Welder/Welding Operator Certificate

Welder/Welding Operator Certificate
Technical Standards and Safety Authority
345 Carlingview Drive
Toronto, Ontario M9W 6N9
www.tssa.org
Welder's Last Name
Initial
Welder/Welding Operator Certificate
Clear Form
Technical Standards and Safety Act
Boilers and Pressure Vessels Regulation
Print Form
First Name
Signature
Residence Address
No.
Stamp No.
Please Print and Sign
Postal Code
Provincial Registration No.
Employer Name
Company PQR No.
Street Address
Company WPS No.used
Postal Code
Welding Process(es) Used
Type(s)
Base Metal Spec. and Type/Grade or UNS No.
manual
machine
Thickness(es)
automatic
Test Coupon
Production Weld
Range Qualified
Actual Values
Variables for All Processes
semi-automatic
Backing (with/without)
Base metal P-Number to P-Number
(
) Plate
to
) Pipe (enter diameter if pipe or tube)
(
Filler metal specification (SFA) and classification (QW-404) (info. only)
Consumable insert for GTAW or PAW (QW-404)
Welding position (1G, 5G, etc.) (QW-405)
Manual or Semi-automatic Variables (QW-350)
Actual Values
Range Qualified
Actual Values
Range Qualified
Actual Values
Range Qualified
Filler metal F-No. (QW-404)
Filler metal product form for GTAW, PAW (QW-404)
Weld deposit thickness for each welding process (QW-404)
Process 1:______________ 3 layers minimum
Yes
No
Process 2:______________ 3 layers minimum
Yes
No
Vertical progression (uphill/downhill) (QW-405)
GTAW, PAW or GMAW backing gas; or OFW fuel gas (QW-408)
GMAW transfer mode (spray/globular or pulse to short circuit) (QW-409)
(QW-409)
GTAW welding current type & polarity (AC, DCEP, DCEN)(QW-409)
Machine Welding Variables (QW-361.2)
Direct or remote visual control
Automatic arc voltage control (GTAW)
Automatic joint tracking
Multiple or single pass per side
Automatic Welding Variables (QW-361.1)
Filler metal used
Yes
No (EBW or LBW)
Laser type for LBW (CO2 to YAG etc.)
Continuous drive or inertia welding (FW)
Vacuum or out of vacuum (EBW)
Note: Values in “Range Qualified” are valid only when used with a Qualified Welding Procedure.
RESULTS
Visual Examination of Completed Weld (QW-302.4) _______________________________________
Transverse root and face bends [QW-462.3(a);
Longitudinal root and face bends [QW-462.3(b)];
Pipe bend specimen, corrosion-resistant overlay [QW-462.5(c)];
Pipe specimen, macro test for fusion [QW-462.5(b)];
Type
Result
Type
Result
Side bends (QW-462.2);
Plate bend specimen, corrosion-resistant overlay [QW-462.5(d)];
Plate specimen, macro test for fusion [QW-462.5(e)]
Type
Result
Alternative volumetric examination results (QW-191)____________________________________________________
Type
RT or UT
Result
(check one)
Fillet weld — fracture test (QW-181.2) ______________________________ Length and percent of defects ____________________________________
Fillet welds in plate [QW-462.4(b)]
Fillet welds in pipe [QW-462.4(c)]
Macro examination (QW-184) ______________Fillet size (in.) __________ x _________ Concavity/convexity (in.) ______________________________
Other tests _________________________________________________________________________________________________________________
Film or specimens evaluated by (print name) ________________________________________________ Company _____________________________
Mechanical tests conducted by (print name) _________________________________________________ Laboratory test no. _____________________
Welding supervised by (print name) _____________________________________________________________________________________________
Test requested by (print name) ___________________________________ Tested at (print address): ________________________________________
We certify that the statements in this record are correct and that the test coupons were prepared, welded, and tested in accordance with the requirements
of Section IX of the ASME Boiler and Pressure Vessel Code.
Please Print and Sign
Organization __________________________________________________ Signature _________________________________ Date __________________
(dd-mm-yyyy)
FOR TSSA INSPECTOR USE ONLY
The Welder named above has passed the welding test required under Ontario’s Technical Standards and Safety Act, Boilers and Pressure Vessels
Regulation and is hereby authorized, subject to the limitations of this certificate.
Check (✔) applicable box below:
To weld for the Employer named above only.
For seeking employment only.
_____________________________________________________________________________________
Inspector Name and Number (Print)
PV 09397 (04/17)
This Certificate expires: _____________________________________________________
(dd-mm-yyyy)
Please Print, Sign, and Date
__________________________________________________________________________________
Inspector Signature and Date
*Information provided in this application is releasable under the Freedom of Information and Privacy Protection
Act and may be disclosed upon request.
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