Rukan Palm Crown Blok HH 4 No.

21, Jakarta Barat – 11830

Telp. : (021) 22543188, Fax. : (021) 22543189
Email : catursekawan89@gmail.com

SealXpert Products
REPAIR ASSESSMENT FORM

1. CUSTOMER INFORMATION
Company
Contact Person

Address

Country
Telephone
E-mail Address

2. PIPE CONDITIONS
Installation
Location
Pipe Identification/ Reference
Pipe Material/ Grade Nominal Pipe Dia.
Pipe OD Pipe Schedule
Pipe Wall Thickness (mm) Current Wall Thickness
Pipe Medium
Design Temp, max (°C) Max Operating Temp.(°C)
Design Temp, min (°C) Min Operating Temp. (°C)
Design Pressure (psi) Operating Pressure (psi)
Existing Pipe Coating
No of years in operation
Note: For any original design calculations, piping isometrics shall be appended to this data sheet

3. DEFECT INFORMATION
Location of Defect Straight pipe / Tee-Joint / Elbow / Others
Type of Defect (tick) Leak Corrosion Others
Cause of Defect Corrosion Erosion
Effect External Internal
Size of Defect (For Leak) Length Width
Size of Defect (For Corrosion) Area Depth
Other Information

EXPERTS IN PIPELINE PRODUCTS

Rukan Palm Crown Blok HH 4 No. 21, Jakarta Barat - 11830 1
Telp. : (021) 22543188, Fax: (021) 22543189
Email:catursekawan89@gmail.com
 3. DEFECT INFORMATION (CON’T)
Details of Defect (sketch or draw):

Weld Joint

4. CONDITIONS DURING REPAIR WORKS

Is Grit blasting permissible? Yes / No
Can pipe be depressurised? Yes / No
Pipe Temperature during repair Minimum Maximum
Ambient Temperature during repair Minimum Maximum
Any constraints during repair?

Other Information
(e.g. Remarks on previous repairs, fire
protection requirements, available design
calculations, etc.)

Prepared By:
Date:

EXPERTS IN PIPELINE PRODUCTS

Rukan Palm Crown Blok HH 4 No. 21, Jakarta Barat - 11830 2

Telp. : (021) 22543188 , Fax : (021) 22543189
Email : catursekawan89@gmail.com