PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 COMPANY OFFICE - 14-Sep-17 CIVIL

2 COMPANY OFFICE 14-Sep-17 CIVIL

3 COMPANY OFFICE 14-Sep-17 CIVIL

4 COMPANY OFFICE 14-Sep-17 CIVIL

5 COMPANY OFFICE 14-Sep-17 CIVIL

6 COMPANY OFFICE 14-Sep-17 CIVIL

7 COMPANY OFFICE 14-Sep-17 CIVIL

8 COMPANY OFFICE 14-Sep-17 CIVIL

9 COMPANY OFFICE 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 1 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

10 COMPANY OFFICE 14-Sep-17 CIVIL

11 COMPANY OFFICE 14-Sep-17 CIVIL

12 COMPANY OFFICE 14-Sep-17 CIVIL

13 COMPANY OFFICE 14-Sep-17 CIVIL

14 COMPANY OFFICE 14-Sep-17 ELECTRICAL

15 COMPANY OFFICE 14-Sep-17 CIVIL

16 CONTRACTOR PFFICE 14-Sep-17 CIVIL

17 CONTRACTOR PFFICE 14-Sep-17 CIVIL

18 CONTRACTOR PFFICE 14-Sep-17 CIVIL

19 CONTRACTOR PFFICE 14-Sep-17 CIVIL

20 CONTRACTOR PFFICE 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 2 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

21 CONTRACTOR PFFICE 14-Sep-17 CIVIL

22 CONTRACTOR PFFICE 14-Sep-17 CIVIL

23 CONTRACTOR PFFICE 14-Sep-17 CIVIL

24 CONTRACTOR PFFICE 14-Sep-17 CIVIL

25 CONTRACTOR PFFICE 14-Sep-17 CIVIL

26 CONTRACTOR PFFICE 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 3 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Plasteran retak-retak rambut diperbaiki dan dirapikan a KELSRI

Meja cor dapur dicat mintak A KELSRI

Design pembuangan floor draine ditoilet kurang A KELSRI

Rapikan pengecatan dinding dan kusen yang belum merata (ALL) A KELSRI

Tambahkan nut lantai yang rusak A KELSRI

Cubicle kamar mandi diselesaikan A KELSRI

Perbaiki dan ganti keramik yang retak-retak dan rusak A KELSRI

Perbaiki kusen pintu kamar mandi yang rusak A KELSRI

Bukaan daun pintu tersendat-sendat A KELSRI

Punch List Entry Form Rev. 001 Page 4 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Kamar mandi diberi slope A KELSRI

Perbaiki partisi kamar mandi terlalu rapat dengan lantai A KELSRI

Perbaiki pipa kamar mandi yang bocor A KELSRI

Perbaiki pemasangan wastafel kamar mandi yang tidak lurus A KELSRI

Perbaiki stop kontak yang rusak A KELSRI

Perbaiki dempulan plafond yang lepas A KELSRI

Tambahkan Flashing pada ruang contactor office A KELSRI

Design pembuangan floor draine ditoilet kurang A KELSRI

Cubicle kamar mandi diselesaikan A KELSRI

Rapikan pengecatan dinding dan partisi yang belum merata A KELSRI

Perbaiki atap ruangan contractor yang bocor A KELSRI

Punch List Entry Form Rev. 001 Page 5 of 99
 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Perbaiki plafond yang rusak A KELSRI

Perbaiki atap kamar mandi bocor A KELSRI

Partisi kamar mandi transparan A KELSRI

Perbaiki partisi kamar mandi yang terlalu rapat dengan lantai A KELSRI

Perbaiki pipa kamar mandi yang bocor A KELSRI

Daun pintu tidak sesuai dengan gambar A KELSRI

Punch List Entry Form Rev. 001 Page 6 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

Punch List Entry Form Rev. 001 Page 7 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 8 of 99

 VERIFIED BY REMARKS

As Build

Punch List Entry Form Rev. 001 Page 9 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.

