11/10/22, 3:36 PM Pipeline Corrosion Report Form Checklist - SafetyCulture

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Title Page

Operator

Location

Inspector

Conducted on

Pipeline Corrosion Report Form

Hi there 👋

Corrosion Protection Requirements

Do you need some help finding the
right form?

Buried or submerged pipelines (constructed, relocated, replaced, or changed) externally

Yes, I'd like some help.
coated

I want to import my own form.

Satisfactory Unsatisfactory Not Applicable

No, I'm good. Thanks!

https://public-library.safetyculture.io/products/pipeline-corrosion-report-form?amp_dev=03a9d32c-a462-4fe3-97a3-2460a360cf4f&sid=166806569… 1/3
11/10/22, 3:36 PM Pipeline Corrosion Report Form Checklist - SafetyCulture

All external pipe coating inspected

Satisfactory Unsatisfactory Not Applicable

Take photo(s) of external pipe coating

Repair any coating damage discovered

Satisfactory Unsatisfactory Not Applicable

Coating Damage

Brief description

Take photo(s) of coating damage

Repairs needed/done

Hi there 👋
Adequate cathodic protection of the system

Satisfactory Unsatisfactory Do you need some help finding the

Not Applicable
right form?

Yes, I'd like some help.

Sufficient number of test leads properly installed
I want to import my own form.
Satisfactory Unsatisfactory Not Applicable

No, I'm good. Thanks!

Take photo(s) of test stations

https://public-library.safetyculture.io/products/pipeline-corrosion-report-form?amp_dev=03a9d32c-a462-4fe3-97a3-2460a360cf4f&sid=166806569… 2/3
11/10/22, 3:36 PM Pipeline Corrosion Report Form Checklist - SafetyCulture

Sign off

Additional Observations

Inspector

Inspector Name & Signature

Site Supervisor Name & Signature

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Hi there 👋

Do you need some help finding the

right form?

Yes, I'd like some help.

I want to import my own form.

No, I'm good. Thanks!

https://public-library.safetyculture.io/products/pipeline-corrosion-report-form?amp_dev=03a9d32c-a462-4fe3-97a3-2460a360cf4f&sid=166806569… 3/3