AWS D1.1/D1.
1M:2020 ANNEX J
Sample Welder Qualification Blank Form (Single-Process)
WELDER, WELDING OPERATOR, OR TACK WELDER
PERFORMANCE QUALIFICATION TEST RECORD
Name Test Date Rev.
ID Number Record No.
Stamp No. OPTIONAL Std. Test No.
PHOTO ID
Company WPS No.
Division Qualified To
Type or AWS
BASE METALS Specification Grade Group No. Size (NPS) Schedule Thickness Diameter
Base Material ASTM A36 -- I -- ---- 3/8” --
Welded To ASTM A36 -- I -- ---- 3/8” --
VARIABLES Actual Values RANGE QUALIFIED
Type of Weld Joint
Base Metal
Groove Fillet Groove Fillet
Plate Thickness
Pipe/Tube Thickness
Pipe Diameter
Welding Process
Type (Manual, Semiautomatic,
Mechanized, Automatic)
Backing
Filler Metal (AWS Spec.)
AWS Classification
F-Number
Position
Groove – Plate & Pipe 24 in
Groove – Pipe < 24 in
Fillet – Plate & Pipe 24 in
Fillet – Pipe < 24 in
Progression
GMAW Transfer Mode
Single or Multiple Electrodes
Gas/Flux Type
TEST RESULTS
Acceptance
Type of Test Criteria Results Remarks
CERTIFICATION
Test Conducted by
Laboratory
Test Number
File Number
We, the undersigned, certify that the statements in this record are correct and that the test welds were prepared, welded, and tested in
accordance with the requirements of Clause 6 of AWS D1.1/D1.1M ( ) Structural Welding Code—Steel.
(year)
Manufacturer or Contractor Authorized by
Date
Form J-4 (See [Link]
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