Building Efficiency Services

PURPOSE: Purpose of the Form.

1. ROLES AND RESPONSIBILITIES

1.1. The checklist shall be completed for each crew at the project site on a daily/shift
basis, at a minimum of first test shot, mid work, (approx.) and last.

1.2. The checklist is valid for the duration of the RT work being performed on each
day/shift.

1.3. If the radiography crew leaves the project site, and they or another crew returns
later, another checklist shall be completed, at the aforementioned intervals.

2. DEFINITIONS

2.1. Technique Shot – Provided by RT technician, to verify that the requirements of

the standard are being met, for each diameter and wall thickness of the pipe
utilized. Can be a production weld, previously inspected weld, or a sample weld.

3. ROUTING INSTRUCTIONS

3.1. Original dated and completed RT form with signature and/or digital electronic
signature accompanies the film packages.

3.2. A copy of the RT and NDE 2 form shall be placed within the Pipeline File
containing an original or digital signature or a copy.

3.3. If the form is completed electronically, print a copy for the film package and
pipeline file as required by SWG or as applicable.

4. REQUIRED FORM RETENTION PERIOD

4.1. Quality affecting records of inspections and/or examinations shall be maintained

for lifetime of the facility plus 5 years. (As-built Drawings 1.6 Record Retention)

4.2. Records Retention - Management of company records must follow the record
retention periods noted above in accordance with the Southwest Gas Corporation
records retention policy.

5. SAMPLE FORM AND DATA ENTRY INSTRUCTIONS:

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Building Efficiency Services

ID Field Description Data Type Validation

1 Building Address(should be Text value) Text Value

2 Date Time Question (should be in calendar) Date &

Time

3 Unit# (should be Text value) Text value

4 In unit Details Button

(when we click on it will show Unit details
screen )

4.1 Top Floor Unit Check box

(value will Yes or No)

4.2 Was steam trap repaired? Check box Only show If 4.1 is yes
(value will Yes or No)

4.3 Steam trap picture Picture Only show If 4.2 is yes

(value will have picture)

4.4 Steam Trap Comment Text Value Only show If 4.1 is yes
(should be Text value)

4.5 Was riser valve installed? Check box Only show If 4.1 is yes
(value will Yes or No)

4.6 Riser Valve Picture Picture Only show If 4.6 is yes

(value will have picture)

4.7 Riser Valve Comment Text Value Only show If 4.1 is yes
(should be Text value)

4.8 Were any low flow measures installed? Check box Only show If 4.1 is yes
(value will Yes or No)

4.9 Low Flow Button Only show If 4.8 is yes

(when we click on it will show Low Flow
screen )

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Building Efficiency Services

4.9.1 Aerators Button

(when we click on it will show Aerators
screen )

4.9.1.1 Aerator picture Picture

(value will have picture)

4.9.1.2 Aerator Location(should be Text value) Text value

4.9.1.3 Aerator Comment(should be Text value) Text value

4.9.2 Was a low flow showerhead installed? Check box

(value will Yes or No)

4.9.3 Low Flow Showerhead Picture Picture Only show If 4.11 is

(value will have picture) yes

4.9.4 Low Flow Showerhead Comment Text value Only show If 4.11 is
yes

4.10 Radiator Location (when we click on it will Button

show Radiator Location screen )

4.10.1 Room Drop down

(value will have Select item)

4.10.2 Room Comment Text value

(should be Text value)

4.10.3 How many radiators in the room? Text value

(should be Text value)

4.10.4 Radiators(when we click on it will show Button

Radiator screen )

4.10.4.1 Enclosure Depth Text value

(should be Text value)

4.10.4.2 Enclosure Length Text value

(should be Text value)

4.10.4.3 Orifice size Drop down

(value will have Select item)

4.10.4.4 Pitch ok? Check box

(value will Yes or No)

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Building Efficiency Services

4.10.4.5 Pitch Comment Text value

(should be Text value)

4.10.4.6 Insert Installed? Check box

(value will Yes or No)

4.10.4.7 Insert image Picture

(value will be picture)

4.10.4.8 Insert Comment Text value

(should be Text value)

4.10.4.9 TRV Installed? Check box

(value will Yes or No)

4.10.4.1 TRV Picture? Picture

0 (value will be picture)

4.10.4.1 TRV Comment Text value

1 (should be Text value)

4.10.4.1 Air Vent installed Check box

2 (value will Yes or No)

4.10.4.1 Air Vent Picture Picture

3 (value will be picture)

4.10.4.1 Air Vent Comment Text value

4 (should be Text value)

