Itp Structure

ATTACHMENT 7.
1
Project Inspection and Test Plan-SITE
CIVIL AND STRUCTURE
(subcon
logo)
PROJECT INSPECTION & TEST PLAN

Discipline
Legend
STEEL STRUCTURE
Project Title
Job No
Description
Equipment Tag No.
: P&G PROJECT
:
: Project Inspection and Test Plan-Site
: -
Location
: -
No.
DESCRIPTION
STEEL STRUCTURE
8.1
Procedure
H
W
p
:
:
:
Hold Point
Witness
Perform
A
R
M
: Approval Required
: Review
: Monitoring
TPI : Third Party Inspection

JOB PMTS : JOB Pertamina-Medco E&P Tomori Sulawesi
TSC : Tripatra-Samsung Consortium
INSPECTION
METHOD
REFERENCE DOCUMENT
ACCEPTANCE CRITERIA
VERIFIED DOCUMENT
INSPECTION LEVEL
SSJ
a.
Welding Procedure Specification / Procedure

Qualification Record ( WPS/PQR )
Review
As applicable WPS/PQR
Comply with spec & proc.
Approved Procedure
P,R
b.
General Fabrication Work
Review
-SNO-S-TS-002 Specification Standard for

structural steel fabrication
Approved Procedure
P,R
c.
General Structure Erection Work
Review
- SNO-X-PR-007 Steel Structure Erection

Procedure
Approved Procedure
P,R
d.
Chipping and Padding Work
Review
- SNO-S-ES-002 Standard Specification for

Stuctural Steel Construction
Approved Procedure
P,R
e.
Grouting Work
Review
- SNO-C-ES-015 Standard Specification for

Grouting of stuctural and equipment
Approved Procedure
P,R
8.2
Material Inspection
Inspect
- SNO-S-TS-001 Specification for structural

steel material
Comply with spec.
SNO -Q-FM- 0002
P,R
8.3
Inspection During Fabrication

a.
WPS/PQR Qualification Test
Inspect
Comply with spec.
SNO -Q-FM- 0038
P,R
b.
Welder Performance test
Inspect
Comply with spec.
SNO -Q-FM- 0037
P,R
c.
Dimensional, Welding, NDT, and Coating Inspection
Inspect
As applicable WPS/PQR,NDT procedure

Comply with spec. & DWG.
SNO -Q-FM- 0019
P,R
(subcon
logo)

Discipline
Legend
STEEL STRUCTURE
Project Title
Job No
Description
Equipment Tag No.
: P&G PROJECT
:
: -
Location
: -
No.
DESCRIPTION
8.4
8.5
H
W
p
:
:
:
Hold Point
Witness
Perform
A
R
M
: Approval Required
: Review
: Monitoring

INSPECTION LEVEL
INSPECTION
METHOD
REFERENCE DOCUMENT
ACCEPTANCE CRITERIA
VERIFIED DOCUMENT

SNO -Q-FM- 0004
P,R
SNO -Q-FM- 0021
P,R
SSJ
Installation
a.
Chipping and Padding check
Inspect
b.
Plumbness check
Inspect
c.
Welding and NDT Inspection
Inspect
As applicable WPS/PQR,NDT procedure

Comply with spec.
SNO -Q-FM- 0020
P,R
d.
Bolt Tightening
Inspect

Comply with spec.
SNO -Q-FM- 0023
P,R
e.
Grouting Work
1. Material Inspection
Inspect

Comply with spec.
SNO -Q-FM- 0002
P,R
2. Mixing proportion
Inspect

Comply with spec.
SNO -Q-FM- 0022
P,R
3. Form-work
Inspect

SNO -Q-FM- 0022
P,R
4. Anchor bolts and embedded items
Inspect

SNO -Q-FM- 0022
P,R
5. Cleaning prior to placing
Inspect

Comply with spec.
SNO -Q-FM- 0022
P,R
6. Grout test (compressive strength)
Inspect

Comply with spec.
SNO -Q-FM- 0017
P,R
f.
Steel Structure Installation Acceptance
Inspect

Comply with spec.
SNO -Q-FM- 0024
P,R
f.
Fire Proofing
Inspect

Comply with spec.
SNO -Q-FM- 0030
P,R
Steel erection work
(subcon
logo)

Discipline
Legend
STEEL STRUCTURE
Project Title
Job No
Description
Equipment Tag No.
: P&G PROJECT
:
: -
Location
: -
No.
DESCRIPTION
H
W
p
INSPECTION
METHOD
:
:
:
Hold Point
Witness
Perform
REFERENCE DOCUMENT
A
R
M
: Approval Required
: Review
: Monitoring

INSPECTION LEVEL
ACCEPTANCE CRITERIA
VERIFIED DOCUMENT
Approved to JSEA
SNO -Q-FM- 0004
P,R
SSJ
a.
Prepare JSEA
Inspect
b.
Inspect all steel work ( Handling Material Process)
Inspect
Comply with spec
SNO -Q-FM- 0021
P,R
1. Hard Stamping
Inspect
Comply with spec.
SNO -Q-FM- 0020
P,R
2. Damage
Inspect
Comply with spec.
SNO -Q-FM- 0023
P,R
3. Paint touch up later concealed areas
Inspect
Comply with spec.
Inspect all steel work after Modules Ground

