Colorado Natural Gas Electrofusion Coupling/Saddle Tee Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Contractor

• Installed By ( Contractor)

• Installed By (Employee Name)

Location

• Address

• Longitude/latitude

Date - Time

• Select date

  Date

Specific task being Inspected

• Electrofusion Coupling

  Yes

  No

  N/A

• Add media

  Media

• Electrofusion 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

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