• Installed By(Company Name)

  • Installed By (employee Name)


  • Address

  • Latitude/Longitude

Date - Time

  • Select date

Specific task being Inspected

  • Butt Fusion

  • Add media

  • Saddle Tap Tee

  • Add media

Pipeline type

  • Add media

  • Pipeline Size

  • Pipeline Type

  • Visual scrape marks present

  • Add media

  • Fuser Initial or Other Markings

  • Add media

  • Bead Size

  • Correct beads on saddle tap base

  • Proper Pipe alignment

  • Add media

  • Add media

Visual Inspection

  • Pass Visual inspection per ASTM 2620-13

Pipeline Safety

  • Was exposed pipeline report completed

  • Caution tape present

  • Add media

  • Tracer wire present

  • Add media

Damage found as a result of initial installation

  • Add media

Additional Comments

  • Third Party Inspector:

  • Certified inspector

  • Certified inspector

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.