Assembly, Including:
Inspect
Comply with spec.
SNO -Q-FM- 0002
P,R
1. Tension of Bolts
Inspect
Comply with spec.
SNO -Q-FM- 0022
P,R
2. Touch up paint & Cleaning
Inspect
Comply with spec.
SNO -Q-FM- 0022
P,R
3. Complete to marking plan
Inspect
Comply with spec.
SNO -Q-FM- 0022
P,R
Inspect All Steel work After erection,including:
Inspect
Comply with spec.
SNO -Q-FM- 0022
P,R
1. Aligment of Structure
Inspect
Comply with spec.
SNO -Q-FM- 0017
P,R
2. Tension of Bolts
Inspect
Comply with spec.
SNO -Q-FM- 0024
P,R
3. Touch up paint & Cleaning

Inspect all Roofing/Walling work for:
1. hard Stamping
2. Quantity
3. Damage
Inspect all Roofing/Walling & accessories after
installation, Including:
1. Visual (cleaning)
2. Connection metal Sheet ( Sheet to Sheet)
3. Overlap joint sheet
4. Joint plashing, Silent, Gutter
Inspect
Inspect
Inspect
Inspect
Inspect
Comply with spec.

Comply with spec.
Comply with spec.
Comply with spec.
Comply with spec.
SNO -Q-FM- 0030

SNO -Q-FM- 0004
SNO -Q-FM- 0021
SNO -Q-FM- 0020
SNO -Q-FM- 0023
P,R
P,R
P,R
P,R
P,R
Inspect
Comply with spec.
SNO -Q-FM- 0002
P,R
Inspect
Inspect
Inspect
Inspect
Inspect
Inspect
Inspect
Comply with spec.

Comply with spec.
Comply with spec.
Comply with spec.
Comply with spec.
Comply with spec.
Comply with spec.
SNO -Q-FM- 0022

SNO -Q-FM- 0022
SNO -Q-FM- 0022
SNO -Q-FM- 0022
SNO -Q-FM- 0017
SNO -Q-FM- 0024
SNO -Q-FM- 0030
P,R
P,R
P,R
P,R
P,R
P,R
P,R
c.
d.
e.
f.
Form Code : SNO-Q-FM-0039 Rev.0
(subcon
logo)
REQUEST FOR INSPECTION

Project Title
Job No
Client
Main Contractor
(Client Name) :
Senoro Gas Development Project

9608/SU2573
JOB Pertamina Medco E & P Tomori Sulawesi
Tripatra-Samsung Consortium
Attn.
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
Mr.
Project Manager
Gentlemen,
We would like to have your presence for inspection according to the following schedules.
Date and time
Place/Area
Inspection Item
Piping
Civil
Instrument
Pipeline
Structural
Electrical
Remarks
Mechanical
COMMENT :
Involvement Party
Signature
Name
Sign Date
Job Title
Performed By
Sub-Contractor
Approved By
TSC
Reviewed By
JOB PMTS
TPI (If applicable)
EQUIPMENT /MATERIAL RECEIVING INSPECTION

REPORT
Project Title
Sub-Contractor
Job No
9608/SU2573
Report No.
Client
Date
Main Contractor
Page
Material Arrival Date
PO.No. / Packing List No
NO.
RESULT2)
ACCEPTED REJECTED
INSPECTION ITEM
(subcon
logo)
DD/MM/YY
of
Remarks
Surface Condition
1
Visual
Dimension
Mill Certificate
Conform to
- Chemical Composition
2
- Mechanical Properties
3 Manufacturer Data Sheet1)
4 Other
Note:
1) If Necessary
2) Put check mark () on the selected result.
Involvement Party
Signature
Name
Sign Date
Job Title
Performed By
Sub-Contractor
Approved By
TSC
Reviewed By
JOB PMTS
TPI (If applicable)
(subcon
logo)
INSPECTION REPORT
Project Title
Job No
Client
Main Contractor

9608/SU2573
TRIPATRA-SAMSUNG CONSORTIUM
1. Type Inspection Item
Sub-Contractor
Report No.
Date
Page
Location :
DD/MM/YY
of
:
Inspection / Test /Examination / Check
2. Inspection Report
3. Remarks
Supporting document attached

YES
NO
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
SURVEY REPORT
Project Title
Job No
Client
Main Contractor
REFERENCES
Item Name
Drawing No.
Revision
Sheet
No.

