Phone

(###)

###

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Projected Test Date

MM

DD

YYYY

TESTING TYPE REQUIRED *

Check all that apply

Shock (MIL-DTL-901E)

Vibration (MIL-STD-167)

Noise

Pitch & Roll

Analysis

Shock Testing Category *

Refer to MIL-DTL-901E

Lightweight

Medium Weight

Heavyweight (any item that is deck mounted onboard ship and installed with resilient mounts must be heavyweight)

Shock Testing Equipment Class *

Refer to MIL-DTL-901E

I (without resilient mounts)

II (with resilient mounts)

III (shipboard applications both with and without resilient mounts)

Shock Testing Mounting Location Aboard Ship *

Hull

Shell

Wetted Surface

Deck (If chosen, then follow up question below)

Shock Testing Frequency (in Hz) *

Refer to MIL-DTL-901E

8-10

12-16

>25

Shock Testing Shock Grade *

Refer to page 2 of MIL-S-901D

A. Must maintain functionality and not be a hazard

B. Operation of equipment not essential; must not be a hazard

Shock Testing Type *

Refer to page 4 of MIL-S-901D

A. (principal unit)

B. (subsidiary component)

C. (subassembly)

Shock Testing Mounting Plane Aboard Ship *

Unrestricted

Restricted

Verticle Axis Specified

Security requirements while at HI-TEST? *

Yes (If yes, customer must provide DD254 prior to receipt of equipment or sensitive documents)

No

Hazardous materials during operation/testing at HI-TEST *

Yes (If yes, please upload MSDS sheet)

No