Welding Daily Shop Report (DSA)

1 DSA File #: DSA Appl. #: DSA LEA #: Welding Daily Shop Report (DSA). Job #: Date: Job Name: Client Job #: Location: Client/District: Rep: Time Arrived: Weather: Mileage: Time Departed: Reported to 1 with 2 at 3 . Time arr 4 dep 5 . Time reobserving 6 retesting 7 . Assignment cancelled by 8 due to 9 . Welding . 11 Reviewed welder qual papers 12 name ____ 13 SSN ____. 14 Inspected Welding 15 In progress 16 completed 17 performed by ____. welder(s) 28 previously reported 18 using 19 SMAW 20 FCAW 21 GMAW 22. ____ process(es) with 23 E_____ electrodes 24 E_____ wire. 25. Verified proper electrode storage. 26 Verified preheat temp. maintained at ____ F. 27 Weldments inspected consisted of the following: STRUCTURAL STEEL. 29 CP 30 PP 31 Multipass 32 Single Pass Fillet Welds Joining 33 Girder to Column 34 Beam to Girder 35 Column to Base Plate (WF TS PIPE).

2 36 Stiffner Plate to WF TS (column or beam) 37 Gusset to WF TS PIPE. (column or beam) 38 Plate to Plate 39 Plate to Column (WF TS PIPE) 40. Plate to Beam (WF TS Channel) 41 Plate to Angle or Channel 42 Splice to WF. TS Angle Channel Plate REBAR. 43 Flare-Bevel Groove Indirect Butt Splice 44 Bevel Groove Direct Butt Splice joining 45 No ____ 46 Grade ____ rebar for ____. Joining 47 Splices (chord bars, wall, beam, column and slab 48 embeds 49 Verified preheat per AWS. CE requirements. DECKING/STUDS. 50 Arc spot 51 Intermitant Stitch Welding of metal decking 52 Arc stud Welding 53 Checked studs for soundness 54 Performed ____ bend tests on a total of ____ studs with ____ failure(s) 55 embeds studs to plate WF TS angle channel. LOCATION. 56 at the following locations ____ 57 floor ____ 58 column line ____. 59 wall line ____ 60 piece no.)

3 ____ 61 member check list 62 on file 63 attached MATERIAL. 64 Identified material against 65 MTR's 66 and Ht. Nos. 67 Collected copy of MTR's 68 on file 69 attached 70 Obtained ____ samples of 71 Steel 72 rebar 73 HS bolts 74 Identified as ____ 75 list attached 76 Acceptable members were marked with identification 77 tags 78 stamp CONFORMANCE. The work was was not The work inspected met did not meet inspected in accordance with the requirements of the DSA the requirements of the DSA approved documents approved documents Material Sampling was was not N/A Non-Compliance conditions were brought to the attention of the performed in accordance with the DSA approved for corrective action IOR Contractor documents Limitations: Please note that this Report shall not be relied upon by others, as acceptance or guarantee of work.

4 Even with diligent inspection techniques, the contractor is responsible for defects or failures to adhere to the code. Inspector Signature CWI# Date CC: Project Architect, Structural Engineer, Project Inspector, DSA Regional Office, School District 4770 Duckhorn Drive, Sacramento, CA 95834 (916) 419-4747 office | (916) 419-4774 fax 2118 Rheem Drive, Suite A, Pleasanton, CA 94588 (925) 462-5151 office | (925) 462-5183 fax