Form no.

Republic of the Philippines

Province of Camarines Norte

PROVINCIAL ENGINEER'S OFFICE

CLEARANCE FOR PLACING OF CONCRETE

Reference No.:
Project Name: Proposed Date:
Location: Type of Structure:
Part of Structure: Type/Strength of Conc.:
Drawing Ref: Concrete Quantity:

INSPECTION CHECKLIST Yes No N/A Remarks INSPECTION CHECKLIST Yes No N/A Remarks
1.0 Excavation 3.0 Reinforcement
1.2 Is the excavation correct in size? 3.1 Are the rebars free from excessive rust?
1.3 Is the base properly compacted? 3.2 Is the spacing correct?
1.4 Is the excavation dry? 3.3 Is the concrete cover as per specs?
1.5 Is the selected fill/blinding concrete in place? 3.4 Are all tie wires in place and correctly tied?
2.0 Formwork 3.5 Are there adequate spacers/all specified intervals?
2.1 Is the bracing adequate? 3.6 Correct number of bars in the reinforcement?
2.2 Has mould oil been applied evenly and thoroughly? 3.7 Are all bars of the correct size?
2.3 Is the formwork vertical 3.8 Are the starter bars in the correct position?
2.4 Is horizontal alignment correct? 3.9 Are the starter bars and splices the correct
2.5 Is access adequate? size and number?
3.0 Cement 4.0 General
3.1 Are there sufficient quantity of cement? 4.1 Is the site clean and free from all debris?
3.2 Is the quality test being carried out 4.2 Are there adequate vibratory pokers on site?
and passed proj specs. requirement? 4.3 Is curing material available on site?
3.3 Is the Concrete Mix Design approved? 4.4 Have slump test and concrete sampling
4.0 Aggregates been organized?
4.1 Are there sufficient qty. of aggregates(C.A & F.A)? 4.5 Has adequate lighting been organized?
4.2 Is the quality test being carried out 4.6 Are stop blocks on site?
and passed proj. specs. requirement? 4.7 Is the access safe?
5.O Concrete 4.8 Other/Special Requirements?
5.1 Placing of Concrete Remarks:
5.2 a. Manual b.Chute c.Pump d.Crane & Bucket
e. Others(Specify)

Contractor: Inspected by:

Approved
Disapproved
Project Engineer Project Inspector
Contractor PLGU
 1.0 This clearance shall be submitted by the contractor twenty four (24) hours prior to the actual placing of concrete.
2.0 The PPMIU Engineer shall inspect and note N/A for items not applicable.
3.0 This forms shall be attached to the Inspection Request Form (IRF).

During Construction
INSPECTION CHECKLIST
Yes No N/A Remarks
5.0 Construction Methodology
5.1
5.2
5.3
5.4