PT.

CEMERLANG
Report No : SAMUDRA
KONTRINDO
Date :
Page : Of
FIELD INSFECTION REPORT PROJECT NO. :
INSPECTION TYPE : ITEM NO :
LOCATION :
CONCRETE PREPOURING CHECK LIST
SIGNATURE
INSPECTION NOTICE NO. : KRN
CSK QC KRM SURVEYOR
KRN SPV KRN QC
CSK INSPECTOR :
KRN SURVEYOR :
KRN SUVERVISOR :
KRN INSPECTOR :
INSPECTION ITEM ACC REJ ACC REJ ACC REJ ACC REJ ACC REJ
FORMATION SURFACE CONDITION
FORMATTING LEVEL
LAYOUT
REINFORCEMENT
FORMWORK
ANCHOR BOLT/POCKET
TEMPALTES
INSERT EMBEDDED
CLEAN OUT
PROPOSED FINISH LEVEL
OTHER
Rebar rigidity
Rebar splice length
Rebar overlap

CONCRETE QUANTITY : REMAKS :

TIME :
METHODE :
EQUIPMENT :
CONCRETE PUMP :
VIBRATOR :
CHUTE :
HAMMER : NOTE:
LIGHT :
OTHER :

Note
ACC : ACCEPTABLE ⁄ COMPLY WITH REFERENCE DOCUMENT

REJ : REJECTED ⁄ IT IS NOT COMPLY WITH REFERENCE DOCUMENT

DISTRIBUTION SUBCONTRACTOR : COPY CONTRACTOR : COPY COMPANY : ORIGINAL

FIELD INSPECTION REPORT
INSPECTION TYPE :
CONCRETE PREPOURING CHECK LIST