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Inspection Record for Instrument Record No.

: –––––

Impulse Hook-ups
Client: ––––– Subcontractor: –––––
Project No.: ––––– Subcontract P.O. No.: –––––
Project Name: ––––– Plant/Area/Unit Nos.:

Reference Document:

Tag No. Hook-up assembly Installation inspected Test pressure (Bar) Date Inspected & tested by
(signature)

1. All union connections to be checked for correct tensioning


2. Tubing slope and configuration to be checked
3. Test pressure to be at least that of connected process piping
4. Tubing to be disconnected from piping nozzle and blinded during impulse line pressure test
5. Do not test against closed process isolation valves
6. Double block and bleed pressure source during pressure test
7. Visually inspect for overstressed or twisted tubing
Remarks:

Accepted for Subcontractor Accepted for Company Accepted for Client


Name: ––––– Name: ––––– Name: –––––
Signature: Signature: Signature:

Date: ––––– Date: ––––– Date: –––––

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