CDRL_Attachment_4_-_INSTRUCTIONS_FOR_COMPLETING_AF_FORM_1222_(7-12-2013).docx

INSTRUCTIONS FOR COMPLETING AF FORM 1222-AF OR EQUIVALENT (7-12-13)

BOILER OR UNFIRED PRESSURE VESSEL (UPV) INSPECTION REPORT

Use a separate form for each boiler or UPV. The following subparagraph numbers refer to number blocks on the report.

1. Type of Inspection: Enter an “x” in the appropriate box for a Boiler or Pressure vessel. Check the type of inspection accomplished (Type BA, BB, BC, BD, BE or VA, VB, VC, VD, VE).

2. Date of Inspection: Enter the date inspection was accomplished.

3. Inspection/Delivery Order No: Enter inspection order number or delivery order number as shown on the inspection order.

4. Contract Number: Enter the contract number for the inspection order.

5. Installation: Enter base name or title of the activity for which the inspection is being made.

6. State: Enter the state where the object being inspected is located.

7. Zip Code: Enter zip code where the object being inspected is located.

8. Location (Bldg No.): Enter the building or structure number assigned by the BCE in which the boiler or UPV is located.

9. Plant: Enter whether object is part of a heat plant; if so, enter total plant capacity and whether it is manned or unmanned.

10. Object Inspected: Enter the type of object inspected by checking the appropriate box.

11. Use: Enter the use or function of the object inspected (steam heating, storage or other) by checking the appropriate box.

12. Manufacturer: Enter the name of the manufacturer.

13. Mfr. Rating: Enter the manufacturer’s rating or capacity in millions of BTUs per hour (MBTU) or in thousands of pounds of steam per hour (klbs/hr). One thousand pounds of steam per hour is approximately equal to 1 MBTUs.

14. (a) National Board No.: Enter the boiler or UPV National Board Number.

14. (b) USAF No.: Enter the boiler or UPV number assigned by the BCE to the object being inspected.

15. Year Built: Enter the calendar year in which the boiler or UPV was built.

16. Year Installed: Enter the year in which the boiler or UPV was installed.

17. Primary Fuel (Boiler): Enter the primary fuel; e.g., natural gas, No. 2 to 6 fuel oil, propane, coal, solid waste, etc.

18. Secondary Fuel: Enter the secondary or back-up fuel; e.g., natural gas, No. 2 to 6 fuel oil, propane, coal, solid waste, etc.

19. Pressure Allowed MAWP PSIG at TEMP: Enter the Maximum Allowable Working Pressure (MAWP) in psig at temperature in degrees Fahrenheit determined as described in the National Board Inspection Code as a result of this inspection. Enter the MAWP in psig from the previous inspection. When inspection indicates that the thickness of the plate or strength of any joint is less than that on which the current maximum allowable working pressure is based, or when it is impracticable to apply the required hydrostatic test, calculate a new maximum allowable working pressure in accordance with rules of the code.

20. Actual Operating Pressure (PSIG): Enter the actual operating pressure at which the boiler operates in psig.

21. Safety &/or Relief Valve Setting: Enter set pressure (psig) and/or temperature of the safety relief valves.

22. Pressure Prior Inspection (PSIG): Enter the set pressure and/or temperature of the safety valve in prior inspection.

23. Pressure This Inspection (PSIG): Enter the set pressure and/or temperature of the safety valve in this inspection.

24. Explain If Pressure Changed: Enter explanation for any pressure or temperature change.

25. Method of Firing (Boilers): Enter the method of firing, either automatic or manual.

26. Pressure Gage Calibrated: Enter yes or no. Check to see if the pressure gage has been calibrated and tested. Record when the gage was last calibrated. Gage range should be 1½ - 2 times the MAWP.

27. Date/Type of Last Inspection: Enter the date when object was last inspected and the type of the last inspection.

28. Hydrostatic Test: If hydrostatic test, enter check for new, retest, or test after repair. Enter the date of the last hydrostatic test and the test pressure in psig.

