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National Rural Infrastructure Development Agency Ministry of

Rural Development, Government of India Template Version : V3.0

Form Id 206261 Format QR Version 2021.0- Part I

Format for information to QM for Inspection of Ongoing/Completed Work

PART I– Work Information (To be filled-up by PIU)

1. GENERAL:

I. Work is: ✔ Ongoing Completed

II. Current stage of work: Stage-I Stage-II ✔ Complete

III. Date of inspection:

✔ NQM Code
IV. Name of Quality Monitor (QM): M Villalan
SQM Code

V. State: Jharkhand District: Saraikela Kharsawan Block: Kuchai

VI. Name of Road: O-Taramba to Atra

VII. Package Number: JH20LWEII-SRK-2

VIII. Sanctioned length: 5.400 km, Flexible pavement: 1.519 km,Rigid/Semi-Rigid pavement: 3.381 km

IX. Executed length: 0.000 km, Flexible pavement: 0.00 km, Rigid/Semi-Rigid pavement: 0.00 km
(in case of completed works only)

X. Reasons for deviation (if any): As per site condition

XI. Name of new technology (if used)

Select new technology used RD from km to km
Select new technology used RD from km to km
Select new technology used RD from km to km

XII. Estimated cost (as cleared by GOI): Rs. 349.74 Lakh

XIII. Technical sanction cost: * Rs. 316.10 Lakh

XIV. Awarded cost: Rs. 316.10 Lakh

XV. Expenditure: (if work is ongoing)

a. Expenditure done: Rs. 220.06 Lakh

b. Bills pending:* Rs. 0.00 Lakh

Total expenditure (a+b) *

Rs. 220.06 Lakh

XVI. Completion cost: (if work is completed) Rs. Lakh

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XVII. The work is a case of (check✓boxes as applicable)

A) New Connectivity Total length: km

(i) Carriageway width (m): 3m 3.75m 5.5m 7m

B) ✔ Up-gradation Total length: 5.40 km

(i) Carriageway width and length:

Existing width m
With widening Length km
Proposed width m

✔ Without widening Proposed width 3.75m Length 5.40 km

XVIII. Terrain: (check ✓ anyone box) ✔ Plain Rolling Hilly Steep

XIX. Date of award of work: (date/ month/ year) 03/09/2022

XX. Date of start of work:(date/ month/ year) 03/09/2022

XXI. Stipulated date of completion:(date/ month/ year)

30/03/2023

XXII. Actual date of completion: (date/ month/ year)

(in case of completed work)
2. PHYSICAL PROGRESS: (Ongoing/Completed)*
I. Construction Programme and Physical Progress:
Item of work Unit Quantity Quantity Completed Fill in start and completion dates Delay in
(length/ As per executed percentage months
number) DPR of item Progress Start Completion
status Date Date
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Due 03/09/2022 15/09/2022
✔ i) Preparatory Work Km 5.40 5.40 100.00
Actual 03/09/2022 15/09/2022
0

ii) Earth Work& Due 03/09/2022 30/03/2023

✔ Km 1076.68 950.000 88.23 0
Subgrade Actual 03/09/2022 30/03/2023
Due 15/09/2022 15/02/2024
✔ iii) CD Works No's 8.000 8.000 100.00 0
Actual 15/09/2022 15/02/2024
Due 15/09/2022 30/01/2024
✔ iv) Protection works m 400.000 310.000 77.50 0
Actual 15/09/2022 30/01/2024
Due 15/09/2022 15/02/2024
✔ v) Sub Base including Km 1580.37 1400.000 88.59 0
shoulders Actual 15/09/2022 15/02/2024
vi) WBM/ WMM Base Due 15/09/2022 30/03/2023
✔ Km 1769.59 1600.000 90.42 0
Course Actual 15/09/2022 30/03/2023
vii) Bituminous Due
Base/Wearing Km
Actual
Course
viii) Bituminous Surface Due
Course Km
Actual
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Due 03/09/2022 20/02/2023
✔ ix) CC Pavement Km 0
Actual 03/09/2022 20/02/2023
Due 03/09/2022 30/03/2023
✔ x) Signage etc. No's 3.000 3.000 100.00 0
Actual 03/09/2022 30/03/2023

3. QUALITY CONTROL:
I. Location of field laboratory: * Taramba Village

II. Geo-tagged photograph of laboratory uploaded on: (date/ month/ year) * 10/09/2022

III. Reason for delay in establishment of field laboratory(if so): NA

IV. Details of contractor, executing the work: *

Name of contractor PAN number Mobile number E-mail ID.