9608/SU2573
:
:
:
:
:
(subcon
logo)
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
Location :
Of
DESCRIPTION
Plan
Coordinate
Actual
Difference
Plan
Elevation
Actual
Difference
Remarks
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E = East
N = North
Involvement
Party
Performed By
Sub-Contractor
Signature
Signature
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
CLEARING AND GRUBBING INSPECTION REPORT

Project Title
Job No
Client
Main Contractor
REFERENCES
Drawing No.
Revision
Sheet

9608/SU2573
Sub-Contractor
Report No.
Date
Page
:
:
:
:
Location
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
DD/MM/YY
of
:
Reviewed
JOB PMTS
Remarks
EXISTING AREA / LOW SWAMPY

Cut off flush of selected trees without
removing its roots
STABLE EXISTING AREA FOR SUPPORT THE WEIGHT OF HAULING EQUIPMENT
Trees, brush, stump and resting
vegetation removal and disposal.
Organic soil material removal and
disposal
Other unsatisfactory soil material
removal
Demolition, relocation, elevation and
protection of existing facilities.
Quality of Cleaning.
COMMENT :
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed by
JOB PMTS
TPI
(If applicable)
(subcon
logo)
EXCAVATION INSPECTION REPORT

Project Title
Job No
Client
Main Contractor

9608/SU2573
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
From KP ... To KP
REFERENCES
Drawing No.
Revision
Sheet
:
:
:
:
Location
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
Demolition or Protection of Existing Facility

Investigation of Existing under-ground
Facilities
Setout location, based on shop drawing and
endorsed Benchmark
Line, Slope and Grades according to
approved drawing
Depth of Excavation, confirmed
Safety regarding excavation works,
confirmed and Protection of Slope
Dewatering
Quality Cleaning of Bottom Surface
COMMENT
Involvement
Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
BACKFILL MATERIAL INSPECTION REPORT

Project Title
Job No
Client
Main Contractor
REFERENCES
Drawing No.
Revision
Sheet

9608/SU2573
:
:
:
:
NO
INSPECTION ITEMS
Sub-Contractor
Report No.
Date
Page
Location
APPROVED
(Sub-Con)
TSC
DD/MM/YY
of
:
REVIEWED
JOB PMTS
REMARKS
1 QUALITY OF MATERIAL USED

a. LS / CLY / SCLY
b. LS / CLY / SCLY
c. LS / CLY / SCLY
2 DISTRIBUTION QUALITY OF MATERIAL
3 VISUAL SOIL MATERIAL GRADATION
4 VISUAL SOIL MATERIAL PLASTICITY
5 COHESIVENESS OF SOIL MATERIAL
a. Cohesive / Little Cohesive / Loose
b. Cohesive / Little Cohesive / Loose
c. Cohesive / Little Cohesive / Loose
6 CLEANING ( REMOFAL OF TRASH, DEBRIS )
7 SLOPE PROTECTION
Legend
LS
CLY
SCLY
Supporting document attached

: Lime Stone
: Clay Silt
: Sandy Clay
YES
NO
COMMENT
Involvement
Party
Performed by
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved by
TSC
Reviewed By
JOB PMTS
TPI
(subcon
logo)
COMPACTION INSPECTION REPORT

Project Title
Job No
Client
Main Contractor
REFERENCES
Drawing No.
Revision
Sheet
NO

9608/SU2573
Sub-Contractor
Report No.
Date
Page
:
:
:
:
Location
RESULT
INSPECTION ITEMS
Accepted
Fill material quality
Area location marking for layer

thickness
Soil spreading methods
Thickness of loose soil
Water spreading methods
Optimum water content
Compactor trip number
Compaction test number for

covered area
Rejected
APPROVED
(Sub-Con)
REVIEWED
TSC
JOB PMTS
DD/MM/YY
of
:
REMARKS
EQUIPMENT
Total Unit
Sheep Foot Compactors
Vibratory Compactors
pc(s)
Running Unit :
pc(s)
Stand Unit
pc(s)
Total Unit
pc(s)
Running Unit :
pc(s)
Stand Unit
pc(s)
Water Source Check

Accepted
Rejected
Accepted
Rejected
Water Quantity Due to Wet

Compaction Check
COMMENT
Involvement
Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
FIELD DENSITY TEST (SAND CONE METHOD)

Project Title
Job No
Client
Main Contractor
Date Of Test
TestMax.
No. Dry Density
TypeOpt.
of Layer
Moist. Content

9608/SU2573
DD/MM/YY
of
REMARK
Location Of Test
VOLUME DETERMINATION
1
2
3
4
5
Weight of Sand + Cone + Jar ( before )

Weight of Sand + Cone + Jar ( after )
Weight of Sand in Hole + Cone
Weight of Sand in Cone
Weight of Sand in Hole
Unit Weight of Sand
Volume Of Hole
UNIT
FORMULA
gram
gram
gram
gram
gram
a
b
c
d
e=c-d
3
g=e/f
UNIT
FORMULA
Weight of Wet Soil + Container

Weight of Dry Soil + Container
Weight of Water
Weight of Container
Weight of Dry Soil
Moisture Content
gram
gram
gram
gram
gram
%
i
j
k=i-j
l
m=j-l
n=(k/m)x100
DENSITY DETERMENATION
UNIT
FORMULA
gram
gram
gram
o
p
q=o-p
r=q/g
7
8
9
10
Weight of Soil from Hole + Container

Weight of Container
Weight of Soil from Hole
WET DENSITY
11
DRY DENSITY
12
13
14
Maximum LAB DENSITY