1 COMPANY CAMP - 12-Sep-17 CIVIL

2 COMPANY CAMP 12-Sep-17 CIVIL

3 COMPANY CAMP 12-Sep-17 CIVIL

4 COMPANY CAMP 12-Sep-17 CIVIL

5 COMPANY CAMP 12-Sep-17 CIVIL

6 COMPANY CAMP 12-Sep-17 CIVIL

7 COMPANY CAMP 12-Sep-17 CIVIL

8 COMPANY CAMP 12-Sep-17 CIVIL

9 COMPANY CAMP 12-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 10 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
10 COMPANY CAMP 12-Sep-17 CIVIL

11 COMPANY CAMP 12-Sep-17 CIVIL

12 COMPANY CAMP 12-Sep-17 ELECTRICAL

13 COMPANY CAMP 12-Sep-17 CIVIL

14 COMPANY CAMP 12-Sep-17 CIVIL

15 COMPANY CAMP 14-Sep-17 CIVIL

16 COMPANY CAMP 14-Sep-17 CIVIL

17 COMPANY CAMP 14-Sep-17 CIVIL

18 COMPANY CAMP 14-Sep-17 CIVIL

19 COMPANY CAMP 14-Sep-17 CIVIL

20 COMPANY CAMP 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 11 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
21 COMPANY CAMP 14-Sep-17 CIVIL

22 COMPANY CAMP 14-Sep-17 CIVIL

23 COMPANY CAMP 14-Sep-17 CIVIL

24 COMPANY CAMP 14-Sep-17 CIVIL

25 COMPANY CAMP 14-Sep-17 CIVIL

26 COMPANY CAMP 14-Sep-17 CIVIL

27 COMPANY CAMP 14-Sep-17 CIVIL

28 COMPANY CAMP 14-Sep-17 CIVIL

29 COMPANY CAMP 14-Sep-17 CIVIL

30 COMPANY CAMP 14-Sep-17 CIVIL

31 COMPANY CAMP 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 12 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
32 COMPANY CAMP 14-Sep-17 CIVIL

33 COMPANY CAMP 14-Sep-17 CIVIL

34 COMPANY CAMP 14-Sep-17 CIVIL

35 COMPANY CAMP 14-Sep-17 CIVIL

36 COMPANY CAMP 14-Sep-17 CIVIL

39 COMPANY CAMP 14-Sep-17 CIVIL

40 COMPANY CAMP 14-Sep-17 CIVIL

41 COMPANY CAMP 16-Sep-17 CIVIL

42 COMPANY CAMP 16-Sep-17 CIVIL

43 COMPANY CAMP 16-Sep-17 CIVIL

44 COMPANY CAMP 16-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 13 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
45 COMPANY CAMP 16-Sep-17 CIVIL

46 COMPANY CAMP 16-Sep-17 CIVIL

47 COMPANY CAMP 16-Sep-17 CIVIL

48 COMPANY CAMP 16-Sep-17 CIVIL

49 COMPANY CAMP 16-Sep-17 CIVIL

50 COMPANY CAMP 16-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 14 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
NAME & NAME &
DATE DATE
SIGN SIGN

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Plasteran retak-retak rambut diperbaiki dan dirapikan A KELSRI

Besi over steak dirapikan B KELSRI

Pasangan nut lantai tidak lurus dan rapi A KELSRI

Pasangan keramik kopong dan renggang diperbaiki A KELSRI

pengecatan dasar dinding belum merata A KELSRI

Dibuat smooking area disamping kanan bangunan A KELSRI

flashing atap belum lengkap A KELSRI

Pintu yang rusak diperbaiki A KELSRI

Punch List Entry Form Rev. 001 Page 15 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Terdapat pasangan pintu yang terlalu berjarak dengan lantai A KELSRI

Kusen jendela yang rusak diperbaiki A KELSRI

Pemasangan stop kontak dirapikan B KELSRI

Pipa pembuangan air AC harus ditanam dan dirapikan A KELSRI

Keramik teras diberi slope A KELSRI

Antara teras keramik dan tanah diberi elevasi / BUATKAN ELEVASI TANAH
A KELSRI
LEBIH RENDAH DIBANDINGKAN DENGAN TERAS KERAMIK

