Project Name

PN: XXXXX
CHEMICAL / MECHANICAL CLEANING
REPORT

System / Package No. Testpack No.

P&ID/Dwg No. Room No.

Equipment Name / Tag No.

NOTE: If a section is NOT relevant enter N/A

Chemical Cleaning (Agent Used: ) or Mechanical Cleaning

P&ID Listing:
………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….
Line Nos.:
…………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

Origin: ………………………………………………… Termination: ……………………………………...

Start Time: ___________hrs End Time: _________hrs Tempertaure: ___________0C

Yes N/A No Yes N/A No

Circuit has been hydrotested. Circuit is blown dry.
Circuit isolated Circuit drained.
Vents and drains installed
Circuit re-instated.
and Instruments removed.

Adequate flow for cleaning. Passivation completed.

Circuit is clean to acceptable Nitrogen purge on
standard for project. if required.

Comments : (If there are NO ADDITIONAL comments enter NONE, initial and date)
Reason to be written in comments section and, where applicable, raised as an exception or outstanding issue as part of
the system handover. If resolved prior to handover comments to be marked appropriately and signed off accordingly.

Completed by Witnessed by Approved by Accepted by

Company
Signature
Print Name
Date

XXXXX 3 CON 8749 REC 37 –Chemical Mechanical Cleaning Report

Prepared By: Amalina Kamal Revision Date: 16-Mar-2020 Page 1 of 1
Create Date: 22-Dec-2011 Revision: 2