Optimum Moisture Content
Present Compaction
gram/cm3
Sheep foot = .X 2 passing
Sheep foot = ..X 2 passing
Vibro smooth drum = ..X 2 passing
Vibro smooth drum = ..X 2 passing
Container No.
Container No.
gram/cm
cm3
MOISTURE CONTENT DETERMENATION

1
2
3
4
5
6
Sub-Contractor
Report No.
Date
Page
Container No.
Container No.
gram/cm3 s=r/(1+(n/100))
t
gram/cm3
%
u
%
v=(s/t)x100
Remarks :
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Form Code : SNO-Q-FM-0009-1 Rev.0
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If Applicable)
(subcon
logo)
SUMMARY SAND CONE TEST REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Min soil Density
Compactor Trip
Compactor Trip
No.
Date of
Test
Involvement Party
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
:
TEST NO / LAYER / ELEVATION
Performed by
Sub-Contractor
Signature
Name
Sign Date
Job Title
LOOSE SOIL
THICKNESS (mm)
Approved by
TSC
WATER
CONTENT
3
(gr/cm )
WET
DENSITY
3
(gr/cm )
DRY
DENSITY
3
(gr/cm )
Reviewed By
JOB PMTS
RESULT (%)
REMARK
TPI
(If Applicable)
PILE DRIVING ANALYZER (PDA) TEST REPORT

Project Title
Job No
Client
Main Contractor

9608/SU2573
Sub-Contractor
Report No.
Date
Page
Drawing No
Hammer Type
Point No
Weight of RAM :
Total Length of Pile
Type of Pile
Location
Date / Time
Test
Load
Point
No
Static Load
Capacity
Pile
Stress
Reading
Pile Energy
Transfer
(subcon
logo)
DD/MM/YY
of
Pile
Integrity
Pile Statement
JUDGEMENT
The piles under tested are
ACCEPTED
REJECTED
according to selected standards, code and specification.
Attachment
1)
2)
3)
Involvement Party
Perform By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Form Code: SNO-Q-FM-0010 Rev.0
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
PILE DRIVING RECORD

Project Title
Job No
Client
Main Contractor
PILE SPECIFICATION
Number
:
Diameter
:
Length
:
Weight
:
DRIVING
Start/ End
Delay
Splicing Joint I
Joint II
Joint III

Sub-Contractor
9608/SU2573
Report No.
Date
DD/MM/YY
Page
of
ITEM NO.
:
LOCATION
:
PILE DRIVING TYPE
:
HAMMER SPECIFICATION
Type
:
Weight
:
Drop Height :
CUSHION
Material Type :
Thickness
:
Final Set
:
cm /
Settlement
:
cm/blow
:
:
:
:
:
blow
DRIVING RECORD
PENETRATION
m
cm
BLOW
COUNT
PENETRATION
m
cm
13
50
PENETRATION
m
cm
26
50
14
50
50
16
50
50
50
18
50
50
19
50
50
20
50
50
21
50
50
22
50
50
23
50
50
24
50
50
25
50
50
Signature
Name
Sign Date
Job Title
50
50
50
38
50
Performed By
Sub-Contractor
50
49
37
50
12
50
48
36
50
11
50
47
35
50
10
50
46
34
50
50
45
33
50
50
44
32
50
50
43
31
50
50
42
30
50
50
41
29
17
50
50
50
50
51
50
Approved By
TSC
BLOW COUNT
40
28
50
PENETRATION
m
cm
39
27
15
BLOW
COUNT
50
50
Involvement Party
BLOW
COUNT
50
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
PILE DRIVING RECORD

Project Title
Job No
Client
Main Contractor

9608/SU2573
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
(subcon
logo)
WELDING INSPECTION REPORT (PILE)

Project Title
Job No
Client
Main Contractor

9608/SU2573
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
WELDING INSPECTION
POINT NO.
JOINT
NO
PILE NUMBER
1
2
2
3
3
4
4
5
DATE1)
START /
FINISH 2)
WEATHER
CONDITION
RESULT
APPROVED
Accepted Rejected SUB-CON TSC
REVIEWED
JOB PMTS
:
:
:
:
:
:
:
:
NOTES :
1) FORMAT MM/DD/YY
2) FORMAT HH:SS
Involvement Party
Signature
Name
Sign Date
Job Title
Performed By
Sub-Contractor
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If appalicable)
REMARKS
FINE AGGREGATE
Project Title
Job No
Client
Main Contractor
STD REFERENCE :
MATERIAL
:
SOURCE
:
SUPPLIER
:
Sieve No.
mm
(subcon
logo)

Sub-Contractor
9608/SU2573
Report No.
Date
Page
TESTING DATE
:
SAMPLING DATE :
PIC
:
TESTING DATE
:
Weight
Retain
Total
% Retain Passing
Weight
ASTM C33
min
max
DD/MM/YY
1
of
Additional Test
Parameter
Spec.
Specific Gravity
Absorption
Silt Content
Washing Loss
Sedimentation
Clay Lumps & Friable
Organic Impurities
Visual Test (Color)
Sand Equivalent
Total
Result
FINE AGGREGATE
(subcon
logo)
(subcon
logo)
COARSE AGGREGATE
Project Title
Job No
Client
Main Contractor
STD REFERENCE :
MATERIAL
:
SOURCE
:
SUPPLIER
:
Sieve No.
mm