PERBAIKI Finishing lantai dibawah pintu masuk A KELSRI

Perbaiki Pemasangan hendle pintu masuk A KELSRI

Pengecatan dinding masih berbayang A KELSRI

Perbaiki dinding yang masih kasar / finishing. A KELSRI

Terdapat celah lebar di bawah pintu bagian samping barat A KELSRI

Punch List Entry Form Rev. 001 Page 16 of 99
 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Tambahkan pengecatan plafond berbayang/tidak rata A KELSRI

Tambahkan aksesoris kamar mandi / TAMBAHKAN GANTUNGAN BAJU A KELSRI

Nut keramik ditambahkan A KELSRI

Perbaiki Pipa shower terlalu menonjol keluar (A-04) A KELSRI

Lengkapi tutup floordryn tidak ada (A-03) A KELSRI

Perbaiki keramik yang retak (A-03) A KELSRI

Perbaiki finishing banwol (A-03) A KELSRI

Dinding yang kasar diperhalus (A-06) A KELSRI

Tambahkan nut keramik kurang(A-06) A KELSRI

Banwol kamar mandi dicat A KELSRI

Ganti lampu kamar mandi putus (A-10) A KELSRI

Punch List Entry Form Rev. 001 Page 17 of 99
 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Perbaiki Daun Pintu rusak (A-12) A KELSRI

Perbaiki Finishing pintu kamar mandi (A-02) A KELSRI

Floordryn tidak lurus dengan lantai (A-02) A KELSRI

Keramik kamar mandi yang pecah diganti/diperbaiki A KELSRI

Tiang pada smooking area di lepaskan. A KELSRI

Lengkapi desk & folding chair A KELSRI

Pasang water heater tank di kamar mandi A KELSRI

Perbaiki Pintu kamar mandi macet ( Rata-rata ) A KELSRI

Bingkai pintu kamar mandi belum lengkap ( A-07, A-010) A KELSRI

Keramik dibawah pintu masuk kopong ( A-09 ) A KELSRI

Perbaiki Pintu kamar mandi tidak bisa dikunci ( A-09, A-05 ) A KELSRI
Punch List Entry Form Rev. 001 Page 18 of 99
 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Perbaiki Pengisian air toilet lambat ( A-10 ) A KELSRI

Perbaiki tabung air pada closet yang bocor ( A-04 ) A KELSRI

Perbaiki Shower yang tersumbat ( A-03) A KELSRI

Pasang kran air yang belum terpasang A KELSRI

Perbaiki tabung air pada Closet yang bocor ( A-02 ) A KELSRI

Daun pintu tidak sesuai dengan gambar / ajukan Field change sheet A KELSRI

Punch List Entry Form Rev. 001 Page 19 of 99

 VERIFIED BY REMARKS

NAME &
DATE
SIGN

As Build

Punch List Entry Form Rev. 001 Page 20 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 21 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 22 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 23 of 99

 VERIFIED BY REMARKS

As Build

Punch List Entry Form Rev. 001 Page 24 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.

RECREATION &
1 - 12-Sep-17 CIVIL
MESSHALL
RECREATION &
2 12-Sep-17 CIVIL
MESSHALL
RECREATION &
3 12-Sep-17 CIVIL
MESSHALL
RECREATION &
4 12-Sep-17 CIVIL
MESSHALL
RECREATION &
5 12-Sep-17 CIVIL
MESSHALL
RECREATION &
6 12-Sep-17 CIVIL
MESSHALL
RECREATION &
7 12-Sep-17 CIVIL
MESSHALL
RECREATION &
8 12-Sep-17 CIVIL
MESSHALL
RECREATION &
9 12-Sep-17 CIVIL
MESSHALL

