Concrete Pouring Request

Ref. No. XXX

Building: _____________ Level: _____________

Housing BLK__________ LT__________ MODEL__________
OTHERS ______________________________
PROJECT: _____________________
CONTRACTOR: _____________________
Area / Structure: Gridline:
Concrete Strength (psi): _____________________ Footing & Wall Footing _______________
Allowable Slump (inches): _____________________ RC Column _______________
Estimated Volume (m³): _____________________ RC Wall _______________
Required No. of Samples: _____________________ Slab On Grade _______________
Suspeded Slab _______________
Concrete Mixing Roof Deck Slab _______________
Ready-Mix Supplier: ______________________ Canopy _______________
Job Site Mix Ratio: _______:_______:_______ Others (Specify) _______________

The Item/s above are ready for concrete pouring on: _________________________ / __________________.
DATE TIME

CHECKLIST
To be filled-out by QA/QC: To be filled-out by Supervisor-in-charge:

1. Attached Plan 7. Provision of Access Ladders & Platforms ________

a. Keyplan ________
b. Architectural FCD ________ 8. Supports & Bracing
c. Structural FCD ________ - adequacy of ties, bolts, clamps installed ________
d. Mechanical FCD ________ - spacing of horizontal & vertical studs ________
e. Electrical FCD ________ - installation of knee & cross bracings ________
f. Plumbing FCD ________ - base stabilizer plates (vertical supports) ________
g. Fire Pro FCD ________ - Removal of debris & waste in forms ________
2. Surveyed area Elevations & Dimensions ________
3. Founding level surface preparation 9. Embedded provisional items
a. Removal of debris & standing water ________ a. Electrical
b. Placement of gravel bedding (for SOG) ________ - breakages & factory defects on ________
c. Soil poisoning ________ conduits / aux items
d. Damp-proofing / Vapor Barrier ________ - cleanliness & snug-fit of joinery works ________
e. Water stops ________ - provision of ties to secure conduits ________
f. Construction joints ________ - remove standing water in conduits ________
4. Reinforcement - tightness / completeness of ________
a. Size ________ end cap / plug
b. Quantity ________ a. Plumbing / Fire Pro
c. Spacing ________ - breakages & factory defects along ________
d. Splicing ________ pipelengths
e. G.I. Ties ________ - cleanliness & snug-fit of joinery works ________
f. Dowels ________ - provision of ties to secure pipes ________
g. Spacer (Blocks Chair bars) ________ - initial leak & flow test for pipes ________
h. Pipe sleeves ________ - remove standing water in pipes ________
5. Formworks - tightness of end cap / plug ________
a. Quality of form boards used
- form surfaces free from, ________ 10. Pouring equipment for RMC
deformities and defamation a. Pumpcrete ________
- cleanliness of form surface and ________ b. Tremie pipes ________
adequate application of form oil c. Chute / Conveyer ________
b. Placement of formworks d. Jib Hoist ________
- watertightness (no gaps / holes) ________ e. Buggy ________
- blockouts (correct size & location) ________ f. Bucket ________
- alignment and plumbness ________ g. Vibrator ________
6. Material supply for Job site Mix h. Others (Please Specify) ________
a. Cement (40kg bags) ________
b. Sand ________
c. Gravel 3/4" ________
d. Water ________
- clean and fresh supply ________
- free from deleterious components ________
e. Admixtures (if required) ________

REMARKS & RECOMMENDATIONS

PROCEED CONCRETE POURING

DO NOT PROCEED CONCRETE POURING

REQUESTED BY INSPECTED BY CHECKED & APPROVED BY NOTED BY

Contractor QA/QC Engineer Project Manager Owner's Representative

 Request No.: ____________

CONCRETE POURING REQUEST FORM

PROJECT:
CONTRACTOR:
Concrete Strength (psi):
Allowable Slump (inches):
Estimated Volume (m³):
Required No. of Samples:
Concrete Mixing
Ready-Mix
Job Site Mix
Building: _____________ Level: _____________
Housing BLK__________ LT__________ MODEL__________
Land Development STA __________ to STA ___________
_____________________ OTHERS ______________________________
_____________________
Area / Structure: Gridline:
_____________________ Footing & Wall Footing _______________
_____________________ RC Column _______________
_____________________ RC Wall _______________
_____________________ Slab On Grade _______________
Suspeded Slab _______________
Roof Deck Slab _______________
Supplier: ______________________ Canopy _______________
Ratio: _______:_______:_______ Others (Specify) _______________

The Item/s above are ready for concrete pouring on: _________________________ / __________________.
DATE TIME
CHECKLIST

1. Attached Plan 7. Embedded provisional items

a. Keyplan ________ a. Electrical
b. Architectural FCD ________ - breakages & factory defects on ________
c. Structural FCD ________ conduits / aux items
d. Mechanical FCD ________ - cleanliness & snug-fit of joinery works ________
e. Electrical FCD ________ - provision of ties to secure conduits ________
f. Plumbing FCD ________ - remove standing water in conduits ________
g. Fire Pro FCD ________ - tightness / completeness of ________
end cap / plug
2. Provision of Access Ladders & Platforms ________ a. Plumbing / Fire Pro
- breakages & factory defects along ________
3. Surveyed area Elevations & Dimensions ________ pipelengths
- cleanliness & snug-fit of joinery works ________
4. Founding level surface preparation - provision of ties to secure pipes ________
a. Removal of debris & standing water ________ - initial leak & flow test for pipes ________
b. Placement of gravel bedding (for SOG) ________ - remove standing water in pipes ________
c. Soil poisoning ________ - tightness of end cap / plug ________
d. Damp-proofing / Vapor Barrier ________
e. Water stops ________ 8. Material supply for Job site Mix
f. Construction joints ________ a. Cement (40kg bags) ________
b. Sand ________
5. Reinforcement c. Gravel 3/4" ________
a. Size ________ d. Water ________
b. Quantity ________ - clean and fresh supply ________
c. Spacing ________ - free from deleterious components ________
d. Splicing ________ e. Admixtures (if required) ________
e. G.I. Ties ________
f. Dowels ________ 9. Pouring equipment for RMC
g. Spacer (Blocks Chair bars) ________ a. Pumpcrete ________
h. Pipe sleeves ________ b. Tremie pipes ________
c. Chute / Conveyer ________
6. Formworks d. Jib Hoist ________
a. Quality of form boards used e. Buggy ________
- form surfaces free from, ________ f. Bucket ________
deformities and defamation g. Vibrator ________
- cleanliness of form surface and ________ h. Others (Please Specify) ________
adequate application of form oil
b. Placement of formworks Remarks & Recommendations
- watertightness (no gaps / holes) ________ Project Engineer:
- blockouts (correct size & location) ________ __________________________________________________
- alignment and plumbness ________ __________________________________________________
c. Supports & Bracing __________________________________________________
- adequacy of ties, bolts, clamps installed ________ Quality Control:
- spacing of horizontal & vertical studs ________ __________________________________________________
- installation of knee & cross bracings ________ __________________________________________________
- base stabilizer plates (vertical supports) ________ __________________________________________________
- Removal of debris & waste in forms ________ __________________________________________________

Requested By: Inspected & Checked By: Noted By:

__________________________ ___________________________ ___________________________

Contractor's Representative Project Engr. / QC Project Manager / PIC