Ph lc A

(qui nh)

Mu "Bin bn kim tra cng tc qun l cht lng thi cng xy dng trn
cng trng"

Tn Ch u t
....................................................
.
....................................................
.

CNG HO X HI CH NGHA VIT NAM

c lp T do Hnh phc
------------------a im, ngy....... thng....... nm..........

BIN BN KIM TRA CNG TC QUN L CHT LNG THI CNG

XY DNG TRN CNG TRNG
1. Cng
trnh:
...............................................................................................................................
2. a
im
xy
dng:
..................................................................................................................
3. Thnh phn trc tip tham gia kim tra: Ghi r h tn, chc v
-

Ngi ph trch b phn gim st thi cng xy dng cng trnh ca ch

u t hoc ngi ph trch gim st thi cng xy dng cng trnh ca
Tng thu i vi hnh thc hp ng tng thu;

Ngi ph trch k thut thi cng trc tip ca nh thu thi cng xy
dng cng trnh.

Trong trng hp hp ng tng thu, ngi ph trch gim st thi cng xy

dng cng trnh ca ch u t tham d kim tra cng tc kim tra ca
tng thu vi nh thu ph.
4. Thi gian tin hnh kim tra:
Bt u :

....... ngy.......... thng ......... nm ...........

Kt thc :

....... ngy.......... thng ......... nm ...........

Ti: .......................................

5. Ni dung v kt qu kim tra.

STT

Ni dung kim tra

Kt qu kim
tra

H thng tiu chun, qui phm k thut chuyn mn c lin

quan

Khng

H thng m bo cht lng thi cng xy dng trn cng

trng

Khng

Ch qui nh trch nhim v cht lng thi cng

Khng

Nng lc ca cn b qun l

Ph
hp

Khng

Nng lc ca cn b k thut thi cng

Chng ch tay ngh ca cc loi th chnh

Khng

Nng lc ca thu ph v ch qun l i vi thu ph

Ph
hp

Khng

Tnh php l ca bn v thi cng

Khng

Bng tng tin thi cng

Khng

10

Bin php thi cng

Khng

11

Ch kim nghim cht lng thi cng

Khng

12

Phng th nghim hin trng

Chun

Khng

13

Nng lc trang thit b phc v thi cng

Ph
hp

Khng

14

iu kin kho bi ct gi v qun l vt liu, thit b hin

trng

t
Y/C

Khng

15

Ch lp v lu tr h s qun l cht lng xy dng cng

trnh

Khng

16

...

.....

..

Ph
hp

Khng

Ghi
........................................................................................................................

6. Kt
lun
kim
tra : ....................................................................................................................
Cc thnh phn tham gia kim tra: (K, ghi r h tn v chc v tng ngi
tham gia)

ch: