Job/Fuser Information

Ticket or Layout Number

Ticket Number

Layout Number

Address on Ticket
Inspector
Company on Site

Please write in Company Name

Inspection Date
Inspection Time

County

Municipalities

M & S Plate

Pressure

Pipe Inspection

Add a Fuse

Joining Type

Butt Fuse
Pipe Size

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 checked?

Were the correct temperatures used?

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?

Fuse Passed Process Inspection?

Please enter comments. Include what actions taken.

Did you perform a visual inspection on this fuse?

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

Fuse Passes Visual Inspection?

Please Enter Comments. Include what Actions taken.

Electrofuse

Type of Electrofuse?

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 Tee?

Is fusing equipment current on inspections and calibrations?

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

Was the pipe marked 1" past tee 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?

Fuse Passed Process Inspection?

Please enter comments. Include what actions taken.

Did you perform a visual inspection of this fuse?

Visual Inspection

Fuse fails visual inspection if any answer is no.

Was Fuser properly OQ'd in Electrofusion Tee?

Automatic Failure

Was pipe properly scraped?

Was pipe properly marked?

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

Fuse Passes 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 calibration?

Automatic Failure

Was the pipe properly cleaned?

Was the stab mark properly made?

was the coupling properly centered?

Was pipe properly scrapped?

Was pipe and coupling cleaned with alcohol wipe after scrapping?

Was coupling properly secured to pipe?

Was continuity verified?

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

Was fuse allowed was fuse marked with time to remove clamp?

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?

Fuse Passed Process Inspection?

Please enter comments

Did you perform a visual inspection of this fuse?

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)

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.

Mechanical

What type of mechanical fitting?

Pipe Size

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?

Fuse Passed Process Inspection?

Please enter comments

Did you perform a visual inspection on this connection?

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 fuse observed? If yes, please make documentation below

Fuse Passes Visual Inspection?

Please Enter Comments. Include what Actions taken.

Pipe Size

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 fusion process did not follow standards or procedures?

Fuse Passed Process Inspection?

Please enter comments

Did you perform a visual inspection on this connection?

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 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

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?

Fuse Passed Process Inspection?

Please enter comments

Did you perform a visual inspection on this connection?

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

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 signed by OQ Mechanic?

Was connection peer inspected and signed?

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

Fuse Passed Process Inspection?

Please enter comments

Did you perform a visual inspection on this connection?

Visual Inspection

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

Automatic Failure

Is the pipe properly marked?

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.

Fuser ID

Peer Fuser

Take a picture of the fuse
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.