Pressure and Vacuum Systems Safety Supplement Part
10: Mandatory Forms |
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These forms are standardized forms that shall be used when applicable for pressure system documentation. These forms are available on the Pressure Systems webpage.
Pressure Systems Forms:
PRESSURE SYSTEM PROJECT COVER SHEET |
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GENERAL |
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Pressure System Number: |
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Pressure System Name: |
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P&ID Number: |
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Overall Installation/Assembly Drawing Number: |
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Design Authority: |
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System Owner: |
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APPLICABLE CODES (Add Code Edition to all that apply) |
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ASME BPVC VIII Div1 |
ASME BPVC VIII Div2 |
ASME B31.1 |
ASME B31.3 |
ASME B31.5 |
ASME B31.9 |
ASME B31.12 |
Other (Specify) |
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Are there pressure components with no directly applicable
Codes? YES NO (If YES then these components require a Peer Review) Briefly describe and list ASME Code and Edition most
applicable: |
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SYSTEM PARAMETERS |
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Fluid: |
Fluid Service: |
Design Temperature: |
Design Pressure: |
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Pressure Vessel Numbers (ASME and Excluded):
Bldg#-PS#-Seq# |
Stored Energy: |
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Brief Description of System and Fabrication Plan (attach
more sheets as needed): |
OVERPRESSURE BY SYSTEM DESIGN APPROVAL |
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GENERAL |
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Pressure System Number: |
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Pressure System Name: |
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Design Authority: |
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OVERPRESSURE BY SYSTEM DESIGN REPORT CONTAINS: (check if
complete) |
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Reason for using overprotection by design |
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Detailed failure analysis by multidisciplinary team |
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Detailed analysis to determine maximum credible pressure |
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Requirements for periodic inspections and testing of
controls, procedures and instrumentation |
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APPROVAL: |
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Comments: |
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Pressure Systems Committee Chair signature: (Not required for ASME B31.3 Category D Service Piping,
ASME B31.5 Piping, ASME B31.9 Piping) |
Date: |
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Design Authority signature: |
Date: |
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TECHNICAL/PEER REVIEW RECORD |
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Pressure System Number |
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Component(s) (if applicable) |
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Design Authority (DA) |
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DA Group/Division |
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Note: Excluded Elements require a Peer Review. Peer Review
must be completed by one or more DAs not associated with the project.
Technical Review is applicable to code compliant components and can be
performed by any DA. |
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Type of Review (check) |
____Technical Review |
____Peer Review |
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Description: |
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Scope of Review: |
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Applicable Code(s): |
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The undersigned have reviewed the calculations and/or
design specifications listed above and verify accuracy and compliance with
JLAB requirements, national consensus codes, or equivalent measures. |
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Reviewer Name |
Signature |
Date |
Group/Division |
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Comments: |
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PRESSURE VESSEL REGISTRATION |
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Pressure System Number: |
Date: |
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Pressure System Name: |
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Pressure Vessel Number: |
P&ID Number: |
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Pressure Vessel Description: |
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MAWP/Design Pressure: |
Design Temperature: |
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Operating Pressure: |
Operating Temperature: |
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Code: |
Code Year: |
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System Fluid: |
Fluid Category: |
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Fluid State: |
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VESSEL DATA |
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ASME Stamp Type ___U Stamp ____UM Stamp ___Other (specify) |
Vessel Type: __Air Tank __Water Tank __Non-Flam Gas Tank __Flam Gas Tank __Other (specify) |
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Vessel Manufacturer |
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National Board Number |
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Serial Number |
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Year Built: |
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Inspection Interval: |
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In Service Date |
Expiration Date: |
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VESSEL LOCATION: |
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Building Number |
Room Number: |
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Specific Location in Bldg: |
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APPROVAL (name and signature) |
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Design Authority: |
Date: |
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Store completed form in Pressure System File and send copy
to Vessel Inspection Coordinator along with a copy of the associated P&ID |
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PRESSURE RELIEF DEVICE DATA SHEET |
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Pressure System Number: |
Date: |
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Pressure System Name: |
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Pressure Vessel Number (if Applicable): |
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Device installed directly on vessel?: __Yes __No |
Code: |
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System Fluid: |
Code Year: |
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Fluid State: |
Fluid Category: |
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RELIEF DEVICE DATA |
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Device Type ___Safety Relief Valve ____Rupture Disk ___Other (specify) |
Certification Type: ___ASME ___CE/PED ___Other (specify) |
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Manufacturer |
Rated Flow Capacity: |
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Part Number |
Converted Flow Capacity: |
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Serial Number |
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Set Pressure |
