GENERAL CHECKS REPORT OF MECHANICAL ANCHORS INSPECTION CHECKLIST FOR CONCRETE

TAG/ITEM: ………………………………………………..……………………………..……………………….........................................................................
DRAWING / SPECIFICATION No. & Rev.: ………………………………………………..……………………………..………………..................................

DATE: …………………………….
MATERIAL: ……………………………………………….................................. MEASURING DEVICES, S.N.: …………………….....…………………....

See Attached Certificate / Report No.: …………………………………….……………………………………………………………….…………………….

Product Name/Manufacturer:

Head Configuration : Hex Nut/Threaded Hex Bolt Head Torque Cap Countersunk
Diameter/Dimension : 1/4" 3/8” 1/2" 5/8” 3/4" 1”
Product

M8 M10 M12 M16 M10 M24

Overall Anchor Length : _______________(in/mm)
Steel Grade/Coating : _____________________
MaterialBase

Base Material Type : Concrete

Base Material Strength 21 Mpa 32 Mpa
:
Base Material Thickness ______________(mm)
CleaningDrilling and Hole

Drill Bit Diameter : ___________________(in/mm)

Hole Depth : ___________________(in/mm)
Drill Bit Type : Carbide-Tip Drill Bit Diamond Core Bit Other __________________
Hole Cleaning : Compossed Air Hand Pump Wire Brush Other _______________
Hole Condition : Dry Water Saturated
Anchor Application: (please check all that apply)
Tension Shear Overhead Other ________________

Anchor Spacing : ________________(in/mm)

Application

Edge Distance : ________________(in/mm)

Embedment (hef*) : ________________(in/mm)

* hef = Efective embedment depth, measured from the concrete surface to the deepest point at which the anchor tension load is
transferred to the concrete, measured prior to appling torque to the anchor.

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 Pull out installation / Setup as per drawing

Load Cell Capacity : ……………………………………………………………… C NC N/A

Webbing Sling Capacity and Proper Installation : ……………………………………………………………….. C NC N/A
Shackle Size and Proper Installation : ……………………………………………………………… C NC N/A
Total Weight Applied : ……………………………………………………………… C NC N/A

Less tensile strength than target value : ……………………………………..………………… Pass Not Passed
Crack on concrete surface : ………………………………………………..……… Pass Not Passed
Displacement : ……………………………………………..………… Pass Not Passed
Anchor damage : ……………………………………………..………… Pass Not Passed

RESULT:  PASS  FAIL

NOTES: INSPECTION NOTIFICATION REFERENCE

RFI No.: ____________________________

QC SUBCONTRACTOR CONTRACTOR COMPANY

NAME  NAME  NAME 

SIGNATURE SIGNATURE SIGNATURE

DATE DATE DATE

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