J-1_Attachment_Shipcheck_Templates.pdf

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DECK COVERING INSPECTION FORM

JSN

COMPARTMENT

FRAME -FRAME

DECK

TYPE

REPL

SQFT

RESEAL

SQFT

COLOR

NOTE

1 2

REMARKS

SHIP NAME __________________ SHIP LOCATION _________________ SHIPCHECK BY ________________

HULL NUMBER ______________ DATE ___________________________ ITEM NUMBER ________________

___ OF ___

NS = Non-Skid M = Electrical Grade Matting T = Terrazzo C = Cosmetic Polymeric P = Painted N = Nomex O = Other (defined in Remarks)

(Existing Terrazzo may be patched. When replacement of Terrazzo is required, use of Cosmetic Polymeric Type I Class 3 or Typ e III)

Note 1 = deck drains and/or rings require replacement, see attached piping form.

Note 2 = bulkhead or deck structures require repair, see attached structural inspection form.

NAVSEA 4790/1G (5-2000)

DOOR/HATCH/SCUTTLE SHIPCHECK REPORT

DATE: __________________________

JOB ID

SHIPCHECK ASSIST -

REQUESTING POC:

SHIPCHECK BY

SHIP NAME:

NAME –CODE:

NAME -CODE:

HULL NO.:

PHONE:

SWLIN/JCN:

FAX: FAX:

SHIP LOCATION:

E:MAIL E:MAIL:

SHIP POC: SHIP POC SIGNATURE: SHIP POC PHONE:

WORK LOCATION

DO OR/HATCH/SCUTTLE NUMBER:

COMPARTMENT TITLE/EXTERIOR LOCATION NOMENCLATURE:

CO MPARTMENT NO :

DECK:

FRAME: SIDE:

PLANNER’S RECOMMENDATION

ACCEPT JOB REJECT JOB REASON:

JOB LEVEL:

SHIP’S FORCE CAPABLE FMA (SIMA) DEPOT (SHIPYARD) ONBOARD REPAIR SHIP TO SHOP REPAIR

FMA WORK CENTERS/SHIPYARD SHOPS

LWC/LEAD SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP

AWC/ASSIST SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP AWC/ASSIST SHOP

VISUAL INSPECTION

DO OR/HATCH/SCUTTLE

SIZE:

# OF DOGS: CONFIGURATION:

ALUMINUM

STEEL

ARMO RED

KEVLAR COVER

BI-METALLIC STRIP

COUNTER WEIGHTS

COLOR OF FITING:

LH / RH

# OF HINGES: CHALK TEST:

SAT

UNSAT

QUICK ACTING

INDIVIDUALLY DOGGED

ALUMINUM / STEEL

STRING TEST:

SAT

UNSAT

NDT REQUIRED:

YES

N O

TEST REQ: YES NO YES NO

CHALK TEST? AIR HOSE TEST?

WATER HOSE TEST? OP TEST?

DSR/DFS:

NO

ACCESS REQUIREMENTS

COMPARTMENT: EXTERIOR LOCATION

ACCESS DIMENSIONS:

NAVSEA 4790/1H (5-2000)

CO NDITIO NS FO UND/RECO MMENDATIO NS / INTERFERENCES

CONTINUED ON SEPARATE SHEET

MATERIAL REQUIREMENTS

MATERIAL QUANTITY MATERIAL QUANTITY

DEVIATIONS FROM AUTHORIZED WORK

GAS FREE REQ UIREMENTS STAGING REQUIREMENTS

PAINTING REQUIREMENTS

SQ. FOOTAGE: SURFACE PREP: PAINT SYSTEM:

DRAWINGS OR MANUALS REQUIRED

DRAWINGs: TMs:

NAVSEA 4790/1H (5-2000) (Back)

ELECTRICAL/ELEX SHIPCHECK REPORT

SYSTEM:

EQUIPMENT NOMENCLATURE:

COMPARTMENT TITLE:

