\begin
Discover why over 20 million people worldwide trust Overleaf with their work.
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\begin{document}
{\large\textbf{Betriebsmittelprüfprotokoll} } \\
\indent {zur Wiederholungsprüfung elektrischer Geräte}
\vspace{0.02\textwidth}
\begin{tabularx}{\textwidth}{|p{0.15\textwidth}|p{0.325\textwidth}|p{0.15\textwidth}|p{0.325\textwidth}|}
\hline
\multicolumn{2}{|p{0.475\textwidth}|}{
Prüfer
} &
\multicolumn{2}{p{0.475\textwidth}|}{
Betrieb (Auftraggeber)
} \\
\multicolumn{2}{|p{0.475\textwidth}|}{} &
\multicolumn{2}{p{0.475\textwidth}|}{} \\
\multicolumn{2}{|p{0.475\textwidth}|}{} &
\multicolumn{2}{p{0.475\textwidth}|}{} \\
\hline
\multicolumn{2}{|p{0.475\textwidth}|}{
\textbf{Auftragsnummer}:
} &
\multicolumn{2}{p{0.475\textwidth}|}{
\textbf{Kundennummer}:
} \\
\hline
\multicolumn{4}{|p{0.9\textwidth}|}{\rule{0pt}{15pt}Prüfung nach: \makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\hspace{0.01\textwidth} DGUV V3\hspace{0.01\textwidth} \makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}$\checkmark$} DIN VDE 0702}\\[1.5ex]
\hline
\multicolumn{4}{|l|}{\rule{0pt}{15pt}\textbf{Elektrisches Gerät}: } \\[.25ex]
% ----
\multicolumn{1}{|l}{
Typ
} &
\multicolumn{1}{l}{
\rule{0.275\textwidth}{0.05mm}
} &
\multicolumn{1}{|l}{
Nennspannung
} &
\multicolumn{1}{l|}{
\rule{0.25\textwidth}{0.05mm} V
} \\
% ----
\multicolumn{1}{|l}{
Hersteller
} &
\multicolumn{1}{l}{
\rule{0.275\textwidth}{0.05mm}
} &
\multicolumn{1}{|l}{
Nennstrom
} &
\multicolumn{1}{l|}{
\rule{0.25\textwidth}{0.05mm} A
} \\
% ----
\multicolumn{1}{|l}{
Fabriknr.
} &
\multicolumn{1}{l}{
\rule{0.275\textwidth}{0.05mm}
} &
\multicolumn{1}{|l}{
Nennleistung
} &
\multicolumn{1}{l|}{
\rule{0.25\textwidth}{0.05mm} W
} \\
% ----
\multicolumn{1}{|l}{
Inventarnr.
} &
\multicolumn{1}{l}{
\rule{0.275\textwidth}{0.05mm}
} &
\multicolumn{1}{|l}{
Frequenz
} &
\multicolumn{1}{l|}{
\rule{0.25\textwidth}{0.05mm} Hz
} \\
% ----
\multicolumn{1}{|l}{
Schutzklasse
} &
\multicolumn{1}{l}{
\rule{0.275\textwidth}{0.05mm}
} &
\multicolumn{1}{|l}{
} &
\multicolumn{1}{l|}{
} \\
% ----
\multicolumn{1}{|l}{
Baujahr
} &
\multicolumn{1}{l}{
\rule{0.275\textwidth}{0.05mm}
} &
\multicolumn{1}{|l}{
Phasen
} &
\multicolumn{1}{l|}{
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\hspace{0.01\textwidth} 1-polig\hspace{0.04\textwidth} \makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\hspace{0.01\textwidth} 3-polig
} \\[1.25ex]
\hline
\end{tabularx}
\vspace{0.01\textwidth}
\begin{tabularx}{\textwidth}{|p{0.35\textwidth}| p{0.184\textwidth}|p{0.184\textwidth}|p{0.184\textwidth}|}
\hline
\rule{0pt}{15pt}\textbf{Sichtprüfung} & \raggedleft\arraybackslash \scriptsize{i.O.} & \cellcolor{gray!10}\raggedleft\arraybackslash \scriptsize{i.O.} & \raggedleft\arraybackslash \scriptsize{i.O.} \\[.25ex]
{\scriptsize Zustand Isolierungen %(unbesch., Knicke, Einsch.)
