Title Page
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Audit Title
Job/Fuser Information
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Ticket Number
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Address on Ticket
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Company on Site
- Con Edison
- Bond Brothers
- CAC
- Creamer
- Danella
- ECI
- ECU
- Ferreira Construction
- Hallen
- Hawkeye
- Manetta
- MECC
- MFM
- Network
- PCT
- Persico Construction
- Petmar
- Posillico
- Safeway
- Stepmar
- Triumph
- Welkin Mech Co
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Inspection Date
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Inspection Time
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County
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M & S Plate
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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 - Tuckshoe
- TB - Town of Bedford
- TV - 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
- Town of Yorktown
- City of White Plains.
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Pressure
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Year Installed
Pipe Inspection
- Add a Fuse
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Joining Type
Butt Fuse
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Pipe Size
- 1 1/4" IPS
- 2 " IPS
- 3" IPS
- 4" IPS
- 6" IPS
- 8" IPS
- 10" IPS
- 12" IPS
- 16" IPS
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Did you witness fuse being performed?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Is the Fuser OQ'd in the correct Butt Fusion?
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Automatic Failure
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Is fusing equipment up to date on Inspection and Calibration?
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Automatic Failure
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Is Iron free of scratches and debris?
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Automatic Failure
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Was pipe properly cleaned?
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Was the pipe marked for slippage?
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Was the iron Temperature checked?
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We're the correct temperatures used?
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Were the proper pressures used? (During Facing, Heating and Fusing)
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Was the fuse signed by the Fuser?
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Was the fuse peer inspected and signed by peer inspector?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments. Include what actions taken.
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Did you perform a visual inspection on this fuse?
Visual Inspection
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Fuse fails visual inspection if any answer is no.
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Is the Fuser OQ'd in Butt Fusion?
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Uniform Roll Back completely around pipe?
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High/Low Okay?
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Properly aligned pipe? (No miter Joints)
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Is bead size sufficient for size of the pipe?
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Fusion clear of any contamination?
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Was the fuse signed by the Fuser?
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Was the fuse signed by the peer inspector?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
Electrofuse
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Type of Electrofuse?
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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"
- 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 1 1/4" CTS
- 8" IPS x 2" IPS
- 8" IPS x 0.5" IPS
- 8" IPS x 1" 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
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Did you witness fuse being performed?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Is Fuser properly OQ'd in Electrofusion Tee?
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Is fusing equipment current on inspections and calibrations?
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Was the pipe properly cleaned? Wiped with an alcohol wipe that meets standards?
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Was the pipe marked 1" past tee on both sides?
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Was pipe properly scraped?
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Was pipe and tee cleaned with alcohol wipe after scrapping?
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Was tee properly secured to pipe, and edges marked on pipe?
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Was continuity verified?
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Was fuse allowed proper amount of time to cool?
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Was fuse marked with time to remove clamps?
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Instruct Mechanic. Good work practice.
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Was fuse signed by Fuser?
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Was fuse inspected and signed by peer inspector?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments. Include what actions taken.
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Did you perform a visual inspection of this fuse?
Visual Inspection
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Fuse fails visual inspection if any answer is no.
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Was Fuser properly OQ'd in Electrofusion Tee?
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Automatic Failure
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Was pipe properly scraped?
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Was pipe properly marked?
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Did Fuser sign the fuse?
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Was the Fuser peer checked and signed by peer inspector?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
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Pipe Size
- 1" IPS
- 1 1/4" IPS
- 2" IPS
- 3" IPS
- 4" IPS
- 6" IPS
- 8" IPS
- 10" IPS
- 12" IPS
- 16" IPS
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Did you witness fuse being performed?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Is Fuser properly OQ'd in Electrofusion Coupling?
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Automatic Failure
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Is Fusing equipment current on inspections and calibration?
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Automatic Failure
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Was the pipe properly cleaned?
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Was the stab mark properly made?
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was the coupling properly centered?
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Was pipe properly scrapped?
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Was pipe and coupling cleaned with alcohol wipe after scrapping?
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Was coupling properly secured to pipe?
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Was continuity verified?
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Was fuse allowed proper amount of time to cool prior to handling?
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Was fuse allowed was fuse marked with time to remove clamp?
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Was fuse signed by Fuser?
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Was fuse peer checked and signed by peer inspector?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments
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Did you perform a visual inspection of this fuse?
Visual Inspection
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Fuse fails visual inspection if any answer is no.
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Was Fuser properly OQ'd in Electrofusion Coupling?
