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    Form-11 - Safety Department

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    tech

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Form-11 - Safety Department

    Uploaded by

    tech
    9 views3 pages

    Original Title

    form-11 - Safety Department

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    9 views3 pages

    Form-11 - Safety Department

    Uploaded by

    tech

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    FORM NO.

    11
    (Prescribed under Rule 61)
    Report of examination or test of pressure vessel or plant.
    Registration number :
    License number :
    *NIC Code number :
    (as given in the licence)
    1. Occupier (or owner) of premises :
    2. Address :
    3. Name, description and distinctive number :
    of pressure vessel or plant.
    4. Name and address of manufacture :
    5. Nature of process(including temperature :
    and pressure parameters)
    6. Particulars of pressure vessel or plant-
    (a) Date of construction :
    (b) Thickness of walls :
    (c) Date on which it was first taken into use.
    (d) Safe working pressure
    Recommended by the manufacture
    7. Date of –
    (a) Last external examination :
    (b) Last internal examination :
    (c) Last hydraulic examination :
    (d) Last ultra-sonic or other :
    non-destructive test.
    8. Whether lagging was removed for :
    purpose of examination.
    9. Description of examinations carried out :
    and findings.
    (a) External examination :
    (give reason if it is not carried out
    six monthly)
    (b) Internal examination :
    (give reasons if it not carried out
    annually)
    (c) Hydraulic test :
    (give reasons if this is not carried
    out at an interval of 2 years or 4
    years)
    (d) Ultra-sonic or other :
    non-destructive test.
    10. Condition of pressure plants -
    (a) Vessel
    (b) Piping
    11. Conditions of fittings and appliances –
    (a) Pressure gauges :
    (b) Safety valve :
    (c) Stop valve :
    (d) Reducing valve :
    (give reasons if not necessary)
    (e) Additional safety valve :
    (required in case reducing valve is
    necessary)
    (f) Other devices
    (Please specify particularly in case
    of jacketed vessels)
    12. Safe working pressure recommended after :
    examination (specify the allowances made
    for conditions of working such as heat,
    corrosion etc.)
    13. (a) Repairs (if any) required :
    (b) Period within which the repairs :
    should be executed.
    (c) Any other condition which the :
    person making the examination
    thinks it necessary for securing
    safe working.
    14. Specify reduced working pressure pending :
    repairs
    15. Safe working pressure calculated as per :
    methods given in sub-rule 8 for thin
    walled pressure vessel or plant.
    16. Other observations.

    I certify that on (date) ……………………………… the pressure vessel or plant


    described above was thoroughly cleaned and (so far as its construction permits)
    made accessible for thorough examination and for such tests as were necessary for
    thorough examination and that on the said date, I thoroughly examined this
    pressure vessel or plant, including its fittings and that the above is a true report of
    my examination.

    Signature and name of


    Competent person :

    Number and date of the


    Competency certificate :

    Date : Issued by :
    *National Industrial Classification (NIC)

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