29. Last Hydrostatic Test: Enter date of last hydrostatic test and test pressure in psi.

30. Repairs/Alterations Made Since Last Inspection: Enter “None” for “no” repairs and “Yes” (Specify) if repairs were made. Describe fully all repairs since last inspection. Verify repairs comply with NBIC and ASME requirements.

31. Internal Inspection (Describe Inspection Fully): Describe fully and state the location of any damage or deposits on internal surfaces (e.g., scale, oil, or other deposits). State location and extent of corrosion and whether active or inactive. State location and extent of any erosion, grooving, bulging, warping, cracking, or similar conditions. Report defective rivets, bowed, loose, or broken stays. State condition of all tubes, wall thickness, tube ends, coils, nipples, etc. Describe adverse conditions of pressure gages, water columns, gage glasses, gage cocks, safety valves, etc. Report the condition of settings, linings, baffles, supports, etc. Describe any adverse conditions, safety, or ASME/NBIC violations, etc. Describe any major changes or repairs made since last inspection.

32. External Inspection (Describe Inspection Fully): State location of any corrosion, leakage, evidence of overheating, soot or other destructive accumulations, safety and/or ASME/NBIC violations. Input combustion efficiency (CE) test results.

33. Inspection of Safety Devices: Verify the installation, operation and testing of safety devices as required by ASME/NBIC. By device, record manufacturer’s name, salient features, (set pressure (psig), size (inches), relieving capacity (lbs/hr), etc), condition, and a brief description of the test or verification procedure performed. State whether ASME/NBIC requirements have been met. If not in compliance, enter No and document all deficiencies and required repairs. Use additional sheets as necessary.

34. Inspection of Pressure Gages: Enter gage number, condition, corrections or adjustments made, whether tested/calibrated and reason not tested. Verify that the gage has the appropriate range for the process being measured.

35. Other Appliances (e.g., water columns, gage glasses, gage cocks): Enter items inspected and condition.

36. CSD-1/NFPA 85 Compliant? (For BC inspections only): Verify the installation, operation and testing of controls and safety devices as required by NBIC, and CSD-1/NFPA 85. Record by control/device the manufacturer’s name, salient features, condition, and a brief description of the test or verification procedure performed. State whether NBIC and CSD-1/NFPA 85 requirements have been met. If not in compliance, enter No and document all deficiencies and required repairs. Use additional sheets as necessary.

37. State Condition of Object: Check Yes if satisfactory for operation or No if unsatisfactory. If No, list deficiencies to be corrected and repairs to be made. Use a supplemental sheet, if necessary.

38. Is Object Safe to Operate?:

· Check Yes if object is safe to operate.

· Check Yes, with restrictions, if operational changes are required for continued safe operation and/or to place time limits on completing repairs. Explain restrictions on a supplemental sheet.

· Check No if the object is not safe to remain in operation. Explain on a supplemental sheet.

39. Name and Title of Inspector: Enter name and title of authorized inspector.

40. Signature of Inspector: Enter signature of authorized inspector.

41. National Board Commission Number: Enter the national Board Number of the authorized inspector.

42. Date: Enter date of inspection.

43. Name and Title of Air Force Representative Accompanying Inspector: Enter name and title of Air Force representative witnessing inspection.

44. Signature: Enter signature of Air Force representative witnessing the inspection.

45. Date: Enter date of signature.

BLOCKS 45-49: Verify work was performed to correct deficiencies prior to re-inspection. A re-inspection is required before returning the object to service.

46. Actions Taken by Air Force at a Later Date to Resolve Deficiencies Cited Above: Enter necessary corrective actions recommended as a result of the inspection.

47. Date of Actions Taken: Enter date of corrective actions taken to correct deficiencies.

48. Name and Title of Certifying Official: Enter name and title of certifying official authorizing corrective actions as a result of the inspection.

49. Signature of Certifying Official: Enter signature of certifying official.

50. Date: Enter date of signature of certifying official.