✔ SAPTSATEE CONSTRUCITON ABCFS3099M 9122494025 saptsate@gmail.com

V. Details of contractor’s engineer available at site: (Responsible for maintaining quality control register part-1) *
Sl. Name of contractor’s Duration of posting at site
no. Identity number Mobile number
engineer at site From To
✔ 1 VIJAY KUMAR CH128340 9934564049 23/09/2022 11/01/2024
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VI. Details of contractor’s lab technician: *
Sl. Name of contractor’s Duration of posting at site
no. Identity number Mobile number
lab technician From To
✔ 1 AMIT YADAV 378060 7870612845 23/09/2022 11/01/2024
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VII. Details of Head of PIU supervising the work: *
Sl. Head of PIU Duration of posting at site
no. Employ number
(Executive engineer) From To
✔ 1 Shyam sunder Murmu RDD1290 23/09/2022 11/01/2024

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*
VIII. Details of Assistant engineer supervising the work and maintaining quality control register Part-II:

Sl. Duration of posting at site

Name of Assistant
no. Employ number Mobile number
engineer From To
✔ 1 Dheeraj Swansi S6795R 8809389137 23/09/2022 11/01/2024
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IX. Details of the Junior engineer supervising the work: *

Sl.
Name of Junior Duration of posting at site
no. Employ number Mobile number
engineer
From To
✔ 1 B BAGE B0628B 9113717122 23/09/2022 11/01/2024
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X. List of equipments available in field lab:* SIEVE SET CORE CUTTER RAPID MOISTURE METER SAND
POURING SYLINDER CONE AIV FALKINESS REBOUND
HAMMER CUBE CASTING MOULD MEASURING TAPES
Table (IX) a TOOLS DIGITAL WEIGHT CAMBER PLATE SPIRIT LEVEL.

Available equipments that are in working condition Available equipments that are not in working
(1) * condition (2)*
All Equipments are in working condition N.A

XI. List of equipments not available in field lab:* N.A

XII. Reasons put forth by PIU for non availability of equipments in field lab:
N.A

XIII. Equipments and documents ready to be made available to QM before or during the inspection:*
QCR 1 2 DPR AGGREMENT AND SQM PART I COPIES

4. DETAILS OF MIX DESIGN(s) (if provided in the sanctioned project):

(Manadatory in case of “Yes”)
If applicable (check✓ the box) Yes No ✔

Sl. Mix Design Institute/laboratory where mix Date

Mix Design
No. Strength design was done
i. Cement Concrete M20
ii. Cement Concrete M 30
iii. Dense Bituminous Macadam
iv. Semi Dense Bituminous Concrete
v. Bituminous Concrete
5. EARLIER INSPECTIONS BY NQM, SQM or SENIOR DEPARTMENTAL 5
OFFICERS (SEs & CEs) AND ACTION TAKEN STATEMENT:
(Details about departmental officers who inspected the work should be added after the NQM/SQM details.):

Date Name and Road distance Level of Major observations Action taken by PIU
of Designation of (RD) work at the with date
visit inspecting officer time of
(NQM/SQM/CE/ From To inspection
(1) SE)(2) (3) (4) (6) * (7) *
(5) *
Lalan Prasad Singh, E SATISFACTORY NA
26/11/2022 E retired 0.000 5.400 Preparatory work

Raviendra Kumar SATISFACTORY NA

26/03/2023
Sharma, SE Retired 0.000 5.400 Base Course

Sunil kumar , SATISFACTORY NA

27/09/2023
Suprintending 0.000 3.000 Base Course
Engineer

Base Course

CD Works

Signature of the Head of PIU……………………………………….……….

Name and Designation of the Head of PIU*………………….…………….

SHYAM SUNDER MURMU EE
Seal of PIU
* 7870612845
Mobile Number of the Head of PIU……………….……………………
rwdsaraikelakharsawan@gmail.com
E-mail of the Head of PIU……………….……………………………
RWD WORKS DIV,OLD COURT ROAD SARAIKELA KHARSAWAN
*
Address of the PIU…………………………………………………………..
* 17/01/2024
Date:……………………………………………………………..…………..