Form R1 PDF Details

The R1 form, officially titled "FORM R-1 REPORT OF REPAIR," plays a crucial role in ensuring the safety and compliance of boiler, pressure vessel, or piping repairs according to the standards laid out by the National Board Inspection Code (NBIC). This document is meticulously crafted to capture essential details of the repair process, starting with the identification of the repair organization responsible for the work, alongside its address and the specific job identifiers. It further requires comprehensive information about the equipment owner, the location where the installation is situated, and detailed directives concerning the item under repair—including its original manufacturer data, various identifying numbers like the manufacturing serial, National Board, and jurisdiction numbers, and the original and repair construction codes. In addition to specifying the type of repair and providing a detailed description of the work undertaken, the form mandates the inclusion of any replacement parts through attached Manufacturer’s Partial Data Reports or Form R-3s. Critical to the process are the certifications of compliance and inspection, which must be signed by authorized representatives from the repair organization and a qualified inspector, respectively. These sections underscore the alignment of the repair work with NBIC requirements and highlight the accountability steps taken to ensure the integrity of the repair. The R1 form thus serves as a comprehensive record, fostering transparency and adherence to safety standards within the pressure equipment repair industry.

QuestionAnswer
Form NameForm R1
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform r 1 report of repair, national dddenda search, form r 1 report, bpng form r1

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FORM R-1 REPORT OF REPAIR

in accordance with provisions of the National Board Inspection Code

1.

Work performed by

 

 

 

 

 

(Qame of Uepair Rrganization)

 

(Form RHJ VWUDW RQ No.)

 

 

 

 

 

 

 

(address)

 

(PO No., Job No., etc.)

2.

Owner

 

 

 

 

(Qame)

 

 

(Dddress)

3.Location of installation

 

(Qame)

 

 

 

(Dddress)

4.,tHP identification

Name of original manufacturer

(boiler, pressure vessel or piping)

5.Identifying nos.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(mfg. serial no.)

 

(National Board No.)

(Jurisdiction No.)

 

(other)

(year built)

6.

NBIC Edition/Addenda

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Hdition)

 

 

 

 

 

 

 

(Dddenda)

 

 

 

 

Original Code of Construction for Item:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Qame / Vection / Givision)

 

 

 

 

 

 

 

 

(Hdition / Dddenda)

 

 

 

Construction Code Used for Repair Performed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Welded

(name / section / division)

 

 

 

 

 

 

 

 

(edition / addenda)

 

 

 

7.

Repair Type:

 Graphite Pressure Equipment

 

 

 FRP Pressure Equipment

8. Description of work:

 

Form R-4, Report Supplementary Sheet is attached

FFSA Form (NB-403) is attached

 

(use Form R-4, if necessary)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pressure Test, if applied

 

psi

MAWP

 

psi

9.Replacement Parts. Attached are Manufacturer’s Partial Data Reports or Form R-3s properly completed for the following items

of this report:

(Qame of Sart, tem Qumber, Gata Ueport WypeRU&HUW I FDWHRI&RPS DQFH, Pfg Qame, and dentifying Vtamp)

10. Remarks:

 

 

 

 

CERTIFICATE OF COMPLIANCE

 

 

 

 

 

I,

 

 

 

 

 

, certify that to the best of my knowledge and belief the statements in this report are

correct and that all material, construction, and workmanship on this Repair conforms to the National Board Inspection Code.

National Board “R” Certificate of Authorization No.

 

 

expires on

 

 

,

 

 

Date

 

,

 

 

 

 

 

 

Signed

 

 

 

 

 

 

(name of repair organization)

 

(authorized representative)

 

 

 

CERTIFICATE OF INSPECTION

 

 

 

 

I,

 

 

, holding a valid Commission issued by The National Board of Boiler and Pressure

Vessel Inspectors and certificate of competency, where required, ISSUED by the Jurisdiction of

 

 

 

 

and employed by

 

 

 

of

 

 

 

 

 

have inspected the work described in this report on

 

,

 

 

 

and state that to the best of my

knowledge and belief this work complies with the applicable requirements of the National Board Inspection Code.

By signing this certificate, neither the undersigned nor my employer makes any warranty, expressed or implied, concerning the work described in this report. Furthermore, neither the undersigned nor my employer shall be liable in any manner for any personal injury, property damage or loss of any kind arising from or connected with this inspection.

Date

 

,

 

Signed

 

Commissions

 

 

 

 

 

 

 

 

(inspector)

 

(National Board and Jurisdiction No.)

This form may be obtained from The National Board of Boiler and Pressure Vessel Inspectors, 1055 Crupper Ave., Columbus, OH 43229

NB-66 Rev. 12

How to Edit Form R1 Online for Free

Working with PDF documents online is actually easy using our PDF editor. You can fill in r 1 report here with no trouble. Our team is continuously working to develop the tool and insure that it is much faster for users with its cutting-edge features. Take advantage of today's modern prospects, and find a trove of new experiences! Here is what you'd need to do to start:

Step 1: Firstly, open the pdf tool by clicking the "Get Form Button" in the top section of this page.

Step 2: When you open the PDF editor, you will notice the form made ready to be completed. Apart from filling out different blank fields, you may as well do other actions with the PDF, namely adding custom words, changing the original text, adding illustrations or photos, affixing your signature to the PDF, and much more.

With regards to the blanks of this specific document, this is what you need to know:

1. First, when completing the r 1 report, start in the section that features the subsequent blanks:

Part no. 1 for filling out nbic r 1 fillable form

2. The next step is to fill in these blank fields: Construction Code Used for Repair, name section division, Welded, Graphite Pressure Equipment, edition addenda, FRP Pressure Equipment, Repair Type Description of work, Form R Report Supplementary Sheet, Replacement Parts Attached are, psi MAWP, Pressure Test if applied, psi, cidame of cidart cidtem cidumber, Remarks, and CERTIFICATE OF COMPLIANCE.

Filling in section 2 in nbic r 1 fillable form

It's easy to make errors when completing your name section division, for that reason make sure you reread it prior to when you submit it.

3. Within this step, review holding a valid Commission issued, CERTIFICATE OF INSPECTION, Vessel Inspectors and certificate, and employed by, have inspected the work described, and state that to the best of my, By signing this certificate, described in this report, Date, Signed, inspector, Commissions, National Board and Jurisdiction No, This form may be obtained from The, and NB Rev. Every one of these should be completed with utmost precision.

Writing part 3 of nbic r 1 fillable form

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