Punch List Entry Form Rev. 001 Page 25 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
RECREATION &
10 12-Sep-17 CIVIL
MESSHALL
RECREATION &
11 12-Sep-17 CIVIL
MESSHALL
RECREATION &
12 12-Sep-17 ELECTRICAL
MESSHALL
RECREATION &
13 12-Sep-17 CIVIL
MESSHALL
RECREATION &
14 12-Sep-17 CIVIL
MESSHALL
RECREATION &
15 12-Sep-17 CIVIL
MESSHALL
RECREATION &
16 12-Sep-17 CIVIL
MESSHALL
RECREATION &
17 12-Sep-17 ELECTRICAL
MESSHALL
RECREATION &
18 12-Sep-17 CIVIL
MESSHALL
RECREATION &
19 14-Sep-17 CIVIL
MESSHALL
RECREATION &
20 14-Sep-17 CIVIL
MESSHALL
Punch List Entry Form Rev. 001 Page 26 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
RECREATION &
22 14-Sep-17 CIVIL
MESSHALL
RECREATION &
23 14-Sep-17 CIVIL
MESSHALL
RECREATION &
24 14-Sep-17 ELECTRICAL
MESSHALL
RECREATION &
25 14-Sep-17 CIVIL
MESSHALL
RECREATION &
26 14-Sep-17 CIVIL
MESSHALL
RECREATION &
27 14-Sep-17 CIVIL
MESSHALL
RECREATION &
28 14-Sep-17 CIVIL
MESSHALL
RECREATION &
29 14-Sep-17 CIVIL
MESSHALL
RECREATION &
30 14-Sep-17 CIVIL
MESSHALL
RECREATION &
31 14-Sep-17 CIVIL
MESSHALL
RECREATION &
32 14-Sep-17 CIVIL
MESSHALL
Punch List Entry Form Rev. 001 Page 27 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL
SYSTEM / INSPECTION
ITEM LOCATION RFI NO DISCIPLINE TAG
SUB SYSTEM DATE
NO.
33 RECREATION &
14-Sep-17 CIVIL
MESSHALL

34 RECREATION &
14-Sep-17 CIVIL
MESSHALL

35 RECREATION &
14-Sep-17 CIVIL
MESSHALL

36 RECREATION &
14-Sep-17 CIVIL
MESSHALL

37 RECREATION &
14-Sep-17 CIVIL
MESSHALL

38 RECREATION &
14-Sep-17 CIVIL
MESSHALL

39 RECREATION &
14-Sep-17 CIVIL
MESSHALL

40 RECREATION &
14-Sep-17 CIVIL
MESSHALL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 28 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
NAME & NAME &
DATE DATE
SIGN SIGN

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Perbaiki plasteran dinding yang retak - retak rambut A KELSRI

Ukuran pipa pembuangan tidak sesuai gambar B KELSRI

Perbiki kusen yang rusak A KELSRI

Posisi teras dibawah existing tanah B KELSRI

Rapikan atau potong besi yang over steak B KELSRI

Rangka atap dipasang dyna bolt B KELSRI

Revisi gambar plumbing B KELSRI

Rapikan pengecatan kusen A KELSRI

Punch List Entry Form Rev. 001 Page 29 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Rapikan nut antara pasangan keramik dan dinding B KELSRI

Selesaikan pengecatan dinding yang belum merata dan masih berbayang A KELSRI

Instalasi listrik mager and continue test B KELSRI

Perbaiki pasangan pintu gantung A KELSRI

Rapikan plasteran dinding kamar mandi A KELSRI

Rapikan Balok yang dicat sebelum diaci A KELSRI

Perbaik dinding keramik kamar mandi yang pecah A KELSRI

Perbaiki pemasangan lampu yang rusak B KELSRI

Perbaiki bukaan jendela yang macet B KELSRI

Luruskan penutup kabel dibawah banwol A KELSRI

Perbaiki Wastafel kamar mandi yang miring B KELSRI

Punch List Entry Form Rev. 001 Page 30 of 99
 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Rapikan pipa pembuangan air AC B KELSRI

Tambahan nut keramik yang masih kurang A KELSRI

Perbaiki sarang stop kontak yang rusak B KELSRI

Pasang sekat urinoil pada toilet A KELSRI

Ganti keramik kamar mandi yang pecah A KELSRI

Perbaiki keramik yang kopong A KELSRI

Cleaning kaca jendela B KELSRI

Ganti kran wastafel kamar mandi dengan kran kepala angsa A KELSRI

Meja cor dapur dicat A KELSRI

Rapikan kran wastafel didapur A KELSRI

Perbaiki keramik yang pecah A KELSRI

Punch List Entry Form Rev. 001 Page 31 of 99
 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
CATEGOR
DESCRIPTION ACTION BY
Y
Perbaiki atap kamar mandi yang bocor A KELSRI

