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.
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project