Sub-Contractor
9608/SU2573
Report No.
Date
Page
TESTING DATE
:
SAMPLING DATE :
PIC
:
TESTING DATE
:
Weight
Retain
Total
Weight
%.
Retain
Passing
ASTM C33
min
max
DD/MM/YY
2
of
Additional Test
Parameter
Spec.
Specific Gravity
Absorption
Silt Content
Washing Loss
Sedimentation
Clay Lumps & Friable
Organic Impurities
Visual Test (Color)
Sand Equivalent
max 3%
max 12%
max 3%
<80%
Total
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
Result
(subcon
logo)
MIX DESIGN CONCRETE

Project Title
Job No
Client
Main Contractor
DESIGN MIX
Slump
W/C Ratio
Cement
Fly Ash
Silica Fume
Fine Aggregates

9608/SU2573
:
:
:
:
:
:
:
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
mm
3
Kg/m
3
Kg/m
Kg/m3
%
COMPOSITION FOR 1 CuM (SSD CONDITION)

Water
:
L
Cement
Type
:
Kg
Fly Ash
:
Kg
Silica Fume
:
Kg
Admixture
:
L
Retarder
:
L
Superplasticiser:
L
Other
:
L
AGGREGATES VOLUME
Aggregates
:
Sand 1
:
Sand 2
:
Gravel - 01
:
Gravel - 02
:
Gravel - 03
:
Total
Density
Kg
Kg
Kg
Kg
Kg
Kg
:
:
Involvement Party
Ton
T/CuM
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
FOUNDATION CHECK LIST
Project Title
Job No
Client
Main Contractor

9608/SU2573
Equipment / Location
Drawing no
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
NO
RESULT
Accepted Rejected
DESCRIPTION
Surveying
Rebar
Form Work
Concrete
Anchor Bolt or Box Embbedded Steel, Water

Stop
Misc, Opening, Sleeve,

etc
REMARK
Location
Elevation
Plumbness
Diameter Bending
Footing/Pedestal
Lap Length
Surface Cleaning of Rebar
Rigidity
Dimension Alignment
Footing/Pedestal
Form Oil Coating
Stability
Top Elevation
Chamfer Spacer
Cleaning Pouring Place
Footing/Pedestal
Slump Test
Using Vibrator
Removal Laitance
Curing
Appearance of Surface
Size Type Number
Location Orientation Level
Stability
Protection of Anchor Bolt Screw
Dimension, Location, Orientation, Material
COMMENT
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed by
JOB PMTS
TPI
(If applicable)
(subcon
logo)
CONCRETE POUR PERMIT

Project Title
Job No
Client
Main Contractor

9608/SU2573
Drawing No.
Revision
Sheet
:
:
:
Design Mix
:
:
Slump
Quantity
:
:
A(fc' = 35 Mpa)
C(fc' = 20.7 Mpa)
DD/MM/YY
of
B (fc' = 28 Mpa)
D (fc' = 10.3 Mpa)
Cm
3
APPROVED BY :
TSC Signatures
(Print name)
Discipline
Sub-Contractor
Report No.
Date
Page
Date
REVIEWED BY
JOB Signatures
(Print name)
Date
Civil
Piping
Mechanical
Electrical / Instrument
Survey
Engineering
WEATHER
Sunny
Cloudy
Placement Start Date

:
Placement Completed Date:
Number of Cube
:
Concrete Tested by
:
Rainy
Time :
Time :
QTY :
(Nos)
REMARKS:
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
CONCRETE COMPRESSIVE STRENGTH TEST REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Testing Laboratory
Sub-Contractor
Report No.
Date
Page
POURING DATA AND DELIVERY

ITEM
NO
DD/MM/YY
of
SAMPLE NO.
Involvement Party
Signature
Name
Sign Date
Job Title
POURING LOCATION
Performed By
Sub-Contractor
INSPECTION DATE AND REPORT OF TESTING SPECIMEN

Actual
Slump
(cm)
DATE
CAST
TEST
AGE
(days)
Approved By
TSC
Cylinder
Size
(dxh)
Cube Size
(pxlxt)
Weight
( kg )
Concrete
Design
Reviewed By
JOB PMTS
BREAKING
LOAD
COMPRESSIVE
STRENGTH
TPI
RESULT
(subcon
logo)
RELEASE OF FOUNDATION
9608/SU2573
Project Title
Job No
Client
Main Contractor
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
Reference Document
Drawing No
Revision
Sheet
:
:
:
THE ABOVE FOUNDATION HAS BEEN COMPLETED, AND COMPLIES WITH THE DRAWING REQUIREMENT,
ALL SURVEY'S HAVE BEEN COMPLETED WITHNESSED AND APPROVED
Attachment Document Hand Over