COMPARTMENT NO:

SHIP’S FORCE CAPABLE FMA (SIMA) DEPOT (SHIPYARD) ONBOARD REPAIR SHIP

TO SHOP REPAIR

LWC/LEAD

SHOP

AWC/ASSIST

NAME PLATE DATA/COMPONENT ID

MANUFACTURER:

APL:

PART NO.:

FRAME NO.:

SERIAL NO./CAT NO.:

HP/SIZE:

ROTATION:

RPM:

MODEL:

MK/MOD:

PHASE: AMPS: VOLTS: KW:

CKT ID:

COUPLING TYPE:

NAVSEA 4790/1D (5-2000)

CONDITIONS FOUND/RECOMMENDATIONS

SKETCH/PHOTOS ATTACHED CONTINUED ON SEPARATE SHEET

ACCESS CUTS

COMPARTMENT: EXTERIOR LOCATION:

ACCESS DEMENSIONS:

OTHER

VIBE ANALYSIS REQUIRED:

DFS:

DSR:

INSULATION:

NONE

MINOR

MAJOR

ACCESS:

REQUIRED

NOT REQUIRED

SECURITY REQUIREMENTS:

SPACES

EQUIPMENT

DOCUMENTS

INTERFERENCE:

INTERFERENCES

NAVSEA 4790/1D (5-2000) (Back)

MACHINERY SHIPCHECK REPORT

NAME –CODE:

SHIP’S FORCE CAPABLE FMA (SIMA) DEPOT (SHIPYARD) ONBOARD REPAIR SHIP TO SHOP REPAIR

SYSTEM:

EQUIPMENT NOMENCLATURE:

MANUFACTURER: MODEL #:

SERIAL NO.: REMOTE STATION:

SIZE: HYDRO TEST DATA:

SPEED (RPM): TECH MANUAL:

RATING: DWG:

COUPLING TYPE: LUBRICATION TYPE:

APL: HOSES:

NSN: RESILIENT MOUNTS:

NAVSEA 4790/1B (5-2000)

SKETCH/PHOTOS ATTACHED CONTINUED ON SEPARATE SHEET

FLANGE SHIELDS REQUIRED:

DESIGN SERVICES/DEPARTURE FROM SPEC:

PIPE/MACHINERY INSULATION:

HULL/VENT INSULATION:

NDT REQUIRED:

ACCESS REQUIREMENTS

COMPARTMENT: EXTERIOR LOCATION:

ACCESS DIMENSION:

INTERFERENCES

NAVSEA 4790/1B (5-2000) (Back)

PIPING SHIPCHECK REPORT

JOB ID SHIPCHECK ASSIST -

NAME- CODE:

NAME - CODE:

SHIP’S FORCE CAPABLE FMA (SIMA) DEPOT (SHIPYARD) ONBOARD REPAIR SHIP TO SHOP REPAIR

PIPE INFORMATION

SYSTEM: FROM: TO:

MATERIAL TYPE:

CUNI COPPER STEEL ALUMINUM CRES OTHER

PIPING CLASS:

P-1 P-2 P-3A P-3B

MIC LEVEL ONE APPLICABLE?

YES NO

OTHER:

TECH MANUAL NUMBER DRAWING NO.:

SYSTEM OPERATING PRESSURE: SYSTEM TEMPERATURE SYSTEM TEST PRESSURE:

NAVSEA 4790/1A (5-2000)

TYPE WORK:

PIPING

VALVE

GAS FREE REQUIRED?

DSR: DFS:

YES YES

NO NO

RESILENT PIPE HANGERS?

STAGING/SCAFOLDING REQUIRED:

NDT REQUIRED

MATERIAL REQUIREMENTS

MATERIAL SIZE TYPE QUANTITY PIPE REPLACEMENT LOCATION

Material should consider: pipe, valves, insulation, insulation pads, flanges, fittings, gaskets, fasteners, hangers, etc.

