Colorado Natural Gas Butt Fusion/ Tap Tee Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Contractor

• Installed By(Company Name)

  Yes

  No

  N/A

• Installed By (employee Name)

  Yes

  No

  N/A

Location

• Address

• Latitude/Longitude

Date - Time

• Select date

  Date

Specific task being Inspected

• Butt Fusion

  Yes

  No

  N/A

• Add media

  Media

• Saddle Tap Tee

  Yes

  No

  N/A

• Add media

  Media

Pipeline type

• Add media

  Media

• Pipeline Size

• Pipeline Type

• Visual scrape marks present

  Yes

  No

  N/A

• Add media

  Media

• Fuser Initial or Other Markings

  Yes

  No

  N/A

• Add media

  Media

• Bead Size

  Yes

  No

  N/A

• Correct beads on saddle tap base

  Yes

  No

  N/A

• Proper Pipe alignment

  Yes

  No

  N/A

• Add media

  Media

• Add media

  Media

Visual Inspection

• Pass Visual inspection per ASTM 2620-13

  Yes

  No

  N/A

Pipeline Safety

• Was exposed pipeline report completed

  Yes

  No

  N/A

• Caution tape present

  Yes

  No

  N/A

• Add media

  Media

• Tracer wire present

  Yes

  No

  N/A

• Add media

  Media

Damage found as a result of initial installation

• Add media

  Media

Additional Comments

• Third Party Inspector:

  Sign

• Certified inspector

  Sign

• Certified inspector

  Sign