Form R1 Report Of Repair
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2NB-66, Rev. 13, (06/25/15)
FORM R-1 REPORT OF REPAIR
(Authorized Rep. initials)
in accordance with provisions of the National Board Inspection Code
(Inspectors initials)
(Form “R” Registration no.)
1. WORK PERFORMED BY:
(P.O. no., job no., etc.)
(name of repair organization)
(address)
2. OWNER:
(name)
(address)
3. LOCATION OF INSTALLATION:
(name)
(address)
4. ITEM 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:
(edition)
(addenda)
Original Code of Construction for Item:
(name / section / division)
(edition / addenda)
Construction Code Used for Repair Performed:
(name / section / division)
(edition / addenda)
7. REPAIR TYPE:
welded
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, of neccessary))
Pressure Test, if applied
psi
MAWP
psi
9. REPLACEMENT PARTS:
(Attached are Manufacturer’s Partial Data Reports or Form R-3’s properly completed for the following items of this report):
(name of part, item number, data report type or certificate of Compliance, mfg’s. name and identifying stamp)
10. REMARKS:
This form may be obtained from The National Board of Boiler and Pressure Vessel Inspectors 1055 Crupper Avenue, Columbus, Ohio 43229-1183
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