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Inspection/Test Interval: |
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In Service Date |
Expiration Date: |
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INITIAL TEST/INSPECTION DATA |
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General condition of device acceptable: |
____ YES |
____ NO |
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Helium (vacuum) leak test required: |
____ YES |
____ NO |
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Leak test passed: |
____ YES |
____ NO |
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Pop test (valve only) pressure: Test pressure within 5% or
3psi of rated pressure |
____ YES |
____ NO |
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APPROVAL (name and signature) |
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Installer: |
Date: |
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Design Authority: |
Date: |
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Store completed form in Pressure System File and send copy
to Vessel Inspection Coordinator |
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MECHANICAL EXAMINATION |
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Pressure System Number: |
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Pressure System Name: |
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Design Authority: |
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CHECK IF COMPLETE, N/A IF NOT APPLICABLE: |
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Materials, components and products meet specifications and
the requirements of engineering design |
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Applicable procedures for assembly, glue bonding, etc. |
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Assembly of threaded, bolted and other joints conforms to
Code and engineering design |
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Alignment, supports and/or cold spring meet engineering
design |
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Dimensional checks of components and materials meet Code
and engineering design |
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Comments: |
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Examiner name and signature: |
Date: |
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PRESSURE/LEAK TEST RECORD |
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TEST DESCRIPTION AND REQUIREMENTS |
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Pressure System Number |
Drawing Number(s) |
PAGE 1 OF |
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Project Name: |
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System or component description (attach description if needed): |
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Test boundaries (attach sketch if needed): |
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Design temperature: |
Design pressure (MAWP): |
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Test method: ___Hydrostatic ___Pneumatic |
Relief Valve Setting: |
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Test fluid: |
Applicable code: |
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Required test pressure: |
Test temperature: |
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Test pressure as % of MAWP: |
Ambient temperature: |
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Elevation difference between highest point and gauge: |
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Required gauge pressure: |
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Test date: |
Start time: |
Actual gauge pressure: |
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Required Duration: |
Finish time: |
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SAFETY |
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Test volume: |
Stored energy of test: |
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SOP/OSP/TOSP Number (if required): |
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TEST EQUIPMENT |
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Type/Number: |
Range: |
Cal date: |
Cal due date: |
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Leak Detection Method: __Visual __He leak test __Bubble test __He leak test (reverse) __Other (attach procedure) |
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Detector Calibration (if applicable): |
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TEST ACCEPTANCE (name and signature) |
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Pressure test result: ____Pass ____Fail |
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Test Engineer: |
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Date : |
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Technician: |
Date : |
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Witness: |
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Date : |
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FINAL SYSTEM WALKTHROUGH AND DOCUMENTATION REVIEW |
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Pressure System Number: |
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Pressure System Name: |
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Design Authority: |
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CHECK IF COMPLETE, N/A IF NOT APPLICABLE: |
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Form PS-1 Pressure System Project Cover Sheet is complete
and filed. |
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Form PS-2 complete and filed if applicable. |
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Review of construction documentation including: o
Review
of pressure/leak test documentation, completed and filed (Form PS-7) o
Technical
and Peer Reviews have been performed and filed (Form PS-3). o
Ensure
that welding and brazing inspections have been performed and filed o
Ensure
that mechanical examinations have been performed and filed (Form PS-6) o
Ensure
that applicable fabrication documents have been filed. |
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Review of P&ID critical elements (i.e. relief devices,
vessels, relief paths, etc.). |
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Conspicuous and durable Jefferson Lab specific tags are
installed on pressure vessels and boilers |
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Forms PS-4 and PS-5 are filed for vessels and their relief
valves |
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General physical system condition and readiness. |
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Checks on all relief devices providing overpressure
protection. |
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Through direct visual examination, relief devices (providing
overpressure protection) are installed and that the relief paths are
free (e.g. stop valves are locked open, test plugs removed etc.) and
direction of discharge is safe. |
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Comments: |
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Owner’s Inspector name and signature: |
Date: |
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PRESSURE SYSTEM TURNOVER |
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Pressure System Number: |
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Pressure System Name: |
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OPERATING REQUIREMENTS: |
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MAINTENANCE REQUIREMENTS: |
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IN-SERVICE INSPECTION REQUIREMENTS: |
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Piping |
Vessels |
Relief Valves |
Component |
Component |
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ISI Category |
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ISI Type (VT, UT, RT, etc) |
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ISI Frequency |
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Special ISI Requirements: |
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System Owner name and signature: |
Date: |
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Design Authority name and signature |
Date |
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Design Authority shall forward this form to the Pressure
Systems Committee Designee for filing and updating the operating pressure
systems database |
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PRESSURE EQUIPMENT IN-SERVICE INSPECTION DATA SHEET |
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Pressure System Number: |
Date: |
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Pressure System Name: |
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Building Number: |
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Specific Location: |
Code: |
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System Fluid: |
Code Year: |
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Fluid State: |
Fluid Category: |
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PRESSURE EQUIPMENT INSPECTION DATA |
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Condition of exterior is free of corrosion, cracks, dents,
gouges, bulges. If insulation is present, condition of insulation is intact: |
____ YES |
____ NO |
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No evidence of leakage: |
____ YES |
____ NO |
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Structural attachments and supports are free of cracks and
distortions: |
____ YES |
____ NO |
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Connections (nozzles, bolts, nuts., accessible flange
faces) are free from corrosion, cracks, distortion or defects: |
____ YES |
____ NO |
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Weld joints and adjacent heat affected zones are free from
cracks or other defects: |
____ YES |
____ NO |
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Operation of control devices (temperature sensors,
pressure gages, etc.) is demonstrated through proper operation of system,
comparison to others on system or through calibration: |
____ YES |
____ NO |
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COMMENTS: |
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Findings and general condition: |
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APPROVAL (name and signature) |
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Pressure Equipment Acceptable for continued use: |
___YES |
___NO |
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Inspector: |
Date: |
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System Owner: |
Date: |
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Form PS-11 Vessel In-Service Inspection – Maintained by Vessel Inspection Coordinator
RELIEF DEVICE OPERATIONAL INSPECTION & TEST DATA SHEET |
Page 1 of 2 |
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Pressure System Number: |
Date: |
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Pressure System Name: |
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Vessel Number (if Applicable): |
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Device installed directly on vessel?: __Yes __No |
Code: |
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System Fluid: |
Code Year: |
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Fluid State: |
Fluid Category: |
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RELIEF DEVICE DATA |
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Device Type ___Safety Relief Valve ____Rupture Disk ___Other (specify) |
Certification Type: ___ASME ___CE/PED ___Other (specify) |
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Manufacturer |
Rated Flow Capacity: |
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Part Number |
Converted Flow Capacity: |
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Serial Number |
Set Pressure: |
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Inspection/Test Interval: |
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In Service Date |
Expiration Date: |
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INSPECTION RESULTS |
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Correct device is installed and manufacturer’s markings
are legible: |
___ yes |
___ no |
___ na |
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Field conditions reflect P&ID: |
___ yes |
___ no |
___ na |
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Tamper resistant devices are intact: |
___ yes |
___ no |
___ na |
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No flow restrictions are present (gags, blinds, closed
valves, bent piping or other obstruction): |
___ yes |
___ no |
___ na |
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No unacceptable leaks including those to relief path: |
___ yes |
___ no |
___ na |
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Discharge and relief piping directed to a safe location: |
___ yes |
___ no |
___ na |
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If equipped with upstream and downstream block valves,
locking handles are secured in open position: |
___ yes |
___ no |
___ na |
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Piping is properly supported and in good condition
(Consider reaction forces of discharge, look for sign of fatigue, cracks,
etc.): |
___ yes |
___ no |
___ na |
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Valve body drains are open: |
___ yes |
___ no |
___ na |
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Lift lever (if equipped) is positioned and functioning properly: |
___ yes |
___ no |
___ na |
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A functioning gage is installed between relief valve and
rupture disk combinations: |
___ yes |
___ no |
___ na |
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Non-reclosing relief is properly oriented (Check flow on
rupture disks): |
___ yes |
___ no |
___ na |
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RELIEF DEVICE OPERATIONAL INSPECTION & TEST DATA SHEET |
FORM PS-12 Page 2 of 2 |
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TEST DATA |
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On-stream Test required: Lift Lever Test allowable: Operating
Pressure ______ Operating
Temperature ______ Lift Lever Test
acceptable: On-stream Pressure Test required: ___Detailed
Instructions only ___SOP/TOSP
(#____________) On-stream Test
passed: (Within 5% or 3psi of rated pressure) Valves are remarked with new test date: |
____ yes ____ yes ____ yes ____ yes ____ yes ____ yes |
____ no ____ no ____ no ____ no ____ no ____ no |
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Shop Test required: ___Detailed
Instructions only ___SOP/TOSP
(#____________) Test 1: opening
pressure ________ closing
pressure ________ Test 2: opening
pressure ________ closing
pressure ________ Test 3: opening
pressure ________ closing
pressure ________ Shop Test
passed: (Within 5% or 3psi of rated pressure) Valves are remarked with new test date: |
____ yes ____ yes ____ yes |
____ no ____ no ____ no |
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COMMENTS: |
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Findings and general condition: |
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APPROVAL (name and signature) |
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Relief Device Acceptable for continued use: |
__ yes |
___no |
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Inspector: |
Date: |
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System Owner: |
Date: |
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ISSUING AUTHORITY |
SUPPLEMENT AUTHOR |
APPROVAL DATE |
REVIEW DATE |
REV. |
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QA/CI Dept. |
11/06/15 |
11/06/20 |
1.0 |
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