SKETCH/PHOTOS ATTACHED CONTINUED ON SEPARATE SHEET

INTERFERENCES/ACCESS REQUIREMENTS

NAVSEA 4790/1A (5-2000) (Back)

SHIP’S VALVE LIST

JSN

Q TY

SIZE

(INCH

NPS)

LOCATION

VALVE

DESIG/

SERVICE

BODY TEST

PRESSURE

(PSIG)

SEAT

TIGHTNESS

TEST PRES

(PSIG)

STEAM TEST

PRES (PSIG)

SERVICE

TEMP

(DEGREES

F.)

OPER

MFR

APL

REMARKS

SHIP NAME SHIP LOCATION SHIPCHECK BY

HULL NUMBER DATE DATE ITEM NUMBER

NAVSEA 4790/1E (5-2000)

STRUCTURAL SHIPCHECK REPORT

SHIP CHECK BY

SHIP’S FORCE CAPABLE FMA (SIMA) DEPOT (SHIPYARD) ONBOARD REPAIR SHIP TO SHOP REPAIR

INSULATION REQUIRED: YES

OTHER TESTS:

GAS FREE REQUIRED: YES NO SPLIT REQUIRED: YES NO

REPLACE DECK COVERING: YES NO

SURFACE PREP:

DECK COVERING TYPE: SQFT:

NAVSEA 4790/1C (5-2000)

STAGING REQUIREMENTS

ACCESS REQUIREMENTS INTERFERENCES

COMPARTMENT:

ACCESS DIMENTIONS:

EXTERIOR LOCATION:

CONTINUED ON SEPARATE SHEET CONTINUED ON SEPARATE SHEET

PAINTING REQUIREMENTS

SQ. FOOTAGE:

SURFACE PREP:

PAINT SYSTEM:

NAVSEA 4790/1C (5-2000) (Back)

THERMAL INSULATION LIST

JSN (SHIP’S

REPAIR PRI)

COMPT #

VENT DUCT

OVERHEAD

BULKHEAD

THICKNESS

REMARKS SIZE SQ FT FR-FR SQ FT FR-FR SQ FT

SHIP NAME SHIP LOCATION SHIPCHECK BY

HULL NUMBER DATE DATE ITEM NUMBER

NAVSEA 4790/1F (5-2000)

VALVE SHIPCHECK REPORT

NAME- CODE:

SHIP’S FORCE CAPABLE FMA (SIMA) DEPOT (SHIPYARD) ONBOARD REPAIR SHIP TO SHOP REPAIR

SERVICE:

VALVE NUMBER:

LOCATION: APL:

TYPE: (CIRCLE ONE) GLOBE GATE ANGLE RELIEF CHECK SWING

REDUCER/REGULATOR SAFETY BALL PLUG BUTTERFLY

STRAINER AIR MANIFOLD SOLENOID GOVERNOR COMB EXH/RELIEF

OTHER:______________

SIZE:

MANUFACTURER:

MODEL NO: ID OR PART NO:

SERIAL NO: DRAWING NO:

PRESSURE: RANGE:

TECH MANUAL:

TEMPERATURE:

MIL SPEC:

MATERIAL: (CIRCLE ONE) CRMO CMO STEEL BRONZE MONEL OTHER:______________________

END CONNECTION: (CIRCLE ONE) FLANGED WELDED IN SILVER BRAZED UNION THREADED

CROSSBOLTED OTHER: ______________________

BONNET TYPE:

OPERATOR:

NAVSEA 4790/1I (5-2000)

LAGGING TO BE REMOVED:

GAS FREE REQD?

REPLACE VALVE : YES NO

REPAIR VALVE: YES NO

OPR REPAIR: YES NO

OPR REPLACE: YES NO

SKETCH/PHOTOS ATTACHED CONTINUED ON SEPARATE SHEET

INTERFERENCES/ACCESS REQUIREMENTS

NAVSEA 4790/1I (5-2000) (Back)