IW 172 Welding Continuity

Verification of Welding Continuity

Ironworkers Local 172
Welder's Name*
Book #*
Welding continuity in the process(es) below must be documented for each 6-month period based on the effective date and expiration date on the front of you card.

This form must be completely filled out and submitted no sooner than 90 days prior the expiration date.
1st SIX MONTHS
Welding Process(es) Used (check all that apply):*

SMAWFCAWGTAWGMAW
Employer*
Employer Phone*
Employed From:*

MonthDayYear
Date
To:*

MonthDayYear
Date
Jobsite
*THIS SECTION IS TO BE FILLED OUT AND SIGNED BY THE PERSON VERIFYING CONTINUITY OF WELDING

Witnessed By: I hereby verify that the above-named person welded in the specified process(es) during the date range specified.
Name*
Signature*

Clear
Check one:*

Foreman / SupervisorJobsite CWI
2nd SIX MONTHS
Welding Process(es) Used (check all that apply):*

SMAWFCAWGTAWGMAW
Employer*
Employer Phone*
Employed From:*

MonthDayYear
Date
To:*

MonthDayYear
Date
Jobsite
*THIS SECTION IS TO BE FILLED OUT AND SIGNED BY THE PERSON VERIFYING CONTINUITY OF WELDING*

Witnessed By: I hereby verify that the above-named person welded in the specified process(es) during the date range specified.
Name*
Signature*

Clear
Check One:*

Foreman / SupervisorJobsite CWI
Note: Falsified documentation will result in revocation of qualification/certification and possible legal action.
Should be Empty:

Verification of Welding Continuity