Checklist for Site Clearance (C & G Works)

SIX LANING OF CHANDIKHOLE - JAGATPUR - BHUBANESWAR SECTION OF NH-5 FROM

Name of Project :
KM.414.00 TO KM.419.00 AND FROM KM.00.000 TO KM.62.000 IN THE STATE OF ORISSA
Client : Shree Jagannath Expressways Private Limited
Project Management
: LEA Associates South Asia Private Limited
Consultant
E PC Contractor : Simplex Infrastructures Limited
Sub Section : Km.414+000 to Km.419+000 and Km.00+000 to Km.32+000

Location: Other information:

/C & G/……………………..
Contractor Engineer
Item Description Date Remarks
Yes No Yes No
1 Setting out
a. Centre-line pegs set out?

b. R.O.W pegs set out?

2 Stripping top soil
a. Top soil stripped not exceeding 150mm thickness?

b. Top soil stockpiled for re-used?

3 Check for any existing underground and overhead services
a. Electrical cables

b. Telecom cables

c. Water pipes

d. Other services
4 Check for any existing structues
a. Bridges

b. Culverts

c. Pipes

d. Kerbs

e. Others
5 Disposal materials
a. Any material dismantled that can be re-used?

b. If "Yes" are the materials stockpiled as required?

6 Final Inspection Pass Fail

For EPC Contractor For PMC Engineer

Name Name
Designation Designation
Signature Signature
Date Date