No
Document Description
Related Inspection Reports
Final Survey after pouring concrete
Punch List report
Acc
Rej
Status Attachment
Remark
COMMENT :
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
DIMENSIONAL, WELDING, NDT & PAINTING

INSPECTION RECORD
9608/SU2573
Project Title
Job No
Client
Main Contractor
SKETCH
(subcon
logo)
Sub-Contractor
Report No.
Date
Page
Drawing No
Revision
Sheet
DD/MM/YY
of
:
:
:
DIMENSIONAL INSPECTION RECORD

DIMENSION (mm)
Mark
RESULT
Actual
Design Tol
DIMENSION (mm)
Accepted Rejected
Mark
Actual
Design Tol
RESULT
Accepted Rejected
Approved By
(Sub-Con)
TSC
Reviewed By
JOB PMTS
WELDING & NDT INSPECTION RECORDS

WPS/PQR Check
Visual Check
Process
Dimension Check
Electrode
NDT
Parameter
Welder ID
Approved By
(Sub-Con)
TSC
Reviewed By
JOB PMTS
COATING / PAINTING INSPECTION RECORD

Painting System
Painting Brand
DFT (micron)
SAMPLE
Surface Preparation :
Primer / DFT
Intermediate / DFT :
Top/ DFT
TOTAL DFT
Std
Tol
Actual
(micron)
RESULT
Accepted Rejected
Approved By
(Sub-Con)
TSC
Reviewed By
JOB PMTS
6
7
8
9
average
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
#DIV/0!
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
NON DESTRUCTIVE EXAMINATION REQUEST

Project Title
Job No
Client
Main Contractor
Discipline
Request No.
Request Date
Area / Unit
NO.

9608/SU2573
Sub-Contractor
Report No.
Date
Page
:
:
:
:
Drawing Number
Involvement Party
Signature
Name
Sign Date
Job Title
RT
UT
MT
PT
Revision
Sheet
Performed By
Sub-Contractor
Member
Section No.
:
:
:
:
Profile
Approved By
TSC
Attachment
Material
Welding
Process
Welder
Stamp
Reviewed By
JOB PMTS
Shoot Date
Result
DD/MM/YY
of
: 1)
2)
Shop Drawing
Sketch of location
Report No.
TPI
(If applicable)
Remarks
(subcon
logo)
PLUMBNESS INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
:
PLUMBNESS
STRUCTURE
NAME
LOCATION
POSITION
TOP
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
N
E
BOT
ELEVATION BASE PLATE

PLAN
ACTUAL
TOLERANCE
REMARK
DIFFERENCE
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
Involvement Party
Signature
Name
Sign Date
Job Title
Performed By
Sub-Contractor
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
GROUTING INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No
Revision
Sheet
NO
:
:
:
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
Equipment / Location :
CHECKING ITEM
RESULT
Accepted Rejected
APPROVED
(Sub-Con)
TSC
REVIEWED
JOB PMTS
REMARKS
SURFACE ROUGHNESS
MIXING PROPORTION
CLEANING
CURING
DIMENSION, ALIGNMENT &
STABILITY OF FORM WORK
TOP ELEVATION OF FORM
WORK
CHAMFER
LOCATION
BASE PLATE
SURFACE FINISHING
NOTE :
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
BOLT TIGHTENING CHECK

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No
Revision
Sheet
:
:
:
DD/MM/YY
of
Equipment / Location :
STRUCTURE NAME
Involvement Party
Sub-Contractor
Report No.
Date
Page
BOLT SPEC./SIZE
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
TENSION STD.
(NM)
Approved by
TSC
BOLT CHECK LOCATION
Reviewed by
JOB PMTS
RESULT
ACCEPTED REJECTED
TPI
(If applicable)
(subcon
logo)
RELEASE OF STEEL STRUCTURE INSTALLATION

9608/SU2573
Project Title
Job No
Client
Main Contractor
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
Reference Document
Drawing No
Revision
Sheet
:
:
:
THE ABOVE STEEL STRUCTURE INSTALLATION HAS BEEN COMPLETED, AND COMPLIES WITH THE DRAWING
REQUIREMENT, ALL SURVEY'S HAVE BEEN COMPLETED WITHNESSED AND APPROVED
Attachment Document Hand Over

No
1
Document Description
Related Inspection Reports

Final Survey (Plumbness)
Punch List report
Acc
Rej
Status Attachment
Remark
COMMENT :
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
AGGREGATE GRADATION REPORT

( SIEVE TEST )
9608/SU2573
Project Title
Job No
Client
Main Contractor
Sample No.
Source of Aggregate
Sieve Size
Inch
mm
Individual
Wt.Ret ( gr )
Wt.Ret
( gr )
SAMPLE I
% Ret
% Pass
Sub-Contractor
Report No.
Date
Page
Spec %
Pass
(subcon
logo)
DD/MM/YY
of
REMARK
TOTAL
NOTE :
Involvement Party
Performed By
Sub-Contrcator
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
GRAVEL INSPECTION REPORT

Project Title
Job No
Client
Main Contractor
REFERENCES
Drawing No.
Revision
Sheet

