OFFICE OF THE PRESIDENT

NATIONAL HOUSING AUTHORITY

Elliptical Road, Diliman, Quezon City

CONCRETE POURING REQUEST

CPR NO. _____
PROJECT NAME: DATE
LOCATION: TIME: TO
CONTRACTOR: LOCATION: TO
IMPLEMENTING OFFICE: LEVEL/STATION: TO
WORK DESCRIPTION:

Drawing Methodology Checklist

ATTACHMENTS:
Others (Required Test Results, specify)
COMPLIANCE
ITEMS FOR INSPECTION REMARKS ACTION REQUIRED
YES NO N/A
REBARS

FORMWORKS

OPENINGS

MEFPS

OTHERS (FDT, etc.)

REQUESTED BY: (Authorized Contractor’s Representative)

Name : ………………………………………………. Company : ……………………………………………….
Signature : ……………………………………………… Date : ………………………………………………
Designation : ………………………………………………
To be filled up by NHA Project Engineer / Representative
Accepted Accepted With Comments Rejected (Resubmit)

NHA REPRESENTATIVE
Name : ………………………………………………. Signature : ……………………………………………….
Designation : ……………………………………………… Date : ………………………………………………
RECEIVED BY: (Contractor’s Representative)
Name : …………………………………………………….
Date : …………………………………………………….
This form must be submitted to NHA Regional/District Office, duly accomplished and signed by the corresponding Contractor's Personnel-in-Charge at least 24 hours before the inspection.
To be accomplished in 2 copies.