4.11 How many air vents installed in total? Text value

(should be Text value)

4.12 How many TRVs were installed in total? Text value

(should be Text value)

4.12 How many orifice plates installed in total? Text value

(should be Text value)

4.13 Extras Button

(when we click on it will show Extras
screen)

4.13.1

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Building Efficiency Services

RADIOGRAPHIC FIELD CHECKLIST

& RADIOGRAPHY WELD TRACKING LOG

1
DATE:
3 4
Radiographer 2 ID # Company
5 6 7
Field Auditor ID # Company
Project: 8 9
Line #

A. Qualifications / Certification / Documentation 10 Yes No

1. Does the technician have a current referenced edition of the API 1104? 11 ☐ ☐
2. Does the technician have their Radioactive Materials License? 12 ☐ ☐
3. Does the technician have the State, and Federal, 10 CFR Part 20 Regulations? 13 ☐ ☐
4. Does the technician have their Radiographer Safety Certification, IRRSP? 14 ☐ ☐
5. Does the Technician have Certification I.D.? (Radiography) 15 ☐ ☐
6. Does the Technician have a current Operators Qualification Card? 16 ☐ ☐
7. Verify the Technician’s Company Level II or III Certification. 17 ☐ ☐

B. Technique Radiograph (Can be single view, independent or production weld) 18 Yes No N/A
1. Does the radiograph contain required identification information? 19 ☐ ☐ ☐
2. Does the radiograph meet density requirements of 1.8 – 4.0? 20 ☐ ☐ ☐
3. Correct number of IQI’s used? (one for < 5”, two for > 5”) 21 ☐ ☐ ☐
4. Were IQI’s placed correctly? (one in center and one within 1” of start or end) 22 ☐ ☐ ☐
5. Were the correct number of exposures used, and is the essential wire visible? 23 ☐ ☐ ☐
6. Did the Technician correct any issues, reshoot and the technique is acceptable? 24 ☐ ☐ ☐

C. Final Radiographs 25 Yes No

1. Does the radiograph contain required identification information? 26 ☐ ☐
2. Does the radiograph meet density requirements? 27 ☐ ☐
3. Correct number of IQI’s used? (one for < 5”, two for > 5”) 28 ☐ ☐
4. Were IQI’s placed correctly? (one in center and one within 1” of start or end) 29 ☐ ☐
5. Is the applicable wire visible, demonstrating required sensitivity? 30 ☐ ☐
6. Were the correct number of exposures used? are the radiographs free of artifacts within the area of 31
☐ ☐
interest?
7. Densitometer calibrated and working correctly? 32 ☐ ☐
8. Were any issues identified by the Field Auditor that required rework? If yes, complete the detailed sheet
33 ☐ ☐
on the following pages.

D. Final Documentation 34 Yes No

1. Does the report contain missing or omitted data? 35 ☐ ☐
2. All information within report correct? (Welds, Thickness, and Diameter etc.) 36 ☐ ☐
3. Were any issues identified by the Field Auditor that required a report revision? If yes, complete the 37
☐ ☐
detailed sheet on following pages.

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 38
Weld Number

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39
View Numbers

40
Pipe Diameter (inches)
Building Efficiency Services

Weld /Material Thickness

41

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Density < 1.8
42

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Density > 4.0
43

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44

Wire Not Visible

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45

Wrong Number IQI

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IQI Location Wrong

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47

Film Artifacts

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48

< 100% Coverage

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ID Missing Info
49
50

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Missed Defect
☐ Report Issues
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51
RADIOGRAPHIC FIELD CHECKLIST

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52

Reshoots Required
& RADIOGRAPHY WELD TRACKING LOG

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53

Issues Corrected
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54

Follow Up Req
55
Notes
 38
Weld Number

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39
View Numbers

40
Pipe Diameter (inches)
Building Efficiency Services

41 Weld /Material Thickness

☐
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☐
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☐ Density < 1.8
42

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Density > 4.0

43

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44

Wire Not Visible

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45

Wrong Number IQI

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46

IQI Location Wrong

☐
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47

Film Artifacts

☐
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48

< 100% Coverage

☐
☐
☐
☐
☐
☐
☐

ID Missing Info
49
50

☐
☐
☐
☐
☐
☐
☐

Missed Defect

Report Issues
☐
☐
☐
☐
☐
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☐
51

☐
☐
☐
☐
☐
☐
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52

Reshoots Required
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53

Issues Corrected
☐
☐
☐
☐
☐
☐
☐
54

Follow Up Req
55
Notes