DIMENSIONAL & SURFACE ROUGHNESS FORM

(FLANGE)

Date : S.O. # :

Client : PN :

Item Description : SN/HN :

Quantity : Tools :

Material : Tools ID :

Inspection Parts:

Blind Flange Raised-Face Facing

Weldneck Flange Ring-Joint Facing

Surface
Dimensional Inspection (mm)
Digital Surface Roughnes
No. Symbol Inspection Parts
Standard Actual Actual Actual Range Actual Actual
Tolerance Average
(Drawing) 1st 2nd 3rd Value 1st 2nd

Nominal Bore/Inside
1 d Diameter

2 O Outside Diameter

Diameter of Bolt
3 C Circle

4a g Raised-Face Diameter

Ring-Joint Facing of
4b K Raised Diameter
Raised-Face
5a E Thickness
Ring-Joint Groove
5b E Depth
 6 T Flange Thickness

Ring-Joint Pitch
7 P Diameter
Ring-Joint Groove
8 F Width
Weldneck Pipe
9 Ah Outside Diameter
Weldneck Hub
10 X Diameter
Weldneck Length-
11 Y Through-Hub
Gramaphone Surface
12 - Roughness

13 t Thickness

* Please put "N/A" for not related dimension with the item inspected.
* All measurement must be to 2 decimal places.
* Please refer to BMI-WI-577-14 Visual and Dimensional Procedure for Dimension and BMI-WI-577-20 Surface Roughness Test Procedure for roughness.

Inspected By:

QC Inspector
Date: Date:
 Doc. ID. No.: QC-577-23
M Revision No.: 1
Effective Date: 10.05.2019
Doc. Ctrl. No.:

Surface Roughness
e Roughness (µm) Comparator Test Remarks
Actual Range (OK/NOT OK)
Average Test Point
3rd Value
ughness.

Approved By:

QC Manager
te: