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Plastic Fusion Inspections Form V.16 - 1/6/16
Plastic Fusion Inspections Form V.16 - 1/6/16
Charles Dvorak

Plastic Fusion Inspections Form V.16 - 1/6/16

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Free Plastic Fusion Inspections Form V.16 - 1/6/16 Checklist

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Title Page

  • Audit Title

  • Prepared by

  • Conducted on

Job/Fuser Information

  • Ticket or Layout Number

  • Ticket Number

  • Layout Number

  • Ticket Number

  • Layout Number

  • Address on Ticket

  • Inspector

    • Morrissey, Mike
    • Stone, Ashton
    • Titus, Mark
    • Quinones, Anthony
    • Di Leonardo, Lauraine
    • O'Brien, Jimmy
    • Franca, Louis
    • McBrien, Frank
    • Giraldi, Nat
    • Dvorak, Charlie

  • Company on Site

    • Con Edison
    • Bond Brothers
    • CAC
    • Creamer
    • Danella
    • ECI
    • Ferreira Construction
    • Hallen
    • Hawkeye
    • Manetta
    • MECC
    • MFM
    • Network
    • Persico Construction
    • Petmar
    • Posillico
    • Safeway
    • Stepmar
    • Triumph
    • Welkin Mech Co
    • Other

  • Please write in Company Name

  • Inspection Date

  • Inspection Time

  • County

  • Municipalities

    • A - Arsdey
    • B - Bronxville
    • BM - Briarcliff Manor
    • BU - Buchanan
    • C - Croton
    • CY - City of Yonkers
    • DF - Dobbs Ferry
    • E - Elmsford
    • H - Hastings
    • I - Irvington
    • L - Larchmont
    • MB - Mount Kisco Town of Bedford
    • MK - Mount Kisco
    • MM - Village of Mamaroneck
    • MN - Mount Kisco Town of New Castle
    • MP - Mount Pleasant
    • MR - Mamaroneck Town of Rye
    • MV - Mount Vernon
    • NC - New Castle
    • NO - North Castle
    • NP - North Pelham
    • NR - New Rochelle
    • NT - North Tarrytown
    • O - Ossining (Village)
    • P - Pelham
    • PC - Portchester
    • PK - Peelskill
    • PL - Pleasantville
    • PM - Pelham Manor
    • R - Village of Rye
    • RB - Rye Brook
    • S - Scarsdale
    • T - Tuckahoe
    • TB - Town of Bedford
    • TC - Town of Cortlandt
    • TE - Eastchester
    • TG - Town of Greenburgh
    • TH - Town of Harrison
    • TM - Town of Mamaroneck
    • TO - Town of Ossining
    • TR - Town of Rye
    • TS - Town of Somers
    • TT - Tarrytown
    • WP - City of White Plains.
    • YT - Town of Yorktown

  • M & S Plate

  • Pressure

Pipe Inspection

  • Is there fusion going on?

  • Picture Required

    • Add a Fuse

  • Joining Type

Butt Fuse

  • Hydraulic or Manual?

  • Straight or Coiled Pipe

  • Pipe Size

    • 1 1/4" IPS
    • 2 " IPS
    • 3" IPS
    • 4" IPS
    • 6" IPS
    • 8" IPS
    • 10" IPS
    • 12" IPS
    • 16" IPS

  • Did you witness fuse being performed?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Is the Fuser OQ'd in the correct Butt Fusion?

  • Automatic Failure

  • Is fusing equipment up to date on Inspection and Calibration?

  • Automatic Failure

  • Is Iron free of scratches and debris?

  • Automatic Failure

  • Was pipe properly cleaned?

  • Was the pipe marked for slippage?

  • Was the iron Temperature correct and verified?

  • Were the proper pressures used? (During Facing, Heating and Fusing)

  • Was the fuse signed by the Fuser?

  • Was the fuse peer inspected and signed by peer inspector?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Uniform Roll Back completely around pipe?

  • High/Low Okay?

  • Properly aligned pipe? (No miter Joints)

  • Is bead size sufficient for size of the pipe?

  • Fusion clear of any contamination?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Fuse fails visual inspection if any answer is no.

  • Is the Fuser OQ'd in Butt Fusion?

  • Uniform Roll Back completely around pipe?

  • High/Low Okay?

  • Properly aligned pipe? (No miter Joints)

  • Is bead size sufficient for size of the pipe?

  • Fusion clear of any contamination?

  • Was the fuse signed by the Fuser?

  • Was the fuse signed by the peer inspector?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Electrofuse

  • Type of Electrofuse?

  • Pipe Size

    • 1 1/4" IPS x 0.5" IPS
    • 2" IPS x 0.5" IPS
    • 2" IPS x 1" IPS
    • 2" IPS x 2" IPS
    • 3" IPS x 0.5" IPS
    • 3" IPS x 1" IPS
    • 3" IPS x 1 1/4" IPS
    • 3" IPS x 2" IPS
    • 4" IPS x 0.5" CTS
    • 4" IPS x 0.5" IPS
    • 4" IPS x 1" IPS
    • 4" IPS x 1 1/4" CTS
    • 4" IPS x 2" IPS
    • 6" IPS x 0.5" IPS
    • 6" IPS x 1" IPS
    • 6" IPS x 1 1/4" CTS
    • 6" IPS x 2" IPS
    • 8" IPS x 0.5" IPS
    • 8" IPS x 1" IPS
    • 8" IPS x 1 1/4" CTS
    • 8" IPS x 2" IPS
    • 10" IPS x 0.5" IPS
    • 10" IPS x 1" IPS
    • 10" IPS x 1" CTS
    • 10" IPS x 2" IPS
    • 12" IPS x 0.5 IPS
    • 12" IPS x 1" IPS
    • 12" IPS x 2" IPS

  • Did you witness fuse being performed?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Is Fuser properly OQ'd in Electrofusion Tee?

  • Automatic failure

  • Is fusing equipment current on inspections and calibrations?

  • Was the pipe and tee properly cleaned before scraping?

  • Was the pipe marked 1" past tee on both sides?

  • Was pipe properly scraped?

  • Was pipe cleaned after scraping?

  • Was tee properly secured to pipe with edges marked?

  • Was continuity verified?

  • Was fuse allowed proper amount of time to cool?

  • Was fuse marked with time to remove clamps?

  • Instruct Mechanic. Good work practice.

  • Was fuse signed by Fuser?

  • Was fuse inspected and signed by peer inspector?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Tee centered?

  • Any melt out?

  • Exposed electro fusion wire?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Fuse fails visual inspection if any answer is no.

  • Was Fuser properly OQ'd in Electrofusion Tee?

  • Automatic Failure

  • Is there evidence that pipe was scraped properly 1" past tee?

  • Is there evidence that fuse was marked 1" past tee?

  • Tee centered?

  • Any melt out?

  • Exposed electro fusion wire?

  • Did Fuser sign the fuse?

  • Was the Fuse signed by peer inspector?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2" CTS
    • 1" IPS
    • 1" CTS
    • 1 1/4" IPS
    • 1 1/4" CTS
    • 2" IPS
    • 3" IPS
    • 4" IPS
    • 6" IPS
    • 8" IPS
    • 10" IPS
    • 12" IPS
    • 16" IPS

  • Did you witness fuse being performed?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Is Fuser properly OQ'd in Electrofusion Coupling?

  • Automatic Failure

  • Is Fusing equipment current on inspections and calibration?

  • Automatic Failure

  • Was the pipe properly cleaned?

  • Was the stab mark properly made?

  • Was pipe properly scrapped?

  • Was pipe and coupling cleaned with alcohol wipe after scrapping?

  • Was the coupling properly centered?

  • Was coupling properly secured to pipe, and edges marked on pipe?

  • Was continuity verified?

  • Was fuse allowed proper amount of time to cool prior to handling?

  • Was fuse marked with the proper time to remove clamps

  • Was fuse signed by Fuser?

  • Was fuse peer checked and signed by peer inspector?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Fuse fails visual inspection if any answer is no.

  • Proper alignment?

  • Tee centered?

  • Any melt out?

  • Exposed electro fusion wire?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Fuse fails visual inspection if any answer is no.

  • Was Fuser properly OQ'd in Electrofusion Coupling?

  • Automatic Failure

  • Proper alignment?

  • Was pipe properly marked?

  • Was pipe properly scraped?

  • Was pipe inserted properly? (No Miter Joints)

  • Any melt out?

  • Exposed electro fusion wire?

  • Did the Fuser sign the pipe properly?

  • Was the fuse peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

  • Did you witness fuse being performed?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Is Fuser properly OQ'd in Electrofusion Coupling?

  • Automatic Failure

  • Is fusing equipment current on inspections and calibrations?

  • Automatic Failure

  • Was the pipe properly cleaned? Wiped with an alcohol wipe that meets standards?

  • Was the pipe marked 1" past fitting on both sides?

