INSPECTION REPORT REPORT NO.

:
ULTRASONIC EXAMINATION PAGE NO. :
CLIENT : LOCATION :
CONTRACTOR : JOB NO. :
PROJECT : DATE OF TEST:
PROCEDURE NO. : REQUEST NO. :
WORK INSTRUCTION : REF. CODE/STD :
EQUIPMENT, MATERIALS & OPERATION PARAMETERS…
UT EQUIPMENT TYPE : BRAND :
MODEL : SERIAL NO. :
PROBE SR. NO. BRAND PROBE ANGLE ACT. ANGLE FREQUENCY (MHz.) SIZE REMARK

CAL BLOCK TYPE : SERIAL NO. :

SIMULATION BLOCK TYPE : SERIAL NO. :
CABLE TYPE / LENGTH : CABLE TYPE / CONNECTOR :
COUPLANT : SPECIAL EQUIPMENT/PROBE :
PART IDENTIFICATION & INFORMATION…
ISO/DWG NO. : DESCRIPTIONS :
MATERIAL : MODULE :
MATERIAL THICKNESS : SURFACE CONDITION :
INSPECTION CATEGORY :
CALIBRATION (SYSTEM PERFORMANCE) & OPERATION PARAMETERS…
TECHNIQUE : CONTACT IMMERSION PULSE ECHO TRU-TRNM
SCANNING METHOD : MANUAL AUTO EVALUATION LEVEL :
TEST RANGE : REF. LEVEL :
SENSITIVITY : SCANNING LEVEL :

SCANNING METHOD
Perpendicular Grid on 225 mm Center Parallel Path Transverse to Major Plate axis on 100 mm centers
Parallel Path Parallel to Major Plate Axis on 75 mm Center Within 50 mm of all edge of plate 100%
EVALUATION… ACCEPTANCE CRITERIA:
INDICATION SCAN DISCONTINUITY AMP IBR DISCONTINUITY SIZE LOCATION(mm) RESULT REMARK
From
NUMBER % of FSH % of IBR % of FSH Length*Width Dia. Dist From Depth ACC. REJ.
Face
FACE mm*mm mm X Y Z

ABBREVIATION ….. IBH : Initial First Back Reflector, FSH : Full Screen Height, AMP : A,plitude
SKETCH

AUTHORIZATION EXAMINED/EVALUATED BY: REVIEWED/WITNESSED BY: REVIEWED/APPROVED BY :

COMPANY :
SIGNED :
NAME :
METHOD (LEVEL) :
DATE :

FM-TI-013 Rev.0 Effective Date : October 13, 2016