Laboratorium Uji Bahan No. Dok : F.01.

10-LUB-PPNS
Politeknik Perkapalan Negeri Surabaya No. Rev : 1
FORMULIR PRAKTIKUM Tanggal : 05/02/2018
RADIOGRAPHY TEST Halaman : 1 dari 2

DESCRIPTION OF THE SPECIMEN FOR PRACTICAL OF RADIOGRAPHY

1. Film Indentification : ……………………………………………………………………………..

2. Material : ……………………………………………………………………………..
3. Weld Thickness : ……………………mm; Mat’l Thickness : ………………………………
4. Source : -ray / X-ray : ……………………………………………………………………………..
5. Source Size / Focal Spot : ……………………………………………………………………………..
6. Film Type and Size : ……………………………………………………………………………..
7. Screen : ………………… : Front : ……………………………………………………………………
Back : ……………………………………………………………………
8. Filter :…………………. : Front : ……………………………………………………………………
Back : ……………………………………………………………………
9. IQI Wire / HOLE : No. : …………………………………………………………………..
10. Technique : ……………………………………………………………………………..
11. SOD (Source to Object : ……………………………………………………………………………..
Distance)
12. Density : IQI : ……………………………………………………………………………..
Left Side : ……………………………………………………………………………..
Right Side : ……………………………………………………………………………..
13. Unsharpness Geometric : ……………………………………………………………………………..
14. Exposure Time : ……………………………………………………………………………..
15. Sensitivity : ……………………………………………………………………………..
16. Remark : ……………………………………………………………………………..
……………………………………………………………………………..
……………………………………………………………………………..
……………………………………………………………………………..
……………………………………………………………………………..

17. Sketch Set-up

………………..,……………….,20…….
Made by,

…………………………………………….
Muharror - D:\DOKUMEN PEKERJAAN\DOKUMEN LAB. UJI BAHAN\DOKUMEN LUB - 2018\01 - Formulir Praktikum\F.01.10-LUB-PPNS - Radiography test.docx
 Laboratorium Uji Bahan No. Dok : F.01.10-LUB-PPNS
Politeknik Perkapalan Negeri Surabaya No. Rev : 1
FORMULIR PRAKTIKUM Tanggal : 05/02/2018
RADIOGRAPHY TEST Halaman : 2 dari 2

Work Order No. : Project No. :

Project Name : Aplicable Codes
Location :
Customer :

PART RADIATION SOURCE RADIOGRAPHIC FILM LEAD SCREEN

Name/OD : ................... Isotope Type : ............................ Brand : ....................... Thickness: .................mm
Base Mat'l. Type : ................... Activity : .........................Ci Film Type : ....................... Placement: Front
Base Mat'l. Thick.: .............mm X-ray Equipment: ............................ Dimension : .......in x ........in Back
Reinforcement : ............mm Voltage : ........................kV No. Of Film in a Cassette: ......... MARKER
Weld Thickness : ............mm Current : ......................mA Lead Letter "B" used: Placement: Source Side
Backing : Yes No Source Size : .....................mm Yes No Film Side

TECHNIQUE EXPOSURE TECHNIQUE SKETCH IMAGE QUALITY INDICATOR (IQI)

Exposure : Single Wall Wire : Type: ......................
Double Wall Wire ID: ...................
Viewing Single Wall Wire Dia.: ................ mm
Panoramic SWSV SWSV DWSV
Double Wall
Exp. Time : ......... min. ......... sec. Placement : Source Side
Ug : ......... mm Film Side
SOD : ......... min
SSOF : ......... mm DWSV DWDV DWDV

Ug: Unsharpness Geometry SOD: Source to Object Distance SSOF: Source Side of Object to Film Distance

Identification Density Sensitivity Discontinuity Type Results

Welder
Date of RT Area of Wire Remarks
Stamp Joint No. Min. IQI Max. IF IP RC UC P SI CR Acc Rep.
Interest ID/Dia.

                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
Type of Discontinuity : IF: Incomplete Fusion IP: Incomplete Penetration RC: Root Concavity UC: Undercut P: Porosity SI: Solid Inclusion CR: Crack
Welding Process(es) :
Total of Films : 4" x 10" = ....................sheet 4" x 10" = ....................sheet
Examined by Reviewed/Witnessed by Authorized Inspector

NDT Level ..................

Date: Date: Date:

Muharror - D:\DOKUMEN PEKERJAAN\DOKUMEN LAB. UJI BAHAN\DOKUMEN LUB - 2018\01 - Formulir Praktikum\F.01.10-LUB-PPNS - Radiography test.docx