  • Was pipe properly scraped?

  • Was pipe and tee cleaned with alcohol wipe after scrapping?

  • Was tee properly secured to pipe, and edges marked on pipe?

  • Was continuity verified?

  • Was fuse allowed proper amount of time to cool?

  • Was fuse marked with time to remove clamps?

  • Instruct Mechanic. Good work practice.

  • Was fuse signed by Fuser?

  • Was fuse inspected and signed by peer inspector?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Any melt out?

  • Exposed electro fusion wire?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Fuse fails visual inspection if any answer is no.

  • Was Fuser properly OQ'd in Electrofusion Coupling?

  • Automatic Failure

  • Was pipe properly scraped?

  • Was pipe properly marked?

  • Any melt out?

  • Exposed electro fusion wire?

  • Did Fuser sign the fuse?

  • Was the Fuser peer checked and signed by peer inspector?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Mechanical

  • What type of mechanical fitting?

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

  • Did you witness connection being made?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Was mechanic properly OQ'd in Stab mechanical fittings?

  • Automatic Failure

  • Was pipe properly checked for imperfections?

  • Was the pipe properly cleaned?

  • Was pipe chamfered?

  • Was pipe properly measured and marked?

  • Was connection signed by OQ mechanic?

  • Was connection peer checked and signed?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Pass Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Was mechanic properly OQ'd in Stab Mechanical fittings?

  • Automatic Failure

  • Is pipe properly marked?

  • Did the OQ mechanic sign the pipe properly?

  • Was the connection peer checked and signed?

  • Any other visual indications of a poor connection observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

  • Did you witness connection being made?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Was mechanic properly OQ'd in Nut Follower mechanical fittings?

  • Automatic Failure

  • Was pipe visually inspected for imperfections?

  • Was the pipe properly cleaned?

  • Was pipe properly measured and marked?

  • Was Stiffener applied (if plastic)?

  • Was coupling tightened correctly (One bolt at a time)?

  • Was proper sized wrench used? (for proper torque)

  • Was connection signed by OQ Mechanic?

  • Was connection Peer Inspected and signed?

  • Any other indications that the connection process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Was Anode Bag installed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Pass Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Was mechanic properly OQ'd in Nut Follower Mechanical fittings?

  • If fuser is not qualified, then fuse needs to be cut out and redone.

  • Is there evidence pipe properly marked?

  • Was Anode Bag installed?

  • Did the OQ mechanic sign the pipe properly?

  • Was the connection peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

  • Did you witness connection being made?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Was mechanic properly OQ'd in Bolt (7/11) mechanical fittings?

  • Automatic Failure

  • Was pipe inspected for imperfections?

  • Was the pipe properly cleaned?

  • Was pipe properly measured and marked?

  • Was stiffener applied (if plastic)?

  • Was coupling tightened correctly (Star Pattern)?

  • Were Bolts properly Torqued?

  • Was connection signed by OQ Mechanic?

  • Was connection peer inspected and signed?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Was Anode Bag installed?

  • Was mastic coating applied?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Passed Visual Inspection?

  • Corrective Action?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Was mechanic properly OQ'd in Bolt (7/11) Mechanical fittings?

  • Automatic Failure

  • Is the pipe properly marked?

  • Was Anode Bag installed?

  • Was mastic coating applied?

  • Did the Fuser sign the pipe properly?

  • Was the fuse peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

  • Did you witness connection being made?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Was mechanic properly OQ'd in Compression (Metfit) mechanical fittings?

  • Automatic Failure

  • Was pipe inspected for imperfections?

  • Was pipe properly measured and marked?

  • Was pipe properly signed by OQ Mechanic?

  • Was connection peer inspected and signed?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Pass Inspection?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Was mechanic properly OQ'd in Compression (Metfit) Mechanical fittings?

  • Automatic Failure

  • Is the pipe properly marked?

  • Did the OQ Mechanic sign the pipe properly?

  • Was the connection peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

Saddle / Sidewall Fusion

  • WARNING Sidewall or Saddle Fusions can only be performed by the development lab

  • Type of Saddle Fusion?

  • Pipe Size

    • 1 1/4" IPS
    • 2 " IPS
    • 3" IPS
    • 4" IPS
    • 6" IPS
    • 8" IPS
    • 10" IPS
    • 12" IPS
    • 16" IPS

  • Did you witness fuse being performed?

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Is the Fuser OQ'd in Saddle Fusion?

  • Automatic Failure

  • Is fusing equipment up to date on Inspection and Calibration?

