EPM-ITP-BC-

Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 1 of 16

IBB MCUP & MODIFICATION OF K-12 BUILDING

PROJECT NO. : SP-173100119

INSPECTION AND TEST PLAN

FOR
CONCRETE PAVING WORK

A 25 Jun, 2020 Issue for Approval MSH NCC

Rev
Date Description Original By Checked By Approved By Checked By Approved By
.

No Part of this document or the information it contains may be reproduced or transmitted in any
form or by any means electronic or mechanical, including photocopying, recording, or by any
information storage and retrieval system, without permission in writing from SABIC or NCC
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 2 of 16

TABLE OF CONTENTS

1.0 ITP for Concrete Paving Work 3

2.0 Checklist-Material Receiving Inspection 6

3.0 Checklist-Field Survey for Excavation 7

4.0 Checklist-Concrete Pavements and Roads Inspection 8

5.0 Checklist-Backfill/Compaction 9

6.0 Checklist Pre-Concrete Inspection 10

7.0 Checklist- Concrete Placement 11

8.0 Concrete Placement and Test LOG 12

9.0 Concrete Curing Record 13

10.0 Checklist- Final Acceptance of Concrete Paving Works 14

 Doc No EPM-ITP-BC-006

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 3 of 16

1.0 ITP for Concrete Paving Work

Print Name Signature Name of Doc No: EPM-ITP-BC-006
INSPECTION AND TEST PLAN (ITP) FOR COMPANY
Prepared By: (1) Georgy Mathew MSH Revision: 00
( CONCRETE PAVING WORK ) Approved By: (2) Date: 25 Oct, 2020
COMPANY App: Page:
Discipline: CIVIL PROJECT: IBB MCUP & MODIFICATION OF K-12 BUILDING
Inspection Level :
Location: (3) IBB/SAFCO
Table No:
Criticality Level : Item Name (3): Tag No (3):

Inspection Responsibility
Sr. Acceptance Verifying Sub-
Inspection Activity Characteristic Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

1 Material Verify or approval

SABIC Approved
Vendor List
SES-B51-S01 Approved Material
1.1 Concrete, steel, filler board, sealant etc. Approved Document Approved Document I W R
SES-C04-S01 Data Submittal
SES-B51-S01
SES-C04-S01

SES-B51-S01 Approved Document

1.2 Concrete Trial Mix approval Concrete Strength SES-B51-S01 I H H
IFC Drawings Lab Test Report

1.3 Material Receiving Inspection As per inspection items IFC Drawings Manufacture CV-MRI-1 I W R
 Doc No EPM-ITP-BC-006

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 4 of 16

Inspection Responsibility
Sr. Acceptance Verifying Sub-
Inspection Activity Characteristic Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

Compliance
Certificate, Material
in the Checklist of QVD
Receiving
Inspection Report

2 Paving Works

SES C02-S01
As per inspection items SES C02-S01
.2.1 Survey & Excavation Works SES C04-S01 CV-003-1 I W W
in the Checklist of QVD SES C04-S01
IFC Drawings

SES-C02-S01 CV-003-2,
Subgrade Material Filling / Compaction As per inspection items SES-C02-S01
2.2 SES-C04-S01 CV-003-3 I W W
Tests in the Checklist of QVD SES-C04-S01
IFC Drawings Lab Test Report

CV-003-2,
As per inspection items SES C02-S01
2.3 Base Course Material /Compaction Test SES C02-S01 CV-003-3 I W W
in the Checklist of QVD IFC Drawings
Lab Test Report

As per inspection items SES-C04-S01 SES-C04-S01

3 Installation of Polyethylene Sheet CV-003-4 I W SW
in the Checklist of QVD SES-B51-S01 SES-B51-S01

As per inspection items SES-C04-S01

4 Rebar & Expansion Joint Filler SES-C04-S01 CV-003-4 I W W
in the Checklist of QVD IFC Drawings

As per inspection items SES-C04-S01

5 Formwork SES-C04-S01 CV-003-4 I W W
in the Checklist of QVD IFC Drawings
 Doc No EPM-ITP-BC-006

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 5 of 16

Inspection Responsibility
Sr. Acceptance Verifying Sub-
Inspection Activity Characteristic Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