9608/SU2573
:
:
:
:
Sub-Contractor
Report No.
Date
Page
Location
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
DD/MM/YY
of
:
Reviewed
JOB PMTS
Remarks
Quality of Cleaning before Spreading

Condition of Compaction
Quality of Cleaning after Spreading
Check Thickness and Width of Gravelling
COMMENT
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
CALIFORNIA BEARING RATIO (CBR) INSITU

9608/SU2573
Project Title
Job No
Client
Main Contractor
Location
Test Date
(subcon
logo)
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
1 of
:
:
Time second
Penetration
x 10-2
Inc
Reading x 10 -2
0
50
100
150
200
250
300
350
400
450
500
600
700
800
900
1000
1100
1200
1300
1400
1500
Load (lbs)
Remarks
Cf=
Ap=
Load= Reading x CF
CBR 0.1"
Corrected load
x 100%
Ap x 1000 Psi
CBR 0.2"
Corrected load
x 100%
Ap x 1500 Psi
Remarks
Cf = Calibration Factor
Ap = Area of Plunger
Note :
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
CALIFORNIA BEARING RATIO ( CBR )REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
:
Test Date
DD/MM/YY
2 of
Load (lbs)
Location
Sub-Contractor
Report No.
Date
Page
(subcon
logo)
Penetration of Plunger ( inch )
CBR 0.1" =
Remarks :
CBR 0.2" =
Involvement
Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed by
JOB PMTS
TPI
(If applicable)
SEWER PIPING AND DRAINAGE INSPECTION

REPORT
9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
(subcon
logo)
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
Check Installation of Pipes

Check Dimensional ( Location, Elevation &
Slope )
Check Connection of pipe and manhole
Concrete
Surface Finishing
Water Flow / Service test
COMMENT
Involvement
Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
BRICK INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
BRICK WORK
Location, wall centre, vertical board
Location of door and windows
Proportioning and Mixing Mortar
Reinforcement and installation of accessories
(Horizontal Dowels, Veltical Dowels, etc)
Installation of Column Practice
Finish of surface
COMMENT
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved by
TSC
Reviewed By
JOB PMTS
TPI (If applicable)
(subcon
logo)
WATER PROOFING INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
Surface Preparation
Condition & Application of Material
Overlap Joint
Leakage Test
COMMENT
Involvement Party
Performed by
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved by
TSC
Reviewed by
JOB PMTS
TPI
(If applicable)
(subcon
logo)
DOORS & WINDOWS INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
Installation of Frames and doors & windows

Installation of Hardware
Fixed condition of glass
Condition of Cleaning
Functional Test
COMMENT
Involvement
Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
WALL , CEILING AND FLOOR INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
I. WALL FINISHING (Brick, Concrete, Gypsum or Partition)

Surface
Flatness
Painting or Wall Paper
Condition of Joint
Condition of Cleaning
II. CEILING (Acoustic Board or Gypsum Board)
Setting Frame
Layout and Pattern
Condition of Joint
Painting
Condition Cleaning and Protection
III. FLOOR WORK
Pattern and Layout of Installation
Surface
Flatness
Treatment of Joint
Cleaning and Waxing
COMMENT
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved by
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
PLUMBING & SANITARY FIXTURE INSPECTION

REPORT
9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
(subcon
logo)
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
I. PLUMBING WORK
Check Location, Elevation & Slope
Installation of Pipes
Connection of Sanitary Hardware to Pipe
Accepted
Water Flow & Service Test
II. SANITARY FIXTURE
Equipment Location
Alignment and Level of Installation
Tightness of screw and / or bolts & nuts
Cleaning Condition
Function Test
COMMENT
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved By
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
ROOFING AND SIDING INSPECTION REPORT

9608/SU2573
Project Title
Job No
Client
Main Contractor
Drawing No.
Revision
Sheet
Sub-Contractor
Report No.
Date
Page
Equipment / Location Name
(subcon
logo)
DD/MM/YY
of
:
:
:
Item of Inspection
Result
Accepted Rejected
Approved
Sub-Con
TSC
Reviewed
JOB PMTS
Remarks
Installation of Framing
Installation of Roof & Accessories
Lapped Joint ( Length & Width )
Condition of Fastening
COMMENT
Involvement Party
Performed By
Sub-Contractor
Signature
Name
Sign Date
Job Title
Approved by
TSC
Reviewed by
JOB PMTS
TPI
(If applicable)
GENERAL PUNCH LIST
(subcon
logo)
SYSTEM / SUB SYSTEM NO.
PUNCH LIST NO.
SYSTEM DISCRIPTION
DATE
TEST PACKAGE NUMBER
DISCIPLINE
REFERENCE DOC/DWG/SPEC.
EQUIPMENT / AREA
COMPLETION DATE
DESCRIPTION
ITEM
PUCH LIST CATEGORY
VERIFICATION CLOSE OUT
ORIGINATOR
PLAN
ACTUAL
REMARKS
A or B
SUB CON
TSC
JOB PMTS
SUB CON
TSC
JOB PMTS
Category A - Item must be complete before Mechanical Completion The System at Approval of JOB Pertamina Medco E & P Tomori Sulawesi
Category B - Item can be complete after Mechanical Completion The System at Approval of JOB Pertamina Medco E & P Tomori Sulawesi
Involvement Party
Signature
Name
Sign Date
Job Title
Performed by
Sub-Contractor
Approved by
TSC
Reviewed By
JOB PMTS
TPI
(If applicable)
(subcon
logo)
INSPECTION, MEASUREMENT & TEST EQUIPMENT CALIBRATION LOG

