Hose compatibility questionnaire (English)

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Aflex sales engineer
Customer details
Company name*
Company contact (Someone at your business we can get in touch with.)
Contact phone
Contact Business email *
Basic information
Brief description of application (Give details of all media/chemicals used inside hose.)
Media/Chemicals used inside hose
CAS numbers (Give CAS numbers of any media/chemicals used inside the hose.)
Fluid/gas/other (Please specify if your hoses are used for a fluid, gas or another substance.)
Minimum temperature (Indicate using °C or °F.)
Maximum temperature (Indicate using °C or °F.)
If cyclic, please describe
Minimum pressure/vacuum (Measurements in psi or bar.)
Maximum pressure/vacuum (Measurements in psi or bar.)
If cyclic, please describe
Internal surface of the end fittings (What is the material of the internal surface of the end fittings/pipe/valve etc that the hose is connecting to?)
Please advise whether this is replacing existing hose assembly(ies) (If NO, please continue to next section)

If YES, please advise type of hose being replaced
Please advise if any problems have occurred with the existing hose(s)
Please describe hose(s) required (Include the bore, length, fittings and any other information)
Antistatic requirements
Is antistatic grade hose accepted for this application? (If 'no', please answer the questions below)

Is the media a single phase gas?

Are there any multiphase conditions? (Such as solid particles in fluid, fluid droplets in gas, non-mixable fluid droplets in water etc.)

Is more than one chemical being used - are they put through hose together?

If so, please state groupings (If you answered 'yes' to above, please give details.)
If fluid, what is the maximum flow rate?
If known, what is the electrical conductivity in pS/m?
Chemical conditions
Do the chemicals mentioned have any penetrating/diffusing characteristics? If so, please describe
Are any of the chemicals flammable, corrosive, toxic or radioactive etc? If so, please describe
Is there a risk of any of the media/chemicals coming into contact with the outside of the hose or fittings? If so, please describe
Are there any other chemicals in contact with the outside of the hose or fittings? If so, please describe
Are there any other external conditions which could affect the hose? If so, please describe (e.g. sea spray)
Mechanical requirements
Is the hose static or dynamic?

If 'dynamic', please describe flexing cycle
Will there be any abrasion of the inside or outside of the hose? If so, please describe
Will the hose be twisted/bent/crushed/pulled excessively in the application? If so, please describe
Flow rates
If high flow rates or specified flow rates are required, please state the flow rates required and the pressure drop between the end fittings
Cleaning procedure
Please describe fully how the hoses are cleaned (e.g. SIP, CIP, SOP, purging conditions etc)
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