Ganti Kunci jendela yang hilang A KELSRI

Perbaiki bukaan pintu dapur yang macet A KELSRI

Perbaiki atap kamar mandi yang bocor A KELSRI

Slope kamar mandi kurang A KELSRI

Perbaiki Handle pintu ruang karaoke yang rusak A KELSRI

Perbaiki Shower rusak A KELSRI

Daun pintu tidak sesuai gambar B KELSRI

Punch List Entry Form Rev. 001 Page 32 of 99

 VERIFIED BY REMARKS

NAME &
DATE
SIGN

As Build

As Build

Punch List Entry Form Rev. 001 Page 33 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 34 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 35 of 99

 VERIFIED BY REMARKS

As Build

Punch List Entry Form Rev. 001 Page 36 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 CONTRACTOR CAMP - 12-Sep-17 CIVIL

2 CONTRACTOR CAMP 12-Sep-17 CIVIL

3 CONTRACTOR CAMP 12-Sep-17 CIVIL

4 CONTRACTOR CAMP 12-Sep-17 CIVIL

6 CONTRACTOR CAMP 12-Sep-17 CIVIL

7 CONTRACTOR CAMP 12-Sep-17 CIVIL

8 CONTRACTOR CAMP 12-Sep-17 CIVIL

9 CONTRACTOR CAMP 14-Sep-17 CIVIL

10 CONTRACTOR CAMP 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 37 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

11 CONTRACTOR CAMP 14-Sep-17 CIVIL

12 CONTRACTOR CAMP 14-Sep-17 CIVIL

13 CONTRACTOR CAMP 14-Sep-17 CIVIL

14 CONTRACTOR CAMP 14-Sep-17 CIVIL

15 CONTRACTOR CAMP 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 38 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 39 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Pengecoran Lantai tidak sesuai gambar B KELSRI

Pasang dinding penutup dari container menuju kamar mandi A KELSRI

Perbaiki plasteran yang retak-retak rambut A KELSRI

Rapikan besi yang over steak B KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Bersihkan cipratan concrete pada container B KELSRI

Bersihkan atap baja yang terkena tanah B KELSRI

Rapikan finishing teras keramik pada kamar mandi A KELSRI

Punch List Entry Form Rev. 001 Page 40 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Selesaikan dinding keramik pada kamar mandi A KELSRI

Rapikan finishing dinding penyambung kontainer dan kamar mandi A KELSRI

Pintu tidak sesuai gambar A KELSRI

Ventilasi tidak sesuai gambar B KELSRI

Pasang water bowl yang belum terpasang A KELSRI

Punch List Entry Form Rev. 001 Page 41 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

Punch List Entry Form Rev. 001 Page 42 of 99

 VERIFIED BY REMARKS

As Build

Punch List Entry Form Rev. 001 Page 43 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 MUSHALLA - 12-Sep-17 CIVIL

2 MUSHALLA 12-Sep-17 CIVIL

3 MUSHALLA 12-Sep-17 CIVIL

4 MUSHALLA 12-Sep-17 CIVIL

5 MUSHALLA 12-Sep-17 CIVIL

6 MUSHALLA 12-Sep-17 CIVIL

7 MUSHALLA 12-Sep-17 CIVIL

8 MUSHALLA 14-Sep-17 CIVIL

9 MUSHALLA 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 44 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

10 MUSHALLA 14-Sep-17 CIVIL

11 MUSHALLA 14-Sep-17 CIVIL

12 MUSHALLA 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 45 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 46 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Rapikan plasteran yang retak-retak rambut A KELSRI

Rapikan besi yang over steak B KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Rapikan pengecatan A KELSRI

Pasang atap pada tempat wudhu A KELSRI

Ganti Kaca jendela yang retak A KELSRI

Tambahkan banwol pada tempak wudhu A KELSRI

Finishing ada bagian luar dinding A KELSRI

Punch List Entry Form Rev. 001 Page 47 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Tambahkan pintu pada mushalla A KELSRI

