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Power Piping Lines Inspection Report
BWC report form for power piping line inspection
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional office No. ____
Date & time of Inspection: ____________
Date & time completed: ____________
POWER PIPING LINES INSPECTION REPORT
General Information
Name of Establishment: _______________________________________________________________
Address: ____________________________________________________________________________
Owner/Manager : _______________________________ Nature of work process:_________________
Type of Workplace (hazardous/non-hazardous: ____________________________________________
Power Piping Lines Date
Manufacturer of Brand: ______________________________ASTM Specification:_________________
Temperature Range: ___________ASA Code max. psi: __________Operating pressure: ___________
Pipe wall thickness : _____________________ Pipe line diameter:_______________________ inches
Pipe line connection : _____________________ Pipe line total equivalent length:________________
Total volume of pipeline under pressure: __________________________________________________
Contents of pipe lines: ________________________________________________________________
Inspection Proper
Pipe Line general condition (pipe, values & fittings): _________________________________________
Hydrostatic Test Application: _____________________________NDT Application: ________________
I hereby certified that this is a true report on conditions specified power piping lines and I am
recommending the issuance of its operation permit at a pressure not to exceed ______psi.
Conducted by:
Evaluation Conducted by:
_______________________________
(Print name & signature)
________________________________
TSSD Chief/or as Authorized
(Print name & signature)
In the Presence of Authorized Representative:
_______________________________
(Print name & signature)
INSPECTION FEE: Php ___________
O.R. Number :
___________
Date Paid
:
___________
