Fillable SAMPLE FORM FOR WELDER AND WELDING OPERATOR QUALIFICATION (City of Oakland)

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SAMPLE FORM FOR WELDER AND WELDING OPERATOR QUALIFICATION (City of Oakland)

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AWS D15.1/D15.1M:2019 ANNEX D
221
SAMPLE FORM FOR WELDER AND WELDING OPERATOR QUALIFICATION TEST RECORD
(For Carbon, Low Alloy, and Stainless Steel Sheet Metal)
Welder or welding operator’s name____________________________________________________________________
Identification no. _______________________________ Qualification Date_______________________________
In accordance with WPS no. ______________________ Revision ______________________________________
Welding process(es) ____________________________ Type _________________________________________
(Automatic, manual, etc.)
Mode of transfer for GMAW__________________________________________________________________________
(Short circuiting, spray, globular)
VARIABLE ACTUAL VARIABLE QUALIFICATION
USED IN QUAL. RANGE
JOINT
Joint type ____________________________ ____________________________
Backing material type ____________________________ ____________________________
Groove welded from:
One side or both sides ____________________________ ____________________________
BASE METAL
Material specification:
Sheet steel ___________ to __________ ____________ to __________
Supporting steel ____________________________ ____________________________
Sheet thickness:
Groove ____________________________ ____________________________
Fillet ____________________________ ____________________________
Arc Spot ____________________________ ____________________________
Arc Seam ____________________________ ____________________________
COATING(S)
Type ____________________________ ____________________________
Thickness ____________________________ ____________________________
POSITION
Groove ____________________________ ____________________________
Fillet ____________________________ ____________________________
Arc Spot ____________________________ ____________________________
Arc Seam ____________________________ ____________________________
Progression ____________________________ ____________________________
GAS ____________________________ ____________________________
ELECTRODE
Size ____________________________ ____________________________
Group Designation ____________________________ ____________________________
VISUAL EXAMINATION RESULTS
Specimen 1 ___________________________________ Specimen 2 ___________________________________
Appearance_____________________ Cracks _________________________ Undercut _____________________
Reinforcement_________________________________ Diameter of arc spot nugget_______________________
Test conducted by ______________________________ Per __________________________________________
Laboratory test no. _____________________________ Date of test____________________________________
The undersigned certifies that the statements in this record are correct and that the test welds were prepared and tested
in accordance with the requirements of AWS D15.1: ( _________ ), Railroad Welding Specification for Cars and Locomotives.
(year)
Company_____________________________________ Authorized by __________________________________
Form D-14A
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SAMPLE FORM FOR WELDER AND WELDING OPERATOR QUALIFICATION (City of Oakland)

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Completed 12 March 2021

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