6 SES-B51-S01,
As per inspection items SES-B51-S01
Embedded Item SES-B53-F01 CV-003-4 I W W
in the Checklist of QVD SES-B53-F01
IFC Drawings
B
As per inspection items SES-B51-S01
7 Release for Concrete Pouring SES-B51-S01 CV-003-4 I W W
in the Checklist of QVD IFC Drawings

As per inspection items IFC Drawings

8 Concrete Pouring SES-B51-S01 CV-003-5 I W SW
in the Checklist of QVD SES-B51-S01

As per inspection items IFC Drawings CV-003-6

9 Sampling & Testing of Fresh concrete SES-B51-S01 I W SW
in the Checklist of QVD SES-B51-S01 Lab Test Report

As per inspection items

10 Concrete Curing SES B51-S01 SES B51-S01 CV-003-7 I W SW
in the Checklist of QVD

SES B51-S01
SES B51-S01
11 Compressive strength of Concrete Concrete Strength Approved Mix Lab Test Report I W W
Approved Mix Design
Design

SES-B51-S01
SES-B51-S01
Joint Sealer & Expansion Joint Filler, As per inspection items SES-C01-F01-03
12 SES-C01-F01-03 &04 CV-003-8 I W SW
Coating & Sealing Applications in the Checklist of QVD &04
SES-B53-F01
SES-B53-F01

13 Final Acceptance As per inspection items SES-B51-S01 SES-B51-S01 CV-003-8 I H H

in the Checklist of QVD SES-C01-F01-03 &04 SES-C01-F01-03
 Doc No EPM-ITP-BC-006

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 6 of 16

Inspection Responsibility
Sr. Acceptance Verifying Sub-
Inspection Activity Characteristic Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

&04
SES-B53-F01 SES-B53-F01
SES-C04-S01 SES-C04-S01
IFC Drawings

Legend

(1) ‘Prepared by’ should be the name, signature and COMPANY’s name for the Vendor’s/Sub-Contractor’s representative.
(2) ‘Approved by’ should be the name, signature and COMPANY’s name for the CONTRACTOR’s representative.
(3) ‘Location’, ‘Item Name’ and ‘Tag Number’ shall be used if applicable.
(4) ‘Characteristics Verified’ are the parameters checked during the inspection activity.
(5) ‘Reference Document’ is the Project Specification / Code / Standard / Drawing, Procedure etc. on the basis of which inspection shall be conducted.
(6) ‘Acceptance Criteria’ is the tolerance, reading, value or an outcome derived from reference documents.
(7) ‘Verifying Document’ is the record generated during inspection & Testing using approved forms / checklists.
(8) ‘Inspection Responsibility’ is the role of Vendor / Sub-Contractor, CONTRACTOR and COMPANY for each inspection step. Inspection responsibility shall be ‘I’ for Inspection, ‘R’ for review, ‘A’ for approval, ‘S’ for
Surveillance, “W’ for 100% Witness, ‘SW’ for random witness and ‘H’ for hold.
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 6 of 16

2.0 Checklist-Material Receiving Inspection

CV-MRI-1
MATERIAL RECEIVING INSPECTION Record No
Date
SP-173100119 Disciplin
Project No. Civil Area No
e
1 Material Type

2 Supplier

3 Purpose & Service

For further details, as per attached (Mention associated report no.)

□ Quality certificate/3rd Party Report

Inspection
Contents □ Test certificate/3rd Party Report
4
□ Catalogue
□ Specification
□ Sample

□ Satisfied
5 Visual Inspection
□ Unsatisfied

6 Remarks

Submitted by:
Review and approval Status:
□ (A) Approved without comments.
□ (B) Approved with comments.
□ (C) Disapproved.
Comments:

Sub-contractor NCC PMT

Name

Signature

Date
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 7 of 16

3.0 Checklist-Field Survey for Excavation

CV-003-1
FIELD SURVEY FOR EXCAVATION Record
No
Date
Project No: SP-173100119 Area No.

