ASSOC.

PIP: INSPECTION HOLD POINT AND

RFTA1000 SIGN-OFF SCHEDULE PIP RFTA1000-F

REFRACTORY ANCHOR AND ACCESSORY INSTALLATION PAGE 1 OF 1

QUALIFICATION, INSPECTION, AND TESTING JANUARY 2017

NO. DATE REVISION DESCRIPTION BY CHECKED APPROVED

                                   
                                   
                                   
PROJECT NO.       PROJECT DOCUMENT NO.      
FACILITY NAME      
LOCATION      

INSTALLER:       REPORT DATE:   /  /     

SIGNOFF SCHEDULE
INSTALLER’S PURCHASER’S
OWNER
HOLD POINT INSPECTOR INSPECTOR
INITIALS/ INITIALS/ INITIALS
REQUIRED REQUIRED REQUIRED
DATE DATE /DATE
1. ANCHOR INSTALLATION
YES       YES       YES      
PROCEDURE

2. ANCHOR AND WELDING

YES       YES       NO      
CONSUMABLE CONFIRMATION

3. ANCHOR WELDER QUALIFICATION YES       YES       NO      

4. SURFACE PREPARATION FOR

YES       YES       NO      
ANCHORS

5. ANCHOR LAYOUT YES       YES       NO      

6. FINAL ANCHOR INSTALLATION

YES       YES       YES      
INSPECTION
COMMENTS:      
     
     
     
     
INSTALLER’S INSPECTOR
(PRINTED)
SIGNATURE:
PURCHASER’S INSPECTOR
(PRINTED)
SIGNATURE: