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Inspector Qualification Form

Date of Interview:

Last Name: First Name: Initials:

Contact information:

Street Address:

City State/Province/Prefecture:

Zip Code/Postal code:

Telephone Number: Cell/Mobile Number: Fa Number:

!"mail Address: #rivin$ %icense: Fiscal Code:

Personal Equipment:

%aptop #es&top Fa #i$ital Cell Phone Car Protective

Computer Application/Electronic Communication Capabilities:

!"mail MS(ord !cel Acrobat )eader File Compression *thers:

LanuaeCapabilities:

!pea"in #ritin $ea%in/Compre&ension

'( : Fluent : +ood : Fair : !cellent : +ood : ,asic : !cellent : +ood : ,asic

)( : Fluent : +ood : Fair : !cellent : +ood : ,asic : !cellent : +ood : ,asic

*( : Fluent : +ood : Fair : !cellent : +ood : ,asic : !cellent : +ood : ,asic

#or"in +nowle%e of In%ustr, Co%es an% !tan%ar%s

ASM! ASTM ANS- A(S T!MA NAC! SSPC .N-"!N -!C#-N -S* AP- ASNT -!!! N!C N!MA ,S MSS

Certifications:

ND- Level II or III

PT " SNT"TC"A 0%evel--1

PT " .N- !N 234 0%evel--1

PT " SNT"TC"A 0%evel---1

PT " .N- !N 234 0%evel---1

Certification Number:

Certification Number:

No

No

MT " SNT"TC"A 0%evel--1

MT " .N- !N 234 0%evel--1

MT " SNT"TC"A 0%evel---1

MT " .N- !N 234 0%evel---1

Certification Number:

Certification Number:

No

No

)T " SNT"TC"A 0%evel--1

)T " .N- !N 234 0%evel--1

)T " SNT"TC"A 0%evel---1

)T " .N- !N 234 0%evel---1

Certification Number:

Certification Number:

No

No

.T " SNT"TC"A 0%evel--1

.T " .N- !N 234 0%evel--1

.T " SNT"TC"A 0%evel---1

.T " .N- !N 234 0%evel---1

Certification Number:

Certification Number:

No

No

*thers:

Certified (eldin$ -nspector Certification Number: No

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ASM! Authori5ed-nspector

Certification Number: No

P!# Authori5ed -nspector Certification Number: No

-S* Certified %ead Auditor Certification Number: NoNAC! Certification Number: No

Certification Number: No

Certification Number: No

Certification Number: No

Inspector Qualification Form.Cont(

Inspector Name: Date:

Inspection Discipline E0pertise

Pressure !'uipment 6alves 7 Pipin$ )otatin$ Machinery !lectrical 7 -nstrumentation

Pac&a$e .nits Flares Steel Structures Pipe Mill

Special !'uipment !peditin$ -S* 8999 Audits Site -nspection

1nl, c&ec" t&e appropriate bo0es above w&en t&ere is confi%ence t&at t&e inspector &as %emonstrate%

competence appropriate to t&e particular equipment an%/or commo%it, roup2 t&rou& &is/&erqualifications2 e0perience an% "nowle%e(

Commo%it,/Equipment +nowle%e/Capabilit,

Non Destructive -est 3oo% 4asic 5ac&iner, 3oo% 4asic

.ltrasonic Centrifu$al Compressors

)adio$raphy )eciprocatin$ Compressors

Ma$netic Particle +ear ,oes

!ddy Current Centrifu$al Pumps

%i'uid Penetrant )eciprocatin$ PumpsPositive Material -dentification 0PM-1 +as Turbines

Pressure Equipment 3oo% 4asic Steam Turbines

)eactors and Clad %ined 6essels #iesel/+as !n$ines

Toers Fans

Pressure 6essels 0;

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#ouble Pipe ?eat !chan$ers #erric&s

Plate ?eat !chan$ers Platforms 7 %adders

Air Coolers Stac&s

Inspector Qualification Form.Cont(

Inspector Name: Date:

Pipin/4ul" 5aterial 3oo% 4asic Electrical 7 Instrumentation 3oo% 4asic

Seamless/(elded Pipes !lectrical Motors

Shop Fabricated Pipin$ +enerators

Pipe Mill Transformers

Strainers ,atteries

!pansion @oints Motor Control Centers

Plates Poer Cable

For$in$ Analy5ers

Castin$s Safety 6alves

Flan$es Control/)elief 6alvesFittin$ Actuators

Tubin$ Sitch$ear

,oltin$ Control/%ocal Panels

+as&ets !lectronic/Pneumatic -nstruments

Linin 7 Coatin 3oo% 4asic Assemble% Pac"aes 3oo% 4asic

)efractory Compressor / Turbine S&id .nits

Nonmetallic %inin$s/Paint %ube *il Consoles

Thermal Spray Aluminum (ater/+as S&id .nits

1il 7 3as Pro%uction 3oo% 4asic !pecial/1t&er 5aterials 3oo% 4asic

)i$s/Platforms/@ac&ets

#rillin$ !'uipment

(ell ?ead !'uipment

5arine Equipments 3oo% 4asic

Terminal !'uipment

%oadin$ Arms

Ships ,oats

E0pe%itin 3oo% 4asic

Pressure !'uipment

)otatin$ !'uipment

6alves and Pipin$

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!lectrical and -nstrumentation

Au%its 3oo% 4asic

uality System Audits 0-S* 89991

Supplier Assessments

Plant Surveys/Audits

Inspector Qualification Form.Cont(

Inspector Name: Date:

Courses Atten%e% .e((2 #el%in2 Coatin2 NDE2 Au%its2 Etc(

Course Date Course Date

$esume/Curriculum 6itae .C6 Attac&e%8 9es No

-ec&nical 5anaers Evaluation/Comments:

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5r(/5s(

Is approve%

Is not approve%

-o perform inspection activities on be&alf of Interte" In%ustrial !ervices(

Certificate of Approval for Inspection Personnel No(

Approval Authority : Technical Mana$er

Name :

Si$nature :

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