SI304-F005

Rev. 03-03-16

Quality Control Pre-Backfill Checklist

SI JOB NO.: REPORT DATE:

PROJECT NAME: REPORT NUMBER:
CLIENT NAME: QC NAME:
LOCATION:

P&ID / Drawing No(s): Rev. #

ISO Drawing No.: Rev. #

System No:

System Description:

Scope of Backfill: describe the area that will be backfilled

Foreman / Supt. Pre-Backfill Release
The area described above is ready for final QC Walkdown before backfill.

Piping Foreman / Supt. Date:

Pre-Backfill Checklist
Item Description QC Initials Date
1 All piping is installed in accordance with current rev. of drawings

2 All pipe supports are installed as specified on current rev. of drawings

3 Welds are all complete and NDE Testing is complete with no outstanding repairs.
Coating (including coatings over welds) is complete as specified with no visible
4
coating damage.

5 Taping (as specified) is complete with proper overlaping

6 Holiday testing is completed with all required coating repairs completed.

7 Ditch is free of rocks, steel, wood and/or other debris.

8 Staged backfill dirt is free of rocks, steel, wood and/or other debris.

9 Backfill area is suitably dry and/or thawed.

Pre-Backfill Acceptance
The below signed confirm that the items initialed in the checklist section of this report are complete and acceptable for the identified piping
system or section.
Name Signature Date

SI Foreman/Supt.

SI QC:

CLIENT:
Comments:

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