Survey Basis Drawing No.

IBB/SAFCO
Location
Description

Point Coordinate
Remark
No. N E

Survey and setting out

Excavation Depth m Check the stability of slope Satisfied Unsatisfied

Excavation EL m Excavation Bottom Satisfied Unsatisfied
Condition
Calibration Record
Surveying Equipment Series No. Manufacturer Calibrated Date Expired Date

Sub-Contractor NCC PMT

Name

Signature

Date
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 8 of 16

4.0 Checklist-Concrete Pavements and Roads Inspection

CV-003-2
CONCRETE PAVEMENTS AND ROADS Record No
INSPECTION CHECKLIST
Date
Are Drawing
Project No SP-173100119
a No No
Location
Description
IBB/SAFCO
Subcontractor CTCI
Item Description of Check
Accept Reject Accept Reject

1.0 Sub grade acceptable

1.1 Material

1.2 Compaction

1.3 Preparation

1.4 Line/grade per drawing

1.5 Field Density and moisture content filed

2.0 Base Course

2.1 Equipment

2.2 Layer thickness/total thickness

2.3 Compaction

2.4 Material

2.5 Field Density and moisture content filed

NOTES :

Sub-Contractor NCC PMT

Name

Signature

Date
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 9 of 16

5.0 Checklist-Backfill/Compaction
CV-003-3
BACKFILL/COMPACTION CHECKLIST Record No
Date
Project No SP-173100119 Area No.
Material Type Drawing No.
Compaction Optimum
Equipment Moisture
Field Test
Proctor Density
Equipment
Location IBB/SAFCO
Description
Examination Items Result Examination Items Result
Keep cleaning without  Satisfied
 Satisfied
water, roots, trash, other Fill material test Reports filed  Unsatisfied
 Unsatisfied
foreign materials  N/A
 Satisfied  Satisfied
Coating protection filler
 Unsatisfied Properly moistened before placing  Unsatisfied
board installed properly
 N/A  N/A
 Satisfied
Material comply with ≧90%
 Unsatisfied Compacted Density
specification ≧95%
 N/A
Bottom Bed/Backfill Depth 200 mm Total Layer of Compaction 2
Layer Density Test (Points)
Laye Thick Repor 1st 2nd 3rd 4th 5th 6th 7th 8th 9th
Result
r No. (mm) t No. Densit Densit Densit Densit Densit Densit Densit Densit Density
y y y y y y y y
1  Sat.  Unsat.
2  Sat.  Unsat.
3  Sat.  Unsat.
4  Sat.  Unsat.
5  Sat.  Unsat.
6  Sat.  Unsat.
7  Sat.  Unsat.
8  Sat.  Unsat.
9  Sat.  Unsat.
10  Sat.  Unsat.

Sub-contractor NCC PMT

Name

Signature

Date
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 10 of 16

6.0 Checklist Pre-Concrete Inspection

CV-003-4
PRE-CONCRETE INSPECTION CHECKLIST Record No
Date
Area Drawing
Project No SP-173100119
No No
IBB/SAFCO
Location
Description
Inspection Results Inspection Results
A. POLYTHYLENE SHEET E. Miscellaneous
Yes No N/A Yes No N/A
Vapor barrier laid as per Design
Key ways
Drawing
Vapor barrier thickness, Laps and
Blockouts
extension as per specification
Surface roughened
B. Formwork Bonding agent
Location Survey for Coordinates
Type of finish
Checked
Size Finished slope
Elevation Joints/Fiber boards
Clean and oiled
Chamfer
Straight, level and plumb, Adequate
bracing

C. Reinforcement
Grade
Size/Type
Spacing/Splices
Spacers
Tying every intersection of rebars
Clearance

Final Acceptance : Release to Pour

D. Embedment
Anchor bolts (Diameter / Length / Type) Name Signature Date
Anchor bolts (Location / Projection)
Anchor bolt sleeves
Subcontracto
r
Thread projection
Weld pads
Angle iron NCC
Inserts
Conduits
Water stop PMT
Others
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 00
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 11 of 16

