Form No : FR-AEC-01

Revision No : 0
Date : 21-Dec-2017
INSPECTION REPORT

PIPE MATERIAL RECEIVED

OFF LOADED DATE Report No. :

Start : Date: :
Finish : Shift :
Page :

RECEIVED AT LOCATION:

QUANTITY LENGTH
NO ITEM MATERIAL DESCRIPTION REMARKS
(Pcs) (Mtr)

TOTAL
Any items which are Over Delivered, Under (Short) Delivered, or Damaged shall be recorded on a separated Over, Short and Damage Report.
Legend : TOTAL
D : Dent NP : No Bevel Protector ND : No Damage
BD : Bevel Damage NEC : No End Cup Protection ACC : Accepted
SC : Scratch TI : Tail Rep : Repair
O : Ovality Mid : Midle (Body) Rej : Reject -
C : Contamination LE : Lead

Material Inspection by KHI Note :

Start :
Finish :

ATTACHMENTS : LIST INCOMING

PT. KHI Pipe Industries

Inspected by, Reviewed by, Witnessed/Reviewed by,

Name : : Muslich Name :: Muslich Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-02
Revision No : 0
Date : 21-Dec-2017

INSPECTION REPORT
COATING MATERIAL RECEIVED
WO. NO. Report No.
Customer Page
Pipe Size Date
Project

Product Receiving Details Comment / Remarks

Product Name / Code: -
Manufacturer: -
Purchase Order No: -
Delivery Date: -
Delivery Order No: -
Quantity Order Received: -
Type of Packaging: -
Packaging Condition: Good Damage -
Certification Received: Yes No -
Order Completed: Yes No -

PT. KHI Testing Required: Yes No Date Sample Delivery to Laboratory: N/A
PT. KHI Test Report Received: Yes No Date Test Report Received: N/A

Product Batch Numbers Date of Manufacture Expire Date

Batch No :

Note : -

PT KHI Pipe Industries

Inspected by, Reviewed by, Reviewed/Witnessed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-03
Revision No : 0
Date : 21-Dec-2017
INSPECTION REPORT
DAILY INSTRUMENT CALIBRATION
WO. NO. Report No.
Customer Date
Pipe Size Shift
Project Page

Instrument
I/D Time Target Results Variance Status Ref. Instrument
Type

Legend: Note : Variance Adjustable to ±5% of Target Value

Acc = Accepted R = Repair
DFT = Dry Film Thickness SPG = Surface Profile Gauge
HD = Holiday Detector SRT = Surface Roughness Tester

PT KHI Pipe Industries

Inspected by, Reviewed by, Witnessed/Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-04
Revision No :0
Date : 21-Dec-2017
INSPECTION REPORT

INCOMING PIPE

WO. NO. : Report No. :

Customer : Date :
Pipe Size : Shift :
Project : Page :

Salt
Length Surface
No Pipe No. Heat No. Visual Inspection Contamination
(Meter) Contamination
Test
No oil, grease,
Status Remarks
Acceptance Criteria - dirt and solid N/A
pollution
Frequency - Every pipe N/A

Name
EQUIPMENT
ID

Legend : ACC : Accepted Note : -

Hold : Hold for Cleaning or Repair
Reject : Reject
- : Blank

PT KHI Pipe Industries

Inspected by, Reviewed by, Witnessed/Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-05
Revision No : 0
Date : 21-Dec-2017

INSPECTION REPORT

SURFACE PREPARATION
WO. NO. : Report No. :
Customer : Date :
Pipe Size : Shift :
Project : Page :

Ambient Conditions, Preheat

Pipe Length Temp. Surface Profile Salt
Blast
No Heat No. Elapsed Time Contamination
Dew Cleanliness Press 'O'
No (M) Pipe RH Visual Test
Point film
Pipe surface temperature All minor defect
No Flash rusting, like burrs and Status Remarks
after blasting shall be 3⁰C 50-100 Max. 2 µg/cm²
Acceptance Criteria RH<85% max 4
above dew point minimum &
Sa. 2½ spalters and
µm (Max. 20 mg/m2)
hrs irregularities shall
RH Max 85% be removed

At start up and once every 4 Once

Frequency Every pipe
hrs
Every pipe Every end
per shift
1 pipe per shift

Name
EQUIPMENT
ID

Legend : ACC : ACCEPTED Note : -

REP : REPAIR
REJ : REJECTED
- : BLANK
PT KHI Pipe Industries
Inspected by, Reviewed by, Witnessed / Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-05A
Revision No :0
Date : 21-Dec-2017
INSPECTION REPORT
SURFACE PREPARATION
WO. NO. : Report No. :
Customer : Date :
Pipe Size : Shift :
Project : Page :

٠ Ambient Conditions, Preheat Temperature & Cleanliness

Item Criteria Frequency Results

Compressed Air Test

Time
Pipe Number
o
Dew Point ( C)
% RH
(Relative Humidity)
Pipe Temperature (oC)

Elapsed time between

blasting & coating

Blast Cleanliness

٠ Surface Profile
Item Criteria Frequency Results
Pipe Number
Profile
(Grit type comparator)

Profile (by Press 'O' film)

Item Criteria Frequency Results

Pipe Number
Profile
(Grit type comparator)

Profile (by Press 'O' film)

Item Criteria Frequency Results

Pipe Number
Profile
(Grit type comparator)

Profile (by Press 'O' film)

٠ Salt Contamination Test

Item Criteria Frequency Results
Pipe Number

Salt Contamination

PT. KHI Pipe Industries

Inspected by, Reviewed by, Witnessed / Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-05B
Revision No :0
Date: : 21-Dec-2017
INSPECTION REPORT
SURFACE PREPARATION
WO. No. : PQT Report No :
Customer : Date: :
Pipe Size : Shift :
Project : Page No :
Equipment Name/ID :

> Dust Test (clear tape As per ISO 8502-3)

Pipe No. Acceptance Criteria Frequency Result

Dust Test Record N/A

Pipe No. Acceptance Criteria Frequency Result

Dust Test Record N/A

Pipe No. Acceptance Criteria Frequency Result

Dust Test Record N/A

Pipe No. Acceptance Criteria Frequency Result

Dust Test Record N/A

Pipe No. Acceptance Criteria Frequency Result

Dust Test Record N/A

PT KHI Pipe Industries

Inspected by, Reviewed by, Reviewed/Witnessed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-06
Revision No :0
Date : 21-Dec-2017
INSPECTION REPORT
COATING PRIMER APPLICATION
WO. NO. : Report No. :
Customer : Date :
Pipe Size : Shift :
Project : Page :

Pipe Dry Film Thickness

Length Visual
No Pipe No. Surface Temp.
(M) X1 X2 X3 X4 X5 X6 Appearance
(°C)
Covered entire
Between 30°C Average
Acceptance Criteria 20 µm surface area and Status Remarks
and 50°C (µm) free from runs,
sags.

Frequency Every pipe 1 per shift Every pipe

NAME
EQUIPMENT
ID

Legend : ACC : ACCEPTED Note : -

REP : REPAIR
REJ : REJECTED
- : BLANK
PT KHI Pipe Industries
Inspected by, Reviewed by, Witnessed / Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-07
Revision No. : 0
Date : 21-Dec-2017

INSPECTION REPORT

COATING APPLICATION
WO. NO. : Report No. :
Customer : Date :
Pipe Size : Shift :
Project : Page :

Equip. Name/ID :

Application Of Asphalt Enamel Temp. Of Heating

Temperature (°C) Kettles (°C)
Length Time Visual
No Pipe No. Visual Primer
(M) (WIB) Dew Asphalt
Pipe Asphalt Quenching 1 2 3
Point
Status Remarks
Within 4 hrs, shall Pipe temp shall be at
Manufacturer's Continous &
Acceptance Criteria be tuch dry & free least 3⁰C above dew
recommendation
Max. 65°C 200-240°C Free Defect
contamination point
1 pipe per
Frequency Every pipe Once per shift Every pipe 1 per shift
shift

Legend : NOTE : -
ACC : ACCEPTED
REP : REPAIR
REJ : REJECTED
- : BLANK
PT KHI Pipe Industries
Inspected by, Reviewed by, Whitnessed / Reviewed by,

Name: Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-08
Revision No. :0
Date : 21-Dec-2017
INSPECTION REPORT

PLACEMENT AND DISTRIBUTION OF WRAPPING

WO. NO. : Report No. :

Customer : Date :
Pipe Size : Shift :
Project : Page :

Equip. Name/ID :

Innerwrap Outerwrap
Length
No Pipe No.
(M) Overlap (mm) Visual Inspection Overlap (mm) Visual Inspection
Status
Acceptance Criteria Min 25 mm Neat, & Smooth Min 25 mm Neat, & Smooth

Frequency 1 per day 1 per day

PT KHI Pipe Industries

Inspected by, Reviewed by, Witnessed/Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-09
Revision No. :0
Date : 21-Dec-2017
INSPECTION REPORT

COATING REPAIR
WO. NO. : Report No. :
Customer : Date :
Pipe Size : Shift :
Project : Page :

Thickness (mm)
Heat Length Holiday Detection Visual
NO. Pipe No. Defect Description (location, Area, Etc) Status Remarks
Number (Meter) at 20 kV X1 X2 X3 X4 X5 AVG Appearance

NAME
EQUIPMENT
ID

Legend : PT KHI Pipe Industries

ACC : ACCEPTED REJ : REJECTED Inspected by, Reviewed by, Whitnessed / Reviewed by,
REP : REPAIR - : BLANK
Note：
1. The record shall be complete,clear and accurate,
no alteration
2. Repair in strict accordance with related techincal documents Name : Name : Name :
Cc.: 1. QA Departement 2.Client Rep. 3. File
 Form No : FR-AEC-10
Revision No. :0
Date : 21-Dec-2017
INSPECTION REPORT

FINAL COATING
WO. NO. : Report No. :
Customer : Date :
Pipe Size : Shift :
Project : Page :

Weight Total Coating Thickness Cutback

Length Visual
No. Pipe No. Heat No. (Pipe+AEC ) (mm) Holiday Distribution of Innerwrap (mm)
(M) Appearance
(Kg) End (1) Middle End (2) Test at 20 E1 E2
Average kV Completely embadded within No wringkling, pinholes, Status REMARKS
Acceptance Criteria Min. 4 mm the middle 50% of the enamel 150 - 160 mm voids, lamination dry wrap
thickness & separate from each and blemish

Frequency Every pipe 3 location (at 12,3,6 and 9 o'clock) Every pipe Once per shift Every pipe Every pipe

Name
Equipment
ID

Legend : ACC : ACCEPTED - : BLANK PT KHI Pipe Industries

REP : REPAIR Inspected by, Reviewed by, Whitnessed / Reviewed by,
REJ : REJECTED
Note： 1. The record shall be complete,clear and accurate, No Alternation
2. Inspection in strict accordance with related techincal document
3. Indicate the reason for rejection
Cc.: 1. QA Departement 2.Client Rep. 3. File Name : Name : Name :
 Form No : FR-AEC-11

Revision No. :0

Date : 21-Dec-2017

INSPECTION REPORT

ADHESION TEST

WO. NO. : Report No. :

Customer : Date :
Pipe Size : Shift :
Project : Page :
:

Equip. Name/Id :

Result of Testing

Production Date :

Testing Date :

Acceptance Criteria :

Continuity Coating Thickness

Length
Testing Pipe No. Heat No. Result of Adhesion Remarks
(Mtr)
At 20 KV Min. 4 mm

Adhesion
Testing

Note : -

PT. KHI Pipe Industries

Inspected by, Reviewed by, Witnessed / Reviewed by,

Name : Name : Name :

Cc.: 1. QA Departement 2.Client Rep. 3. File