Perbaiki dinding yang rusak A KELSRI

Rapikan pengecatan plafond yang berbayang A KELSRI

Punch List Entry Form Rev. 001 Page 48 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

Punch List Entry Form Rev. 001 Page 49 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 50 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 PIMPONG SHELTER - 12-Sep-17 CIVIL

2 PIMPONG SHELTER 12-Sep-17 CIVIL

3 PIMPONG SHELTER 12-Sep-17 CIVIL

4 PIMPONG SHELTER 12-Sep-17 CIVIL

5 PIMPONG SHELTER 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 51 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

PUNCH ITEM CATEGORY:

Punch List Entry Form Rev. 001 Page 52 of 99
 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
A – Before Ready For Commissioning
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 53 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Perbaiki plasteran balok dan kolom yang retak-retak rambut A KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Rapikan pengecatan balok dan kolom A KELSRI

Finishing all A KELSRI

Punch List Entry Form Rev. 001 Page 54 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Punch List Entry Form Rev. 001 Page 55 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

Punch List Entry Form Rev. 001 Page 56 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 57 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 WAREHOUSE - 12-Sep-17 CIVIL

2 WAREHOUSE 12-Sep-17 CIVIL

3 WAREHOUSE 12-Sep-17 CIVIL

4 WAREHOUSE 12-Sep-17 CIVIL

5 WAREHOUSE 12-Sep-17 CIVIL

6 WAREHOUSE 12-Sep-17 CIVIL

7 WAREHOUSE 12-Sep-17 CIVIL

8 WAREHOUSE 12-Sep-17 CIVIL

9 WAREHOUSE 12-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 58 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

10 WAREHOUSE 12-Sep-17 CIVIL

11 WAREHOUSE 14-Sep-17 CIVIL

12 WAREHOUSE 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 59 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 60 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Perbaiki plasteran yang retak-retak rambut A KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Bekisting tombak layar dilepaskan B KELSRI

Rapikan dan bersihkan pengecatan dinding yang masih berbayang dan kotor A KELSRI

Pasangan jendela tidak sesuai gambar B KELSRI

Lepaskan kayu pada pintu gerbang B KELSRI

Perbaiki lantai yang rusak A KELSRI

Rapikan pemasangan kawat jendela yang tidak rapi dan masih renggang A KELSRI

Punch List Entry Form Rev. 001 Page 61 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Perbaiki pemasangan pintu renggang, tidak bisa ditutup rapat dan tidak lancar saa A KELSRI

Cat Rel pintu masuk B KELSRI

Tombak layar diaci A KELSRI

Punch List Entry Form Rev. 001 Page 62 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

Punch List Entry Form Rev. 001 Page 63 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 64 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 GENSET SHELTER - 12-Sep-17 CIVIL

2 GENSET SHELTER 12-Sep-17 CIVIL

3 GENSET SHELTER 12-Sep-17 CIVIL

4 GENSET SHELTER 12-Sep-17 CIVIL

5 GENSET SHELTER 12-Sep-17 CIVIL

6 GENSET SHELTER 12-Sep-17 CIVIL

7 GENSET SHELTER 12-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 65 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 66 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 67 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Perbaiki plasteran kolom & balok yang retak-retak rambut A KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Dibuat banwol pada genset A KELSRI

Detail potongan banwol tidak ada pada gambar B KELSRI

Pengecatan kolom dan balok belum merata dan masih berbayang A KELSRI

Besi over steak dirapikan B KELSRI

Punch List Entry Form Rev. 001 Page 68 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Punch List Entry Form Rev. 001 Page 69 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

As Build

Punch List Entry Form Rev. 001 Page 70 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 71 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 CLINIK - 12-Sep-17 CIVIL

2 CLINIK 12-Sep-17 CIVIL

3 CLINIK 12-Sep-17 CIVIL

4 CLINIK 12-Sep-17 CIVIL

7 CLINIK 12-Sep-17 CIVIL

8 CLINIK 12-Sep-17 CIVIL

9 CLINIK 12-Sep-17 CIVIL

10 CLINIK 12-Sep-17 CIVIL

11 CLINIK 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 72 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

12 CLINIK 14-Sep-17 CIVIL

13 CLINIK 14-Sep-17 CIVIL

14 CLINIK 14-Sep-17 CIVIL

15 CLINIK 14-Sep-17 CIVIL

16 CLINIK 14-Sep-17 CIVIL

17 CLINIK 14-Sep-17 CIVIL

18 CLINIK 14-Sep-17 CIVIL

19 CLINIK 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 73 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 74 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Pintu ruangan emergency tidak sesuai gambar B KELSRI