7.0 Checklist- Concrete Placement

CV-003-5
CONCRETE PLACEMENT CHECKLIST Record No
Date
PROJECT NO SP-173100119 AREA NO

TYPE AND SOURCE

DRAWING NO
OF CONCRETE
CYLINDERS
TEST REPORT NO.
TAKEN
LOCATION OF CYLINDERS
POUR IDENTIFICATION

Inspection Results
Item Description of Check Sub Cont. NCC
Yes No Yes No
1.0 Concrete Delivery
1.1 Sub-contractor ready to place
1.2 Delivery ticket correctly completed
1.3 Correct mix concrete received
2.0 CONCRETE TESTING
Slump test, temperature, air content and unit weight checks have been
2.1
carried out and are within the specified tolerances
2.2 Specified number test cylinders/cubes taken
3.0 CONCRETE PLACEMENT
Method of placement :
3.1
Crane and bucket  Chute Pump
3.2 Pouring height maintained to avoid NCCregation
3.3 Correct size of vibrator(s) together with back-ups on location
Compaction / vibration is in accordance with the specified requirements:
3.4 - vibration carried out around reinforcement and embedment
- penetration into previous layer
4.0 CONCRETE FINISH
Brushed  Hand float 
4.1 Rough  Power float 
Steel Trowel 
Remarks:
NOTES :
Sub-Contractor NCC PMT
Name
Signature
Date
Note: Verify delivery ticket and attach the relevant fresh concrete placement log to this form
 Doc No EPM-ITP-BC-006

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 02

ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 12 of 16

8.0 Concrete Placement and Test LOG

CV-003-6
CONCRETE PLACEMENT AND TEST LOG Page: ____of ____ Record
Pour
Contract No: SP-173100119 Contractor: NCC Mix Design No: ________________ _______________________________ Mix Type:
Truc Pour Time Concrete
Ticket Placement Represented Placed Cumulate Sample Air Unite
k Batc Finis Temp Slum ACC REJ.
Number (Structures) Start (m3) (m3) Taken Content Weight
No h h (℃) p
(mm)

Sub-Contractor NCC PMT

Name
Signature
Date
Note: Third Party Reports for 7 days and 28 days of test to be attached to this report.
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 02
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 13 of 16

9.0 Concrete Curing Record

CV-003-7
CONCRETE CURING RECORD Record No
Date
Project No SP-173100119 Area No
Location IBB/SAFCO Drawing No.
Description

Pouring Date
Curing Method WATER CURING
Curing End
Date

Curing Record
NCC Inspector
Result
No. Date Time Person of Curing/Signature
Accept Reject

Sub-Contractor NCC PMT

Name
Signature
Date
10.0 Checklist- Final Acceptance of Concrete Paving Works
 EPM-ITP-BC-
Doc No 006
SAFCO/IBB MOBILE COATING
Rev. No. 02
UNIT POJECT
ITP FOR CONCRETE PAVING WORK Date 25th Jun, 2020
Page 14 of 16

CV-003-8
FINAL ACCEPTANCE OF CONCRETE PAVING WORKS Record
No
Date
Project No SP-173100119 Area No
Location
IBB/SAFCO Drawing No.
Description
Sub-contractor NCC
Description of Check Rejec
Accept Reject Accept t
1 vapor barrier as per IFC drawing and specification
Rebar/Wire mesh ( spacer, Overlaps/joints, covers
2 etc, diagonal bars at openings) as per IFC Drawing
and specification
Embedment ( smooth dowel bars, pockets, anchor
3
bolts etc.) as per IFC drawing and specification
Construction joints, expansion joints and isolation
4
joints as per IFC drawing and specification
5 Concrete mix design as per specification
Concrete pouring and finishing as per IFC drawing
6
and specification
7 Finish surface smoothness and free from cracks

8 Slope of surface is correct

9 Properly cured

10 Control joint provided as per IFC drawing

11 Applied joint sealant as per specification

12 Coating application as per specification

Comments:　

Sub-contractor NCC PMT

Name

Signature

Date