Sample Procedure Qualification Record (Pqr) Form Page 2
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2AWS D1.4/D1.4M:2011
Sample Procedure Qualification Record (PQR) Form
Continuation of Procedure Qualification Record (PQR) No. ______________
TEST RESULTS
VISUAL EXAMINATION
Test Assembly Number One
Test Assembly Number Two
Pass
Fail (AWS D1.4, Clause 4.4)
Pass
Fail (AWS D1.4, Clause 4.4)
Comments____________________________________
Comments ____________________________________
____________________________________________
_____________________________________________
_______________________________________________________________________________________________
TENSILE TEST
Test Assembly Number One
Test Assembly Number Two
Pass
Fail (AWS D1.4, Clause 6.3.7.2)
Pass
Fail (AWS D1.4, Clause 6.3.7.2)
Ultimate
Ultimate
Character of
Tensile Load
Unit Stress
Failure and
Specimen No.
Width
Thickness
Area
(lbs)
(psi)
Location
MACROETCH TEST
Test Assembly Number One
Test Assembly Number Two
Pass
Fail (AWS D1.4, Clause 6.3.7.3)
Pass
Fail (AWS D1.4, Clause 6.3.7.3)
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Welder’s Name ________________________________
Clock No. ____________
Stamp No. ______________
Test conducted by _______________________________________________________________________ (Laboratory)
Test Number ___________________________________
Per __________________________________________
We, the undersigned, certify that the statements in this record are correct and that the welds were prepared and tested in
accordance with the requirements of AWS D1.4/D1.4M:2011, Structural Welding Code—Reinforcing Steel.
Manufacturer or Contractor __________________________________________________________________________
Authorized by _______________________________________________________
Date ___________________
Form A-1 (back)
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