Subcontractor Name :
NO.
EQUIPMENT / INSTRUMENT
IDENTIFICATION NO.
DESCRIPTION
SIZE-RANGE
MANUFACTURER
MODEL No.
MANUFACTURER SERIAL
NUMBER
CALIBRATION DETAILS
Calibration Date
Exp. Date
Certificate Number
Tag Number
REMARKS
(subcon
logo)
WELDER LIST
Project Title
Job No
Client
Main Contractor
Sub-Contractor
NO
WELDER NAME
Involvement Party
Signature
Name
Sign Date
Job Title
:
:
:
:

9608/SU2573
JOB Pertamina Medco E & P Tomori Sulawesi.
:
WELDER
STAMP
WPS / PQR NO
STANDARD /
REFERENCES
Performed by
Sub-Contractor
TEST COUPON
BASE
METAL
JOINT
DISEGN
DIAMETER
(Inch)
THICKNESS
(mm)
Approved By
TSC
Rev.
Date
Sheet
RANGE QUALIFIED
WELDING
PROCESSES
POSITION
WELDING
PROGRESS
BASE
METAL
JOINT
DISEGN
Reviewed By
JOB PMTS
DIAMETER
(Inch)
THICKNESS
(mm)
WELDING
PROCESSES
POSITION
TPI
(If applicable)
WELDING
PROGRESS
REMARKS
(subcon
logo)
WPS / PQR MATRIX

Project Title
Job No
Client
Main Contractor
Sub-Contractor
NO
:
:
:
:

9608/SU2573
JOB Pertamina Medco E & P Tomori Sulawesi.
DESCRIPTION
Involvement Party
Signature
Name
Sign Date
Job Title
WPS/PQR NO
STANDARD /
REFERENCES
TEST COUPON
BASE
METAL
Performed By
Sub-Contractor
JOINT
DISEGN
DIAMETER
(Inch)
Rev.
Date
Sheet
RANGE QUALIFIED
THICKNESS
(mm)
WELDING
PROCESSES
Approved by
TSC
POSITION
WELDING
PROGRESS
BASE
METAL
JOINT
DISEGN
DIAMETER
(Inch)
Reviewed By
JOB PMTS
THICKNESS
(mm)
WELDING
PROCESSES
POSITION
WELDING
PROGRESS
PWHT
HARDNESS
TPI ( if applicable )
REMARKS

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ATTACHMENT 7.

PROJECT INSPECTION & TEST PLAN

TPI : Third Party Inspection

Welding Procedure Specification / Procedure

Comply with spec & proc.

General Fabrication Work

-SNO-S-TS-002 Specification Standard for

Comply with spec & proc.

General Structure Erection Work

- SNO-X-PR-007 Steel Structure Erection

Comply with spec & proc.

Chipping and Padding Work

- SNO-S-ES-002 Standard Specification for

Comply with spec & proc.

- SNO-C-ES-015 Standard Specification for

Comply with spec & proc.

- SNO-S-TS-001 Specification for structural

Comply with spec.

SNO -Q-FM- 0002

Inspection During Fabrication

WPS/PQR Qualification Test

Comply with spec.

SNO -Q-FM- 0038

Welder Performance test

Comply with spec.

SNO -Q-FM- 0037

Dimensional, Welding, NDT, and Coating Inspection

As applicable WPS/PQR,NDT procedure

Comply with spec. & DWG.

SNO -Q-FM- 0019

PROJECT INSPECTION & TEST PLAN

TPI : Third Party Inspection

- SNO-S-ES-002 Standard Specification for

Comply with spec. & DWG.

SNO -Q-FM- 0004

Comply with spec. & DWG.

SNO -Q-FM- 0021

Chipping and Padding check

Welding and NDT Inspection

As applicable WPS/PQR,NDT procedure

Comply with spec.

SNO -Q-FM- 0020

- SNO-S-ES-002 Standard Specification for

Comply with spec.

SNO -Q-FM- 0023

- SNO-C-ES-015 Standard Specification for

Comply with spec.

SNO -Q-FM- 0002

- SNO-C-ES-015 Standard Specification for

Comply with spec.

SNO -Q-FM- 0022

- SNO-C-ES-015 Standard Specification for

Comply with spec. & DWG.

SNO -Q-FM- 0022

4. Anchor bolts and embedded items

- SNO-C-ES-015 Standard Specification for

Comply with spec. & DWG.

SNO -Q-FM- 0022

5. Cleaning prior to placing

- SNO-C-ES-015 Standard Specification for

Comply with spec.

SNO -Q-FM- 0022

6. Grout test (compressive strength)