F - ABCD - 43FLBLDG - 04

ABC Construction Corporation

TYPE YOUR PROJECT NAME
Project :

Date Prepared WIRB No.

WORK INSPECTION REQUEST

FOR BACKFILLING

REQUESTED BY : Name/ Designation :

Contractor : Signature :

Note : All signatories should print their name and sign.

AREA (Pls. enclose key plan) GRIDLINE/LOCATION LEVEL STRUCTURE

PREPARED BY CHECKED BY INSPECTED BY

CHECK ITEMS
CONTRACTOR PROJECT SUPERVISOR QC

1.0 Approved Fill

2.0 Soil Poisoning

3.0 Layer Thickness

4.0 FDT Results Passed

5.0 Embeds

6.0 Electrical

7.0 Mechanical

8.0 Fire Protection

9.0 Plumbing

REMARKS :

CHECKED BY : RECOMMENDING APPROVAL :

PROJECT SUPERVISOR QC

APPROVED BY : NOTED BY:

VP-CONSTRUCTION OPERATIONS

NOTE : This form must be submitted to The QC TEAM, duly accomplished including the work inspection report for the
pre-concreting and signed by the corresponding Contractor's Personnel-in-Charge at least 24 hours before
actual pouring.

Rev. 0 August 27, 2019