Title Document no. Rev.

Page Of
1 1 5
930 G 0028
Confidential class 2
Project Document state
Inspection Form
Project number
- Issued
INSPECTION REPORT
Customer Supplier

Doc. type Issued by Language Product / Structure Derived from

930 G Engineering English -/- 930G0028 rev.0

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11/3/2017 3-11-2017 11/3/2017

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 Title Document no. Rev. Page Of

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INSPECTION REPORT 930 G 0028
Confidential class 2

PACKAGE UNIT

Manufacturer: Project:

MECHANICAL:

1 CHECKS ON MECHANICAL INSTALLATION RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
11 Visual schematic (P&ID) check of components and
piping
12 Visual check of skid and piping supports
13 X-ray ... % (if applicable)
131 Other non destructive test ....................
14 Flushing pipework (if applicable)
15 Pressure test ...,. bar (if applicable)
16 Pickling and passivizing (if applicable)
17 Alignment of drive/pump (if applicable)
18 Cleaning and painting
19 Painting color (RAL ....)
110 Proper installations of bolting, gaskets and flanges
111 Correct installation of filters and strainers (if
applicable)
112 Tests and inspections as mentioned in the Quality
plan
113 Others:

ELECTRICAL:

2 CHECK OF LOW VOLTAGE ELECTRICAL RESULTS INTIALS RESULTS

MOTOR (Number of E-Motors ......) SUBVENDOR SUBVENDOR THOMASSEN
2.1 Equipment undamaged
2.2 All holding down bolts used and tightened
2.3 Bearing lubrication (if applicable)
2.4 Nameplate details conform to driven equipment
design data
2.5 Stator windings connections; Y or /\
2.6 Anti-condense heaters (if applicable)
2.7 Earthing of motor and driven equipment
2.8 Cable core connections correct and identified
2.9 Cable terminations satisfactory
2.10 Cables identified correctly
2.11 All covers replaced and fastened
2.12 Insulation resistance test completed

Ansaldo Thomassen reserves all rights on this document that can not be reproduced in any part without its written consent.
 Title Document no. Rev. Page Of

1 3 5
INSPECTION REPORT 930 G 0028
Confidential class 2

2 CHECK OF LOW VOLTAGE ELECTRICAL RESULTS INTIALS RESULTS

MOTOR (Number of E-Motors ......) SUBVENDOR SUBVENDOR THOMASSEN
2.13 Correct "ex" marking and glanding on motor (if
applicable)
2.14 Check that all main and auxiliary terminal boxes are
correctly gasketed with all fixing screws/bolts
tightened down

ELECTRICAL (Cont'd):

3 CHECK OF ELECTRICAL HEATER RESULTS INTIALS RESULTS

(Number of E-heaters .. ) SUBVENDOR SUBVENDOR THOMASSEN
3.1 Equipment undamaged
3.2 Nameplate detail correct
3.3 Terminal box correct
3.4 Electrical connections correct and tightened
3.5 Cable terminations satisfactory
3.6 Cable core identified correctly
3.7 High temperature cut-out tested (if applicable)
3.8 Earthing of heater shell satisfactory
3.9 Terminal box covers replaced, gasketed and fastened
3.10 Insulation resistance test completed

4 EARTHING RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
4.1 Earthboss on frame
4.2 Earth continuïty of mechanical equipment

INSTRUMENTATION:

5 CHECK ON INSTRUMENT INSTALLATIONS RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
5.1 Tag n° nameplate
5.2 Cable identification
5.3 Core identification
5.4 Earthing and screen correct (conform TI standard)
5.5 Instruments within easy reach of maintenance
5.6 Instrumentation air piping installations correct
(including filter/reducer)
5.7 Instrument process piping correct

Ansaldo Thomassen reserves all rights on this document that can not be reproduced in any part without its written consent.
 Title Document no. Rev. Page Of

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INSPECTION REPORT 930 G 0028
Confidential class 2

6 NAMEPLATES OF CONTROL PANEL RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
6.1 Thomassen nameplate on paneldoor
6.2 Nameplates on door (function of pushbuttom)
6.3 Nameplates back of door (pushbuttoms, lights)
6.4 Internal equipment tagged/labelled

INSTRUMENTATION (Cont'd):

7 CONTROL PANEL EARTH CONNECTIONS RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
7.1 Earth bar
7.2 Paneldoor earthed
7.3 Mounting plate earthed
7.4 Earth terminals

8 WIRING OF CONTROL PANEL RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
8.1 Electrical connections correct and tightened
8.2 Core identification

9 VENTILATION OF CONTROL PANEL (if applicable) RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
9.1 All airflow inlets and exhaust free from obstructions
9.2 Correct ventilation fan operation

10 CHECK ON ALL MOVING PARTS OF CONTROL RESULTS INTIALS RESULTS

PANEL SUBVENDOR SUBVENDOR THOMASSEN
10.1 Mainswitch functioning
10.2 Controlswitch functioning
10.3 Pushbuttom functioning
10.3.1 Circuitbreaker functioning

11 CONTROL PANEL: GENERAL RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
11.1 Installed material conform selected vendors
11.2 Fuse ratings correct and fuses insert
11.3 Circuit breakers correct

Ansaldo Thomassen reserves all rights on this document that can not be reproduced in any part without its written consent.
 Title Document no. Rev. Page Of

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INSPECTION REPORT 930 G 0028
Confidential class 2

12 CONTROL PANEL ACCESSORIES RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
12.1 Anti-condens heater
12.2 Indoor lighting/socket outlet
12.3 Transparant door
12.4 Swing frame

13 MECHANICAL INSTALLION OF CONTROL PANEL RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
13.1 Outside dimensions
13.2 Cable entry top/bottom
13.3 Hoisting lugs
13.4 Doorseals and doorlocks

14 CONTROL PANEL SPECIAL REQUIREMENTS RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
14.1 Ex protection
14.2 Protective class IP ..

15 FUNCTION TEST OF CONTROL PANEL RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
15.1 Functioning conform logic diagrams

DOCUMENTATION:

16 REVIEW OF DOCUMENTS: RESULTS INTIALS RESULTS

SUBVENDOR SUBVENDOR THOMASSEN
16.1 Latest "as built" drawings
16.2 Documentation of applied components
16.3 Ex. conformance certificates (PTB/BASEEFA)
16.4 Vendors test certificate

Test performed by Subvendor: Inspection witnessed/accepted by Witnessed by Customer:

Ansaldo Thomassen

Signature: Signature: Signature:

Date Date: Date:

Ansaldo Thomassen reserves all rights on this document that can not be reproduced in any part without its written consent.