  • Automatic Failure

  • Is Iron free of scratches and debris?

  • Automatic Failure

  • Was Pipe probably supported?

  • Was the pipe and fitting properly scrapped?

  • Was the pipe and fitting properly cleaned?

  • Was the pipe marked with the proper pressures?

  • Were the correct temperatures used and verified?

  • We're correct pressures used? (During heat, heat soak, and fusion)

  • Was fuse allowed proper amount of time to cool?

  • Was the fuse signed by the Fuser?

  • Was the fuse peer inspected and signed by peer inspector?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Is there evidence of scraping?

  • Is there evidence of pressures marked on pipe?

  • Are there 3 uniform adequately sized beads with no sign that the iron slipped?

  • Is the fitting centered on pipe?

  • Fusion clear of any contamination?

  • Is the base of the tee level or above bead pattern?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Pass Inspection?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Is the Fuser OQ'd in saddle fusion?

  • Is there evidence of scraping?

  • Is there evidence of pressures marked on pipe?

  • Are there 3 uniform adequately sized beads with no sign that the iron slipped?

  • Is the fitting centered on pipe?

  • Fusion clear of any contamination?

  • Is the base of the tee level or above bead pattern?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

Process Inspection

  • Answer all if they performed the step without any prompting or Forced remediation

  • Is the Fuser OQ'd in Saddle Fusion?

  • Automatic Failure

  • Is fusing equipment up to date on Inspection and Calibration?

  • Automatic Failure

  • Is Iron free of scratches and debris?

  • Automatic Failure

  • Was Pipe probably supported?

  • Was the pipe and fitting properly scrapped?

  • Was the pipe and fitting properly cleaned?

  • Was the pipe marked with the proper pressures?

  • Were the correct temperatures used and verified?

  • We're correct pressures used? (During heat, heat soak, and fusion)

  • Was fuse allowed proper amount of time to cool?

  • Was the fuse signed by the Fuser?

  • Was the fuse peer inspected and signed by peer inspector?

  • Any other indications that the fusion process did not follow standards or procedures?

  • Passed Process Inspection?

  • Corrective Action?

Visual Inspection

  • Is there evidence of scraping?

  • Is there evidence of pressures marked on pipe?

  • Are there 3 uniform adequately sized beads with no sign that the iron slipped?

  • Is the fitting centered on pipe?

  • Fusion clear of any contamination?

  • Is the base of the tee level or above bead pattern?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Pass Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Fuser ID

  • Fuser Name

  • Fuser NGA QR Code

  • Peer Fuser

  • Peer Inspector Name

  • Peer Inspector NGA QR Code

  • F2F Unique ID #

  • Take a picture of the fuse

Preexisting Fuses

  • Are there any preexisting fuses that are not part of the current job?

    • Add a Preexisting Fuse

  • Joining Type

Butt Fuse

  • Pipe Size

    • 1 1/4" IPS
    • 2 " IPS
    • 3" IPS
    • 4" IPS
    • 6" IPS
    • 8" IPS
    • 10" IPS
    • 12" IPS
    • 16" IPS

Visual Inspection

  • Is there evidence that the pipe was properly marked?

  • Uniform Roll Back completely around pipe?

  • High/Low Okay?

  • Properly aligned pipe? (No miter Joints)

  • Is bead size sufficient for size of the pipe?

  • Fusion clear of any contamination?

  • Was the fuse signed by the Fuser?

  • Was the fuse signed by the peer inspector?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

Electrofuse

  • Type of Electrofuse?

  • Pipe Size

    • 1 1/4" IPS x 0.5" IPS
    • 2" IPS x 0.5" IPS
    • 2" IPS x 1" IPS
    • 2" IPS x 2" IPS
    • 3" IPS x 0.5" IPS
    • 3" IPS x 1" IPS
    • 3" IPS x 1 1/4" IPS
    • 3" IPS x 2" IPS
    • 4" IPS x 0.5" CTS
    • 4" IPS x 0.5" IPS
    • 4" IPS x 1" IPS
    • 4" IPS x 1 1/4" CTS
    • 4" IPS x 2" IPS
    • 6" IPS x 0.5" IPS
    • 6" IPS x 1" IPS
    • 6" IPS x 1 1/4" CTS
    • 6" IPS x 2" IPS
    • 8" IPS x 0.5" IPS
    • 8" IPS x 1" IPS
    • 8" IPS x 1 1/4" CTS
    • 8" IPS x 2" IPS
    • 10" IPS x 0.5" IPS
    • 10" IPS x 1" IPS
    • 10" IPS x 1" CTS
    • 10" IPS x 2" IPS
    • 12" IPS x 0.5 IPS
    • 12" IPS x 1" IPS
    • 12" IPS x 2" IPS

Visual Inspection

  • Is there evidence that the pipe was properly marked?

  • Is there evidence that the pipe was properly scraped?

  • Is fuse signed by fused?

  • Was fuse inspected and signed by peer inspector?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2" CTS
    • 1" IPS
    • 1" CTS
    • 1 1/4" IPS
    • 1 1/4" CTS
    • 2" IPS
    • 3" IPS
    • 4" IPS
    • 6" IPS
    • 8" IPS
    • 10" IPS
    • 12" IPS
    • 16" IPS

Visual Inspection

  • Proper alignment?

  • Is there evidence that the pipe was properly marked?

  • Is there evidence that the pipe was properly scraped?

  • Was pipe inserted properly? (No Miter Joints)

  • Is fuse signed by fused?

  • Was the fuse peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1 1/4" IPS x 0.5" IPS
    • 2" IPS x 0.5" IPS
    • 2" IPS x 1" IPS
    • 2" IPS x 2" IPS
    • 3" IPS x 0.5" IPS
    • 3" IPS x 1" IPS
    • 3" IPS x 1 1/4" IPS
    • 3" IPS x 2" IPS
    • 4" IPS x 0.5" CTS
    • 4" IPS x 0.5" IPS
    • 4" IPS x 1" IPS
    • 4" IPS x 1 1/4" CTS
    • 4" IPS x 2" IPS
    • 6" IPS x 0.5" IPS
    • 6" IPS x 1" IPS
    • 6" IPS x 1 1/4" CTS
    • 6" IPS x 2" IPS
    • 8" IPS x 0.5" IPS
    • 8" IPS x 1" IPS
    • 8" IPS x 1 1/4" CTS
    • 8" IPS x 2" IPS
    • 10" IPS x 0.5" IPS
    • 10" IPS x 1" IPS
    • 10" IPS x 1" CTS
    • 10" IPS x 2" IPS
    • 12" IPS x 0.5 IPS
    • 12" IPS x 1" IPS
    • 12" IPS x 2" IPS

Visual Inspection

  • Fuse fails visual inspection if any answer is no.

  • Is there evidence that the pipe was properly marked?

  • Proper alignment?

  • Is there evidence that the pipe was properly scraped?

  • Was pipe inserted properly? (No Miter Joints)

  • Is pipe signed by fused?

  • Was the Fuser peer checked and signed by peer inspector?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

Mechanical

  • What type of mechanical fitting?

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

Visual Inspection

  • Was mechanic properly OQ'd in Stab Mechanical fittings?

  • Automatic Failure

  • Is pipe properly marked?

  • Is pipe signed by joiner?

  • Was the connection peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

Visual Inspection

  • Is there evidence that the pipe was properly marked?

  • Was Anode Bag installed?

  • Is pipe signed by joiner?

  • Was the connection peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

Visual Inspection

  • Is there evidence that the pipe was properly marked?

  • Was Anode Bag installed?

  • Was mastic coating applied?

  • Is pipe signed by joiner?

  • Was the fuse peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Pipe Size

    • 1/2"
    • 1"
    • 1 1/4"
    • 1 1/2"
    • 2"
    • 3"
    • 4"
    • 6"
    • 8"
    • 10"
    • 12"
    • 16"

Visual Inspection

  • Is there evidence that the pipe was properly marked?

  • Is pipe signed by joiner?

  • Was the fuse peer checked and signed?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Passes Visual Inspection?

  • Please Enter Comments. Include what Actions taken.

Visual Inspection

  • Is there evidence of scraping?

  • Is there evidence of pressures marked on pipe?

  • Are there 3 uniform adequately sized beads with no sign that the iron slipped?

  • Is the fitting centered on pipe?

  • Fusion clear of any contamination?

  • Is the base of the tee level or above bead pattern?

  • Any other visual indications of a poor fuse observed? If yes, please make documentation below

  • Fuse Pass Inspection?

  • Please Enter Comments. Include what Actions taken.

  • Fuser ID

  • Peer Fuser

  • Take a picture of the fuse

Plastic Fusion Inspections Form V.16 - 1/6/16
Charles Dvorak

Plastic Fusion Inspections Form V.16 - 1/6/16

Use this Template
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. You should independently determine whether the template is suitable for your circumstances.

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