

ANSI C63.4:

CISPR 16-1-2:

CISPR 25:

Mil-Std-461:

RTCA DO-160:

Other(s) (specify):

Note: For any standards or specifications listed under ‘other’ above, please provide the referenced document, containing the relevant information necessary for performing the calibrations, such as applicable limits, test setup diagrams and/or calibration procedures.

Frequency Range of Calibration:

Start Frequency:

Stop Frequency:

Calibration(s) Requested (check all that apply):

Impedance

Phase

Insertion Loss/Voltage Division Factor

Isolation

Special Instructions:

LISN Calibration Request Form

SECTION A -CUSTOMER/RETURN SHIPPING INFORMATION

TECHNICAL CONTACT

PURCHASING CONTACT

RETURN SHIPPING INFORMATION

SECTION B -LISN INFORMATION

TABLE 1 -STANDARD CALIBRATION SERVICES

SECTION C -CALIBRATION INFORMATION

Frequency Range of Calibration: