Project No:

Name:
Client:

INSPECTION TEST REPORT FORM NO:

I-01 A INSTRUMENT INSTALLATION & CALIBRATION INSPECTION REV. 0
I-01A
A – Mechanical Completion Project Phase:
Scope Owner :
ITR Item:
Other Tag
Tag No / Tag set No:
No:

Description:

System:

Sub-System:

Location:

Drawing No: Rev:

ITR Instructions:
This ITR shall be read in conjunction with
(i) Mechanical Completion / Commissioning / Hand Over Management Document and Completions ITR & Certification Portfolio.
ITR Activities:

Activity Complete
Inspection Activity
No:
Yes No N/A
General Activity Checks:
1 Equipment IP rating: ____________- Correct for location.
Verify nameplate details against instrument data sheet.
MANUFACTURER TYPE / MODEL NO. SERIAL NO. DATA SHEET NO.
2

3 Instrument has valid calibration tag attached in accordance with instrument data sheet.

4 Equipment mounted and installed properly and secured.

5 Equipment tagged correctly.

6 No external damage to equipment.

7 Equipment free of debris.

8 Equipment preservation installed as required.

9 Equipment location acceptable (display visible, line of sight clear, etc.).

10 Equipment location accessible.

11 All spare cable entries plugged correctly.

12 All equipment internal terminations completed.

13 All equipment internal wiring has been labeled properly with ferrules.

14 Equipment earth bond installed and connected.

15 Equipment terminal blocks / internals labeled correctly.

16 All gaskets and seals undamaged.

17 All covers installed correctly.

18 Red line drawings / Final AFC drawings attached.

Tubing Check list:

Reference Document:

19 Document Type Document No Rev No Inst.TIE-IN-PT

Process Tapping Type:

20
† Impulse Line † Capillary † Direct Mounted † Thermowell
21 Tagging at both ends installed correctly.
Sensing / Air / Hydraulic Lines /Tubing installed correct, correct rating, fittings/manifold type is correct as per design drawings,
22
hook up drawings and project specification.
23 Confirm installer trained and qualified.

24 Tubing / capillary tube properly supported and secure.

25 Confirm tubing edge deburred.

26 No damages or kinks on the Tubing / Capillary Tube.

Form: ITR Rev.: 0 Printed: 1/4

Project No:
Name:
Client:

INSPECTION TEST REPORT FORM NO:

I-01 A INSTRUMENT INSTALLATION & CALIBRATION INSPECTION REV. 0
I-01A
A – Mechanical Completion Project Phase:
Scope Owner :
ITR Item:
Other Tag
Tag No / Tag set No:
No:

Description:

System:

Sub-System:

Location:

Drawing No: Rev:

27 Confirm process tapping location v/s instrument installation location correct for liquid / gas service.

28 Confirm tapping correct for differential head measurement.

29 Confirm drains / vents etc. positioned correctly.

30 Confirm all drain and vents valves are capped.

31 Check all hazardous fluid vents / drains are directed to safe areas.

32 Signal lines installed correctly.

33 Aspirator tubes installed correctly.

Flushing:
Confirm all tubing blown clear and dry.
34 NOTE: For Hydraulic tubing: Oil flushing, For Instrument tubing: Dry Air flushing, Process tubing. (sample, Impulse): Water
flushing with limitation on chlorine content (as per project specification).
35 Hydraulic lines oil flushed to NAS 1638 or ISO 4406.
!!WARNING!!:
Confirm instrument is disconnected or the instrument manifold vent is open before beginning tubing test. The instrument is not
36
to be exposed to the tubing test pressure.
Process Tubing (Sampling or Impulse tubing):
Confirm Process Tubing (Sampling or Impulse tubing) checked for leakage using water with low chlorine content (as per project
37
specification).
38 Confirm process tubing tested to 150% of design pressure for minimum 15 minutes.

39 After Process tubing pressure test, tubing shall be drain and dried.

Hydraulic Tubing:

40 Confirm hydraulic tubing tested to 150% of design pressure for minimum 15 minutes.

Pressure Test Parameters:

Service: Instrument air tubing / Process tubing / Hydraulic tubing:

41
Test Medium: Test Duration: Test Pressure:

Test Equipment Data:

Make / Model Serial No. Calibration Cert. No. Expiry Date

42

43 Tubing lines depressurized and capped after flushing / test (If performed offsite).

44 Confirm line is correctly re-connected. Tubing connectors tight and secure. Check fit up of tube testing.

45 100% inspection of fittings.

Instrument Calibration Checks:
46 Instrument supplied in accordance with instrument data sheet. Attach vendor calibration certificate.
NOTE: Incase valid vendor calibration certificate is not available then the instrument shall be re-calibrated & readings shall be recorded as below:

Data Required:

47 Complies with Data Sheet.

Form: ITR Rev.: 0 Printed: 2/4

Project No:
Name:
Client:

INSPECTION TEST REPORT FORM NO:

I-01 A INSTRUMENT INSTALLATION & CALIBRATION INSPECTION REV. 0
I-01A
A – Mechanical Completion Project Phase:
Scope Owner :
ITR Item:
Other Tag
Tag No / Tag set No:
No:

Description:

System:

Sub-System:

Location:

Drawing No: Rev:

Other Data:
Description Detail Description Detail

Function Range

Type / Model Serial No.

48 Service Accuracy ( + / -)

Manufacturer Process Connection

Test Equip. Used Line / Equip. No

Test Fluid Test Voltage

Test Pressure Ambient Temp.

Calibration (Analogue):
Analogue Records

Range Input Rising Unit Output Rising Unit Input Falling Unit Output Falling Unit

0%

49 25%

50%

75%

100%

Calibration Digital:

Switch Action N/O [ ] N/C [ ]

Set point Unit Rising Falling Reset point Unit Rising Falling
50

51 Confirm percentage error should not exceed manufacturers stated limits for accuracy and hysteresis.

Test Equipment Data:

Make/ Model Serial No. Calibration Cert. No. Expiry Date

52

Measuring Sensor Type:

Temperature Sensor Type
RTD

Thermo couple (T/C)

Punchlist Raised (In above, any item marked “No” should be recorded as Punchlist item below)

Form: ITR Rev.: 0 Printed: 3/4

Project No:
Name:
Client:

INSPECTION TEST REPORT FORM NO:

I-01 A INSTRUMENT INSTALLATION & CALIBRATION INSPECTION REV. 0
I-01A
A – Mechanical Completion Project Phase:
Scope Owner :
ITR Item:
Other Tag
Tag No / Tag set No:
No:

Description:

System:

Sub-System:

Location:

Drawing No: Rev:

□No □Yes
Item Punchlist Punch
Description of Punch Item Action By
No Type Code Category

Inspector Comments:

ITR Signatures:
SUPPLIER / CONTRACTOR MODEC REPRESENTATIVE CERT.AUTH (IF APPL) CMS ADMIN

Print Name:
Signature:
Title:
Date:

Form: ITR Rev.: 0 Printed: 4/4