Piping Insulation QA/QC

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Compliance Verification NOTE: Reported nonconformances and incomplete items in the Follow-Up section

• Compliance with safety policies and procedures

  Off

  On

• Compliance with material inspection and tests

  Off

  On

• Compliance with initial job ready requirements

  Off

  On

Heightened awareness check points based on Spec

• Proper material type

  Meets Requirements

  Does Not Meet Requirements

  Not Applicable

• Proper material thickness

  Meets Requirements

  Does Not Meet Requirements

  Not Applicable

• Fittings/Valves installed properly

  Meets Requirements

  Does Not Meet Requirements

  Not Applicable

• Vapor Sealed if required

  Yes

  No

  N/A

• If jacketing is required

  Meets Requirements

  Does Not Meet Requirements

  Not Applicable

Field Management Quality and Completion Scores

• Quality of Work

• ON-Time

• Safety of Site

• Quality Score: 5= 100% NO Problems 4= 1 minor problem 3= Hotspot or 2-3 minor problems 2= 6+ or major problems 1= Excessive problems
  
  ON-Time Score : 5= On Time 4= Late 3= Late by 1 day 2= Late by 2 days 1= Late by more than 2 days
  
  Safety Score: 5= 100% NO Problems 4= 1 minor problem 3= Hotspot or 2-3 minor problems 2= 4+ or major problems 1= Injury
  
  

• Print and Sign

  Sign

• Cell#/ID#