Tim survei tentukan titik nol-nol perbangunan untuk pasangan lantai B KELSRI

Perbaiki plasteran yang retak-retak rambut A KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Plafond yang rusak diperbaiki A KELSRI

Pengecatan dinding dirapikan A KELSRI

Peletakan wastafel terlalu rendah A KELSRI

Pemasangan keramik pada pintu kamar mandi tidak lurus B KELSRI

Perbaiki ppengecatan masih berbayang A KELSRI

Punch List Entry Form Rev. 001 Page 75 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Ganti keramik yang retak A KELSRI

Pintu dicat putih semua A KELSRI

Pintu masuk gantung A KELSRI

Rapikan finishing dinding bagian luar A KELSRI

Cleaning seluruh kaca A KELSRI

Colokan AC tidak standar A KELSRI

Perbaiki pipa wastafel yang bocor A KELSRI

Perbaiki pintu kamar mandi yang tidak bisa dikunci A KELSRI

Punch List Entry Form Rev. 001 Page 76 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

Punch List Entry Form Rev. 001 Page 77 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 78 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 SECURITY POST - 12-Sep-17 CIVIL

2 SECURITY POST 12-Sep-17 CIVIL

3 SECURITY POST 12-Sep-17 CIVIL

4 SECURITY POST 12-Sep-17 CIVIL

5 SECURITY POST 12-Sep-17 CIVIL

6 SECURITY POST 12-Sep-17 CIVIL

7 SECURITY POST 12-Sep-17 CIVIL

9 SECURITY POST 12-Sep-17 CIVIL

10 SECURITY POST 14-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 79 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

11 SECURITY POST 14-Sep-17 CIVIL

12 SECURITY POST 14-Sep-17 CIVIL

13 SECURITY POST 14-Sep-17 CIVIL

13 SECURITY POST 14-Sep-17 CIVIL

14 SECURITY POST 14-Sep-17 CIVIL

15 SECURITY POST 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 80 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 81 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Pemasangan pintu kamar mandi tidak sesuai gambar B KELSRI

Jendela kamar security dipasang terlalu tinggi B KELSRI

Jendela ruang utama jaga terlalu besar B KELSRI

Tim survei tentukan titik nol perbangunan untuk pasangan laintai B KELSRI

Perbaiki plasteran yang retak-retak rambut A KELSRI

Rangka atap dipasang perkuatan dyna bolt B KELSRI

Rapikan pengecatan kusen A KELSRI

Pintu kamar mandi gantung A KELSRI

Rapikan banwol pada kamar mandi A KELSRI

Punch List Entry Form Rev. 001 Page 82 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Aelesaikan pegecatan dinding dan plafond yang masih berbayang A KELSRI

Finishing pintu kamar mandi diperhalus A KELSRI

Cleaning all A KELSRI

Perbaiki closet yang bocor A KELSRI

Pintu tidak sesuai gambar B KELSRI

Ventilasi tidak sesuai gambar A KELSRI

Punch List Entry Form Rev. 001 Page 83 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

As Build

Punch List Entry Form Rev. 001 Page 84 of 99

 VERIFIED BY REMARKS

As Build

Punch List Entry Form Rev. 001 Page 85 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 LAUNDRY - 12-Sep-17 CIVIL

2 LAUNDRY 12-Sep-17 CIVIL

3 LAUNDRY 12-Sep-17 CIVIL

4 LAUNDRY 12-Sep-17 CIVIL

5 LAUNDRY 12-Sep-17 CIVIL

6 LAUNDRY 12-Sep-17 CIVIL

7 LAUNDRY 12-Sep-17 ELECTRICAL

9 LAUNDRY 14-Sep-17 CIVIL

10 LAUNDRY 14-Sep-17 ELECTRICAL

Punch List Entry Form Rev. 001 Page 86 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

