Record No.

Inspection Record for Grouting

Client:

Subcontractor:

Project No.:

Subcontract P.O. No.:

Project Name:

Equipment/Structure No.::

Reference Document:

Subcontractor

Items to inspect

inspected
initials/date
1.0

Equipment/structure released for grouting

1.1

Equipment levelled and shimmed

1.2

Concrete surfaces prepared and clean

1.3

Forms/chamfers

2.0

Materials and procedure

2.1

Procedure/materials approved

2.2

Test cube sampling

3.0

Application

3.1

Casting

3.2

Test results

3.3

Curing and drying

3.4

Anchor bolts tightened

3.5

Final inspection

H - Companys presence is mandatory for all activities in section.

Company
Hold
Point

Remarks

inspected*
initials/date

Attachments, No. of pages:

h - Companys presence is mandatory.

Accepted for Subcontractor

Name:

Signature:
Date:

Accepted for Company

Name:

Signature:

Date:

Accepted for Client

Name:

Signature:

Date:

* Company only initials for holdpoint

C:\RB_Forms\RB26J10.DOT\

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