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DOC No

PAGE

1 of

REV

DATE

STRUCTURE RELEASE
Division:
Contract Name:

Date:
Ref No:

Contract Number:

Structure/Area
Element Description

Description
Post concrete inspection
1. Surface status satisfactory
2. Overall position checked
3. Built in items checked
4. Joint sealing complete
5. Scabbling & cleaning

Concrete inspection checklist no


Post concrete survey report no
Average 7 day cube results
Average 28 day cube results
Concession request numbers
Nonconformity record no.
Released for backfill

Handed Over

Structure released for


backfill / next process

Released to next process

Company

Name

Signature

Date

1.
2.
3.

Handed Over
Company
Handed Over To
Handed Over By:

Name

Yes

No

Date

Signature

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