11 LAUNDRY 14-Sep-17 CIVIL

12 LAUNDRY 14-Sep-17 CIVIL

13 LAUNDRY 14-Sep-17 CIVIL

14 LAUNDRY 14-Sep-17 CIVIL

15 LAUNDRY 14-Sep-17 CIVIL

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning

Punch List Entry Form Rev. 001 Page 87 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 88 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Tim survei tentukan titik nol perbangunan untuk pasangan lantai B KELSRI

Perbaiki plasteran yang retak-retak rambut B KELSRI

Besi over steak dirapikan atau dipotong B KELSRI

Pasangan pintu kamar mandi tidak sesuai gambar B KELSRI

rangka atap dipasang perkuatan dyna bolt B KELSRI

Flasing belum dipasang B KELSRI

Rapikan Instalasi listrik yang belum rapi B KELSRI

Selesaikan pengecatan dinding dan plafond yang masih berbayang A KELSRI

Lengkapi penutup kabel diatas panel A KELSRI

Punch List Entry Form Rev. 001 Page 89 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Perbaiki daun pintu yang rusak A KELSRI

Clenaing all A KELSRI

Perbaiki kunci jendela yang macet A KELSRI

Pintu tidak sesuai gambar B KELSRI

Ventilasi tidak sesuai gambar A KELSRI

Punch List Entry Form Rev. 001 Page 90 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

Punch List Entry Form Rev. 001 Page 91 of 99

 VERIFIED BY REMARKS

As Build

Punch List Entry Form Rev. 001 Page 92 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

1 OUTSIDE - 12-Sep-17 CIVIL

2 OUTSIDE 12-Sep-17 CIVIL

3 OUTSIDE 12-Sep-17 CIVIL

4 OUTSIDE 12-Sep-17 Elektrical

6 OUTSIDE 12-Sep-17 CIVIL

7 OUTSIDE 12-Sep-17 CIVIL

8 OUTSIDE 12-Sep-17 CIVIL

9 OUTSIDE 12-Sep-17 CIVIL

Punch List Entry Form Rev. 001 Page 93 of 99

 PROJECT:

CLIENT:

ORIGINATOR : PARTY :

PL ITEM LOCATION SYSTEM / SUB RFI NO INSPECTION DATE DISCIPLINE TAG

NO. SYSTEM

PUNCH ITEM CATEGORY:

A – Before Ready For Commissioning
B – After Ready For Commissioning

Punch List Entry Form Rev. 001 Page 94 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

NAME & SIGN DATE NAME & SIGN DATE

Halaman diratakan kembali A KELSRI

Tanah bekas galian drainase dirapikan kembali A KELSRI

Perbaiki tangki air yang bocor A KELSRI

Tambahkan stop kontak pada mesin A KELSRI

Perkuat kawat pada pagar A KELSRI

Perletakan drainase tidak sesuai gambar A KELSRI

Water treatment kurang dan tidak sesuai gambar A KELSRI

Akses jalan dari company camp menuju messhall diberi atap A KELSRI

Punch List Entry Form Rev. 001 Page 95 of 99

 BLOCK-A GAS DEVELOPMENT PROJECT

MEDCO ENERGI

PUNCH LIST FORM

INPUT DATE : LOCATION :

DONE BY CLEARED BY
DESCRIPTION CATEGORY ACTION BY

Punch List Entry Form Rev. 001 Page 96 of 99

 VERIFIED BY REMARKS

NAME & SIGN DATE

As Build

As Build

Punch List Entry Form Rev. 001 Page 97 of 99

 VERIFIED BY REMARKS

Punch List Entry Form Rev. 001 Page 98 of 99

 LIST OF MATERIAL

NO LOCATION FURNITURE QTY

1 CPY AND CTR OFFICE CHAIR 73
DESK 33
LONG TABLE 3
BOOKCASE 2
2 COMP CAMP SINGLE BED 20
DESK AND FOLDING CHAIR 20
BEDSIDE TABLE 20
TABLE LAMP 20
3 CTR CAMP BED 10
DESK 10
CHAIR 10
4