Inspection Report

Report # (NFI) / Rev: 10666-001 P.O.: 6500000004

Inspection start date: 06 SEP 2017 Inspection end date: 07 SEP 2017
Affiliate Name: SIEMENS Project name (if any): CAREM

Section 1
SIEMENS
AKTIENGESELLSCHAFT
Main Vendor Stated on the P.O. Location MUNIC (Baviera-Alemania)
WITTELSBACHER PLATZ
2
Tel. No. 49896360
Main Vendor Contacts name: Curd Wukasch
‘e’ mail -
Actual Manufacturer: SIEMENS AG Location GERMANY, Goerlitz
Tel. No. +49 (3681) 68 - 1495
Manufacturer Contacts Mr.THOMAS SCHINDLER
‘e’ mail Schindler.thomas@siemens.com
Subcontractor to Manufacturer PT Siemens Indonesia Location CILEGON - INDONESIA
Tel. No. +62 254 369521
Subcontractor Contacts Mr.FAHMI PRASETYA
‘e’ mail Fahmi.prasetya@siemens.com
JANUAR TARGET
Inspector Name Review by
WILLYAM
Date of Previous Visit - Date of Next Scheduled Visit

Section 2
Item
P.O. QTY Qty Qty Qty
Brief Description comp
Item Ordered Insp’d Rej’d Rel’d
Y/N
1 LEAK TEST OF STEAM SIDE-CONDENSER 1 1 - 1 Y

Expected P.O. delivery date (up to date at inspection stage): P.O. Completed Y/N: Y
Section 3
INSPECTION CONCLUSION and ADVERSE QUALITY EVENTS
Proposed to use only 3 Segments istead of 4 Segments of plate Roll Steam
Number of NCR Cause : 1
Number of Problems identified and solved before inspection end : 1

Section 4
Waiting In conjunction with NFI
Work Rep. Travel Normal Mileage
Date Time at Overtime (Please refer to NFI’s done on the same
Time Time Time Hours in KM days)
site
06 Sep 2017 08:00 7 Hrs 1 Hr 09:00 ~ 17:00 8 Hrs -
07 Sep 2017 09:00 3 Hrs - 09:00 ~ 12:00 3 Hrs -

Travel Mileage
Totals
charged charged
Personal car Rent car Plane Public transportation (Bus...)
Taxi
Travel type used
Other; detail here
Tra
Reason for Waiting Time at site<4h: -

Form-0029 Rev05 1
 Inspection Report
Report # (NFI) / Rev: 10666-001 P.O.: 6500000004
Inspection start date: 06 SEP 2017 Inspection end date: 07 SEP 2017
Affiliate Name: SIEMENS Project name (if any): CAREM

Section 6
Document Number Rev.No Document (, Quality Plans, Documents and Test Procedures)
PO Nr 6500000004 0 Purchase Order
BB001193SAFB1601A 1 Invitation Leak Test of Steam Side of CIREM
10666-SIEMENSSTG-QC-PQ-068 0 Pressure Test Procedure
10666-SIEMENSSTG-G-PT-119 A Pressure Test Procedure
10666-SIEMENSSTG-G-PT-120 A Test Report Pressure and Leak Test-Condenser
10666-SIEMENSSTG-M-RP-038 D Condeser assembly drawing
IC-Nr./01 - Customer Witness Report & Participants List
600/ALBAAK - Report of Analysis for Clean Water

Section 7
Attendees during inspection (people met in the workshop0)
Name Company Name Company
Mr.Januar Target Socotec Oil & Gas Mr.Teguh Triyono PT Siemens Indonesia (Order
Willyam (Inspector) Management)
Mr. Sardi Septian PT Siemens Indonesia Mr.Rohadi PT Siemens Indonesia (Order
(Order Management) Management)

Section 8
Summary of Vendor QC Inspection Activity per Item (Performed Without Inspector Presence)
P.O. item No Inspection Activities
BB001193SAF1601A Leak Test of Steam Side

Section 9
Results of QC Inspection Activities Performed by Inspector Per Order Item - This Visit
Note: Copy below Table and Complete for each Item inspected during visit
Description as per P.O. or supplier description (highlight discrepancy if any)
Item No.
If P.O. description is too short to clearly understand, please describe more here.

BB001193A (Surface Supplier Drawing

Assy Part No.. 1-50000-BB1193A-00 REV E
Condenser) No. & Rev
Serial Nos. -
Purpose Of Inspection Visit
Leak Test of Steam Side

Inspections Performed Result (Pass/Fail)

Witness for Leak test of Steam Side - Condenser Pass
Review Documents related for leak test Pass

Qty with probl.

Qty Qty Item Date of
Qty Rejected solve during Qty Released
Ordered Inspected Complete Y/N Release
inspection
Socotec Rejects -
1 1 - 1 Y 07 Sep 2017
Vendor Rejects -
Written Inspection Summary (Include Test Pressures / Hold Times / Equipment Used (Incl Ser. Nos and Calibration Status
Etc – When carrying out Sample inspections the Serial Nos of the individual items inspected must be recorded )
All Vendor Internal NCR’s/QN’s and Socotec issued NCR’s must be recorded

Form-0029 Rev05 2
 Inspection Report
Report # (NFI) / Rev: 10666-001 P.O.: 6500000004
Inspection start date: 06 SEP 2017 Inspection end date: 07 SEP 2017
Affiliate Name: SIEMENS Project name (if any): CAREM

Section 10
Document Package Review and Traceability
Material Certificates Reviewed (List Cert Nos) Documents Reviewed, Stamped and Endorsed (Incl Doc. Nos)
J 9072 (ASTM A516 Gr.70) GDS-QC-2017-0927 OK (SEE ATTACHED)
J9069 (ASTM A516 Gr.70) GDS-QC-2017-0927 OK (SEE ATTACHED)
J9069 (ASTM A516 Gr.70) GDS-QC-2017-0378 OK (SEE ATTACHED)
J9188 (ASTM A516 Gr.70) GDS-QC-2017-3170 OK (SEE ATTACHED)
B 2056913 (ASTM A516 Gr.70) GDS-QC-2017-0781 OK (SEE ATTACHED)

Note : Where volume of documents is high only the Data Book unique reference number is to be recorded

Section 11
Attachments to this Report (Documents, Release notes, NCR’s, Punch Lists, Certificates, Photographs etc.) insert all these
documents in this document,
NOTE: ALL RELEASE NOTES AND NCR’S MUST BE SIGNED BY THE VENDOR (if the vendor do not want to sign it, please report
it clearly).
SEE ATTACHED
Document Description

ADD INSPECTION PICTURES:

Photograph Inspection (During Leaktest)

Form-0029 Rev05 3
 Inspection Report
Report # (NFI) / Rev: 10666-001 P.O.: 6500000004
Inspection start date: 06 SEP 2017 Inspection end date: 07 SEP 2017
Affiliate Name: SIEMENS Project name (if any): CAREM

After 24 Hours Holding (Release Water) Witness Participants

Blowing

Date of report completed and sent :

Inspector Name: JANUAR TARGET Inspector Surname:

WILLYAM
Inspector Signature: Inspector Stamp:

Form-0029 Rev05 4