Microsoft Word - FN5.005.6-R1.doc

AWS D1.1 STRUCTURAL WELDER CERTIFICATION

Welder’s Name
Welding Procedure Specification No.:

Identification No.
Rev

Variables	Record Actual Values Used in Qualification	Qualification Range
Process/Type [Table 4.10, Item (2)]
Electrode (single or multiple) [Table 4.9, Item (9)]
Current/Polarity

Position [Table 4.10, Item (5)]
Weld Progression [Table 4.10, Item (7)]

Backing(YES or NO)[Table 4.10, Item(8)]
Material/Spec.[Table 4.10, Item(1)]	to
Base Metal
Thickness:(Plate)
Groove
Fillet
Thickness:(Pipe/tube)
Groove
Fillet
Diameter:(Pipe)
Groove
Fillet
Filler Metal[Table 4.10, Item(3)]
Spec.No.
Class
F-No.
Gas/Flux Type[Table 4.10, Item(4)]
Other

VISUAL INSPECTION(4.8.1)Acceptable□YES or□NOGuided Bend Test Results(4.30.5)
Type	Result	Type	Result
-----------------------------	--------	--------	--------

Fillet Test Results(4.30.2.3and4.30.4.1)
Appearance		Fillet Size
Fracture Test Root Penetration		Macroetch
(Describe the location,nature,and size of any crack or tearing of the specimen.)
Inspected by		Test Number
Organization		Date

RADIOGRAPHIC TEST RESULTS(4.30.3.1)
Film Identification #	Results	Remarks	Film Identification #	Results	Remarks
------------------------	--------	---------	------------------------	--------	---------


Interpreted by		Test Number
Organization		Date

We, the undersigned, certify that the statements in this record are correct and that the test welds were prepared, welded, and tested in accordance with the requirements of section 4 of ANSI/AWS D1.1, () Structural Welding Code-Steel.
(year)

Organization

Date By

DCR 10003

FN 5.005.6 (Rev. 1)