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Automatic Failure
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Proper alignment?
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Was pipe properly marked?
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Was pipe properly scraped?
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Was pipe inserted properly? (No Miter Joints)
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Did the Fuser sign the pipe properly?
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Was the fuse peer checked and signed?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
Mechanical
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What type of mechanical fitting?
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Pipe Size
- 1/2"
- 1"
- 1 1/4"
- 1 1/2"
- 2"
- 3"
- 4"
- 6"
- 8"
- 10"
- 12"
- 16"
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Did you witness connection being made?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Was mechanic properly OQ'd in Stab mechanical fittings?
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Automatic Failure
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Was pipe properly checked for imperfections?
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Was the pipe properly cleaned?
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Was pipe chamfered?
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Was pipe properly measured and marked?
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Was connection signed by OQ mechanic?
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Was connection peer checked and signed?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments
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Did you perform a visual inspection on this connection?
Visual Inspection
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Was mechanic properly OQ'd in Stab Mechanical fittings?
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Automatic Failure
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Is pipe properly marked?
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Did the OQ mechanic sign the pipe properly?
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Was the connection peer checked and signed?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
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Pipe Size
- 1/2"
- 1"
- 1 1/4"
- 1 1/2"
- 2"
- 3"
- 4"
- 6"
- 8"
- 10"
- 12"
- 16"
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Did you witness connection being made?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Was mechanic properly OQ'd in Nut Follower mechanical fittings?
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Automatic Failure
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Was pipe visually inspected for imperfections?
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Was the pipe properly cleaned?
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Was pipe properly measured and marked?
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Was Stiffener applied (if plastic)?
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Was coupling tightened correctly (One bolt at a time)?
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Was proper sized wrench used? (for proper torque)
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Was connection signed by OQ Mechanic?
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Was connection Peer Inspected and signed?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments
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Did you perform a visual inspection on this connection?
Visual Inspection
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Was mechanic properly OQ'd in Nut Follower Mechanical fittings?
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If fuser is not qualified, then fuse needs to be cut out and redone.
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Is pipe properly marked?
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Was Anode Bag installed?
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Did the OQ mechanic sign the pipe properly?
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Was the connection peer checked and signed?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
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Pipe Size
- 1/2"
- 1"
- 1 1/4"
- 1 1/2"
- 2"
- 3"
- 4"
- 6"
- 8"
- 10"
- 12"
- 16"
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Did you witness connection being made?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Was mechanic properly OQ'd in Bolt (7/11) mechanical fittings?
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Automatic Failure
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Was pipe inspected for imperfections?
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Was the pipe properly cleaned?
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Was pipe properly measured and marked?
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Was stiffener applied (if plastic)?
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Was coupling tightened correctly (Star Pattern)?
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Were Bolts properly Torqued?
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Was connection signed by OQ Mechanic?
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Was connection peer inspected and signed?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments
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Did you perform a visual inspection on this connection?
Visual Inspection
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Was mechanic properly OQ'd in Bolt (7/11) Mechanical fittings?
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Automatic Failure
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Is the pipe properly marked?
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Was Anode Bag installed?
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Was mastic coating applied?
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Did the Fuser sign the pipe properly?
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Was the fuse peer checked and signed?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
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Pipe Size
- 1/2"
- 1"
- 1 1/4"
- 1 1/2"
- 2"
- 3"
- 4"
- 6"
- 8"
- 10"
- 12"
- 16"
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Did you witness connection being made?
Process Inspection
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Answer all if they performed the step without any prompting or Forced remediation
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Was mechanic properly OQ'd in Compression (Metfit) mechanical fittings?
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Automatic Failure
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Was pipe inspected for imperfections?
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Was pipe properly measured and marked?
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Was pipe properly signed by OQ Mechanic?
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Was connection peer inspected and signed?
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Was connection signed by OQ Mechanic?
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Was connection peer inspected and signed?
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Any other indications that the fusion process did not follow standards or procedures?
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Fuse Passed Process Inspection?
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Please enter comments
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Did you perform a visual inspection on this connection?
Visual Inspection
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Was mechanic properly OQ'd in Compression (Metfit) Mechanical fittings?
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Automatic Failure
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Is the pipe properly marked?
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Did the Fuser sign the pipe properly?
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Was the fuse peer checked and signed?
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Any other visual indications of a poor fuse observed? If yes, please make documentation below
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Fuse Passes Visual Inspection?
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Please Enter Comments. Include what Actions taken.
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Fuser ID
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Peer Fuser
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Take a picture of the fuse