} & \raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Keine Schmorstellen} & \raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Auswahl/Anwendung von Leitungen} &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Netzstecker, Klemmen, Adern, Pins} &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Biegeschutz } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Zugentlastung der Anschlussleitung } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Befestigungen und Leitungshalterungen } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Gehäuse, Abdeckungen (Risse, Besch.) } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Luftfilter } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Dichtigkeit von Behältern } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,&
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Bedienbarkeit von Steuereinrichtungen } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,&
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,&
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Lesbarkeit sicherheitsrel. Aufschr. } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,&
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
\hline
\rule{0pt}{15pt}\textbf{Messung} & \scriptsize{Messwert} & \cellcolor{gray!10}\scriptsize{Messwert} & \scriptsize{Messwert} \\[.25ex]
{\scriptsize Schutzleiterwiderstandsmessung } &
\rule{0.1\textwidth}{0.05mm}\,\,\,\, $\Omega$
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\rule{0.1\textwidth}{0.05mm}\,\,\,\, $\Omega$
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\rule{0.1\textwidth}{0.05mm}\,\,\,\, $\Omega$
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\
{\scriptsize Isolationswiderstandsmessung } &
\rule{0.1\textwidth}{0.05mm}\hspace{0.5mm} M$\Omega$ \makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\cellcolor{gray!10}\rule{0.1\textwidth}{0.05mm}\hspace{0.5mm} M$\Omega$
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\rule{0.1\textwidth}{0.05mm}\hspace{0.5mm} M$\Omega$
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\\
{\scriptsize Schutzleiterstrommessung } &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\cellcolor{gray!10}\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\\
{\scriptsize Berührungsstrommessung } &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\cellcolor{gray!10}\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\\
{\scriptsize Fehlerstromschutz FI Auslösestrom } &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\cellcolor{gray!10}\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} mA
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\\
{\scriptsize Fehlerstromschutz FI Auslösezeit } &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} ms
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\cellcolor{gray!10}\rule{0.1\textwidth}{0.05mm}\hspace{1mm} ms
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}} &
\rule{0.1\textwidth}{0.05mm}\hspace{1mm} ms
\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\\
% ----
\hline
\rule{0pt}{15pt}\textbf{Funktion} & \raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,&
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,&
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\,\\[.25ex]
\hline
\rule{0pt}{15pt}\textbf{Prüfplakette} & \raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\[.25ex]
{\scriptsize Nächster Prüftermin } &
\rule{0.15\textwidth}{0.05mm} &
\cellcolor{gray!10}\rule{0.15\textwidth}{0.05mm} &
\rule{0.15\textwidth}{0.05mm}
\\
\hline
\rule{0pt}{15pt}\textbf{Hinweise} & &\cellcolor{gray!10} &
\\[.25ex]
{\scriptsize Keine Mängel } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Mängel durch Reparatur beseitigt } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Auf Mängel wurde hingewiesen } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
{\scriptsize Gerät nicht weiter verwenden } &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\cellcolor{gray!10}\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, &
\raggedleft\arraybackslash\makebox[0pt][l]{$\square$}\raisebox{.15ex}{\hspace{0.1em}}\,\,\,\,\,\,\, \\
\scriptsize{Bemerkungen} & &\cellcolor{gray!10} &
\\
&
&\cellcolor{gray!10}
& \\
\hline
\rule{0pt}{15pt}\textbf{Verwendetes Messgerät} & &\cellcolor{gray!10} &
\\[.25ex]
\hline
\rule{0pt}{15pt}\textbf{Dokumentation} & &\cellcolor{gray!10} &
\\[.25ex]
{\scriptsize Ort } &
\rule{0.175\textwidth}{0.05mm} &
\cellcolor{gray!10}\rule{0.175\textwidth}{0.05mm} &
\rule{0.175\textwidth}{0.05mm}
\\
{\scriptsize Datum } &
\rule{0.175\textwidth}{0.05mm} &
\cellcolor{gray!10}\rule{0.175\textwidth}{0.05mm} &
\rule{0.175\textwidth}{0.05mm}
\\
{\scriptsize Unterschrift des Prüfers } &
\rule{0.175\textwidth}{0.05mm} &
\cellcolor{gray!10}\rule{0.175\textwidth}{0.05mm} &
\rule{0.175\textwidth}{0.05mm}
\\
\hline
\end{tabularx}
\pagestyle{empty}
\newcommand{\teilnehmer}{Hans Mustermann (Dozent), Stud Ying (Student)} %Teilnehmer der Besprechung
\newcommand{\nrb}{1.} % nte BEsprechung
\newcommand{\titel}{Weichendiagnose} % Titel der Arbeit
\newcommand{\datum}{Montag, 13.10.2014} % Datum der Besprechung
\newcommand{\institut}{Schule} % Schule
%\par \today \par
\end{document}