Self disclosure/ Selbstauskunft	☐ Yes ☐ No

1. Company name, address:	Contact to fabrication
Name:	Dept./ function:
Place of workshop applying for qualification, if deviating from Company :	Date:
Note: Detailed supplier information see form „ General supplier information „ (VORQS04) For multiple workshops pls use further template(s)

2. Manpower workshop related
Total number of pers.:
Own staff	External staff
- work preparation
- Material receiving and storage
- Fitters/ assemblers mechanical works
- Welding overhead (engineers/ foremen/ supervisors)
- Welders & welding operators
Corrosion protection
- Quality Assurance
- Documentation (data book complies)
- Others
Attachment required: For addressed functions (above) attach orgachart and detail relevant personal certification as qualification matrix. ☐ Yes, chart attached/ NO, not available ☐

3.	Production Capacity (max./ average past three years)
- man-hours per month	/
- metric tons per month	/
Main components in production (min. top three): 1: 2: 3: (…)	[metric] tonnage or number (as average per year - rated over past 3 years)
Do you have a regular vacation closedown of workshop?	☐ Yes, when:	☐ No

4.	Size and Infrastructure of workshop ? wird der Punkt gebraucht?
Manufacturing area: Attach layout drawing of manufacturing area (at least size of different main production areas specified)	Under roof: Outside:	m² m² ☐ Yes, layout attached
Cranes [Number]:
Length x span [m]:
Max. lifting capacity [metric tons]
Height under hook [m]:
Shipping capabilities:	max. transport dimensions [mxmxm]
Max. tonnage [metric]

5. Material handling
material storage [m²]:	under roof	outdoor
Temperature/ humidity-controlled filler metal storage:	☐ Yes	☐ No
standard receiving inspection and procedure for material identification/ verification and control on damaging in place	☐ Yes	☐ No
Marking transfer procedure and PED-NoBo agreement available	☐ Yes	☐ No
Which material grades are you familiar with?	O = occasionally; C = constantly/ on regular basis
welding	Hot forming	Cold forming/ machining
Low alloy, carbon steel	☐ O / C ☐	☐ O / C ☐	☐ O / C ☐
Fine grain (P460+, WB36 etc)	☐ O / C ☐	☐ O / C ☐	☐ O / C ☐
Chromium martensitic	☐ O / C ☐	☐ O / C ☐	☐ O / C ☐
Austenitic/ Ni-Base	☐ O / C ☐	☐ O / C ☐	☐ O / C ☐
Others, specify:	C ☐	C ☐	C ☐

6. Manufacturing Equipment Attach list of equipment at least containing info about Material cutting and machining capabilities Bending (hot & cold) forming (Qualification, machine type…) Welding and related handling equipment (quiver, redrying, turntables, lath banks etc.) and is mandatory for qualification scope	☐	Yes, list attached

6.1 Measurement Instruments Please add the list of calibrated measurement instruments Calibration cycle:	☐	Yes, list attached

6.2 Heat treatment equipment
Quality determining heat treatment (N & N+T & stress relief annealing) executed where?	External ☐	Inhouse ☐	Not executed at all ☐
For furnace:	Fuel	Quantity	Temperature range Min. heating rate [K/hr]
- Max. workpiece weight [kg]
- furnace size (width x heigth x length)	x x (Meter)
- Max. furnace temperature / min. heating rate	[DgrC]	[K/h]
- Thermo couple fixed on workpiece per heating zone	Yes	☐	No ☐
- Furnace thermo couple (type) used - Period of furnace calibration [months]	Acc. EN 60584-1
Can supplier ensure that annealing is executed in furnace only? (e.g. stress relief annealing for nozzle welds..)	Yes	☐	No: ☐, exemptions why:
Attach: For external service pls name subsuppliers add references/ certificates and specify kind/ number of equipment and relevant range of application	☐	detail attached
Local Preheating
none:	☐
- by gas (rose bud type, ring burner) :	☐	Fuel:
- Induction: ☐ resistance heating elements: ☐

6.3 Equipment for Straightening	☐ Yes	☐ No	Quantity
- Presses	☐
- Flame burner	☐
-	☐
Pls. specify what straightening may be applied for:

6.4	Welding
List available? , Yes	Acc. to standards:
Documents acc. to code:	Yes	No	EN	ASME	AWS
List of Welding procedure specifications (WPS)	☐	☐	☐	☐	☐
List of Procedure qualification reports (WPQR)	☐	☐	☐	☐	☐
List of Welder/ welding operators qualifications	☐	☐	☐	☐	☐
Standard Third Party NoBo/AIA: /
Onboarding procedure for external welders/ operators available ☐ Yes/ No ☐ attached:	☐

