Quality Management System :PRESSURE TESTING Fill in the form below and submit accordingly, Alternatively click to download fillable form. 1. Request Details 1.1 Date and Time of Request* 1.2 Date and Time of Inspection Required* 1.3 Date and time of Delivery of Request* 1.4 Details of Section of Work to be Inspected/Approved* Request checked by site agent: Please Select: YesNo Signature of Site Agent: Upload Digital Signature? (png,jpg,gif)NoYes Please sign below: Signature of Recipient (Engineer’s Representative): Upload Digital Signature (png,jpg,gif)?NoYes Please sign below: 2. Pipe Details 2.1 Material 2.6 Wall-Thickness 2.2 lining 2.7 Joint Type 2.3 Coating 2.8 Working Pressure 2.4 Nominal-Diameter 2.9 Max-test-pressure 2.5 Actual internal diameter 2.10 Min test Pressure Inspection 3.1 Start point* Chainage: Elevation: Pressure: 3.2 End point* Chainage: Elevation: Pressure: 3.3 Highest point* Chainage: Elevation: Pressure: 3.4 Lowest point* Chainage: Elevation: Pressure: 3.5 Pump Location* Chainage: Elevation: Pressure: 3.6 Test Head* Chainage: Elevation: Pressure: 3.7 Permissible loss (lts)* 3.8 Actual loss (lts)* 3.9 Date and Time inspection Started (lts)* 4. Sketch of section under inspection 5. Approval The sections of pipe, as detailed above have been Please SelectApprovedNot Approved The contractor can now commence with backfilling for the above portion of the Works. In the case of NON approval, the contractor is to rectify the following*: Name* Signature: Upload Digital Signature?: NoYesPlease sign below: