Annex 20 Form No.

REPUBLIC OF THE PHILIPPINES

PLGU LOGO
PHILIPPINE RURAL DEVELOPMENT PROJECT (PRDP)
Province of____________, Region____.
INSPECTION REQUEST FORM (IRF)
Name of Project
Project Location:
Contractor: ID Number:
IRF Number: Date Prepared:

Construction Activity for which inspection is requested:

Ref. Pay Item
Description of Activity Location Date Time Remarks
No.

Requested by: Received by:

Signature Signature
Name Name
Title Project Engineer (Contractor) Title PPMIU Resident Engineer
Date/Time
Result of Inspection

Inspected by:
Testing Needed Survey Needed
Signature Yes No Yes No
Name
Title PPMIU Resident Engineer
Date
Time

Result of Test / Survey:

Test/ Survey witnessed by: Request to proceed is:

Approved Disapproved
Signature
Name Signature
Title PPMIU Resident Engineer Name
Date Title PPMIU Engineer
Time Date
Note: See form filling-out instructions at the back page Time
Form filling-out instructions (back page)

1 "Construction activity for which inspection is requested" shall be the activity defined in the Inspection and Test Plan (ITP) that
requires inspection. The reference pay item number shall be that stated in the BOQ which covers the activity subject to
inspection. The location shall define clearly the place/position of the item to be inspected. The date and time shall indicate the
expected inspection time. These shall be no less than 24hours before the time of receipt of the IRF by the PPMIU - RE.

2 The "Request by" box for the IRF shall be filled in and signed by the Contractor's personnel at the project manager level or that
equivalent to the level of the RE
3 The result of the Inspection shall be filled out by the inspector concerned. Additional tests or survey tick boxes shall also be
determined by the inspector, after which, he/she signs at the "Inspected by" box
4 Test/ Survey Results shall be filled in by the PPMIU - RE, after which he signs at the "Test/ Survey Witnessed by" box.
5 The "Request to Proceed" box is to be filled in by the PPMIU Engineer(Provincial Engineer), whether it is approved or
disapproved, based on the results of inspection/ test/ survey, after which, the PPMIU Engineer(Provincial Engineer) affixes
his/her signature, date and time of approval / disapproval.

Note:

1 Approval by the PPMIU Engineer of an IRF is not intended, nor is it to be so interpreted, as written acceptance of any of the
Contractor's previously completed work. In other words, throughout the duration of the construction of the project, all the
Contractor's work is subject at all times to the PSO/RPCO,NPCO Engineer's review.
 Form No.

REPUBLIC OF THE PHILIPPINES

PLGU
PHILIPPINE RURAL DEVELOPMENT PROJECT LOGO
Province of Sultan Kudarat, Region 12
INSPECTION REQUEST FORM (IRF)
Name of Project Construction of One (1) Unit Sitio Kebeng Barangay Salumping Warehouse with Solar Dryer
Project Location: Sitio Embaley, Brgy. Salumping, Esperanza, Sultan Kudarat
Contractor: FPJ Construction and Supply Contract Number: PRDP-IP-RO12-SUK-033-ESP-012-
IRF Number: IRF-008 Date Prepared: 5/14/2023

Construction Activity for which inspection is requested:

Ref. Pay Item
Description of Activity Location Date Time Remarks
No.
900(6) Reinforced Concrete (Beam) B1-(1-2) and (2-3) 5/17/2023 10:18 AM We are now ready to remove the
formworks on our beams.

Requested by: Received by:

Signature Signature
Name KIMBERLY B. PRAIRE Name ELVIE MAE B. MURILLO
Title Project Engineer (Contractor) Title PPMIU Resident Engineer
Date/Time
Result of Inspection

Inspected by:
Testing Needed Survey Needed
Signature Yes No Yes No
Name ELVIE MAE B. MURILLO
Title PPMIU Resident Engineer
Date
Time

Result of Test / Survey:

Test/ Survey witnessed by: Request to proceed is:

Approved Disapproved
Signature
Name ELVIE MAE B. MURILLO Signature
Title PPMIU Resident Engineer Name ARMANDO B. TUERES
Date Title PPMIU Engineer
Time Date
Note: See form filling-out instructions at the back page Time
Form filling-out instructions (back page)

1 "Construction activity for which inspection is requested" shall be the activity defined in the Inspection and Test Plan (ITP) that requires
inspection. The reference pay item number shall be that stated in the BOQ which covers the activity subject to inspection. The location
shall define clearly the place/position of the item to be inspected. The date and time shall indicate the expected inspection time. These
shall be no less than 24hours before the time of receipt of the IRF by the PPMIU - RE.

2 The "Request by" box for the IRF shall be filled in and signed by the Contractor's personnel at the project manager level or that
equivalent to the level of the RE
3 The result of the Inspection shall be filled out by the inspector concerned. Additional tests or survey tick boxes shall also be determined
by the inspector, after which, he/she signs at the "Inspected by" box
4 Test/ Survey Results shall be filled in by the PPMIU - RE, after which he signs at the "Test/ Survey Witnessed by" box.
5 The "Request to Proceed" box is to be filled in by the PPMIU Engineer, whether it is approved or disapproved, based on the results of
inspection/ test/ survey, after which, the PPMIU Engineer affixes his/her signature, date and time of approval / disapproval.

Note:

1 Approval by the PPMIU Engineer of an IRF is not intended, nor is it to be so interpreted, as written acceptance of any of the Contractor's
previously completed work. In other words, throughout the duration of the construction of the subproject, all the Contractor's work is
subject at all times to the RPCO,PSO,NPCO Engineer's review