7.	Corrosion protection
Equipment available	☐ inhouse	☐ external, pls. specify (location, supplier etc.)
surface preparation processes applied	☐ Shotblasting with: ☐ Other, specify:
Max. workpiece dimension [mxmxm]
coating shop, separated from workshop	☐ Yes	☐ No
Painting & drying location	☐ Indoor	☐ outdoor
Coating staff qualified for VT-recheck of weld quality	☐ Yes	☐ No
Coating processes applied:
- brush Painting	☐ Yes	☐ No
- Air paint spraying	☐ Yes	☐ No
- Airless paint spraying	☐ Yes	☐ No
Others:	☐ Yes	☐ No

8.	Inspection and test equipment
8.1	Non-destructive examination	☐ inhouse	☐ external supply*
*External NDE supplier(s): pls. specify company name(s)/ location:
Equipment
available	Quantity
Radiographic test
- X-Ray	☐
- Gama-Ray	☐
Phased Array	☐
Ultrasonic test equipment	☐
HT-devices	☐	Type:
Magnetic particle test	☐
Special testing equipment (like PAUT)
Qualification and Certification of NDE personnel
qualification of staff according to	Yes	Certification Organisation(s)
ISO 9712	☐
NDT	VT	PT	MT	UT	RT	HT (mobile)	Replica	☐
Level 3 available	☐	☐	☐	☐	☐	☐	☐	☐
Level 2 number
Written authorized level 3-NDT-responsible person available:	☐ Yes	Internal: ☐ Yes ☐ No
SNT-TC-1A, Edition:	☐
Other standard:	☐
Are NDT procedures available?	☐ Yes	☐ No
for methods:
☐ VT	☐ PT	☐ MT	☐ UT	☐ RT	☐ HT (mobile)	Others: ☐ …… ………..	Others: ☐ …… ………
released by Level 3-inspector? ☐ Yes ☐ No

8.2	Other testing and treatment
Pressure test plant/ equipment	☐ Yes	☐ No
- Pressure test range	from to
- Test medium	(e.g. demin, tap etc.)
Pickling bath internal ☐ / external ☐	Size	Typical composition
Balancing/ trial run/ performance test plant	☐ Yes, specify:

8.3	Destructive examination
Laboratory available:	☐ Yes / No ☐
Internally	☐ Yes / No ☐	Accredited acc. ISO 17025: ☐
Externally	☐ Yes / No ☐	Accredited acc. ISO 17025: ☐
Hot tensile testing	☐	Yes	Max. temp.
Notch impact	Hammer type
Chemical analysis	☐	Spectrometrical	☐	Wet chemical

9.	Inspection relation
Can you provide connectivity in work shop in case of remote inspection?	☐ Yes	☐ No
Will you allow photos of project related components in your work shop?	☐ Yes	☐ No
Will you be able to ensure (at least preliminary) full up-to-date documentation acc. to current ITP-step in case of any ad hoc intermediate inspection?	☐ Yes	☐ No
Will you announce any sub suppliers and external welding staff used for production of our components?	☐ Yes	☐ No
Will you be able to issue a full fabrication ITP or we willing at least to implement our main steps provided?	☐ Yes	☐ No
Will you be able to issue and keeping updated a manufacturing time plan displaying the main fabrication periods per item to enable our inspection plannings?	☐ Yes	☐ No

10.	Confirmation of correctness of data/ statement provided in case of self-disclosure:
Name & function of supplier’s representative:	Date:	(advanced e-)Signature:

11.	Beurteilungsdurchführung / Performance of assessment (wird von Power Service Solutions GmbH ausgefüllt / Fill in by Power Service Solutions GmbH )
Hauptprozess / Main Process	Formular/Form	Beurteilung / Assessment* (Zahl entsprechend eintragen / Enter number accordingly) *0 = nicht qualifiziert / not qualified 1 = bedingt qualifiziert; siehe Bemerkungen / fairly qualified; see remarks 2 = qualifiziert / qualified
Fertigung / Fabrication	Anlage 2 /Annex 2
Beurteilung wurde durchgeführt von / Assessment carried out by:
Name / Name:	Org.-Einh. / Dept.:	Datum / Date:	Unterschrift / Signature: