SAMPLE CHECKLIST
1 Respective Material Transmittal Reference number: CPC07d-MT-PLM-0003 REV 1
2 Item Description: UPVC puddle pipe (no-leak flange)
3 Manufacturer name:
Weltech Vision Trading Co. W.L.L.
4 Supplier Name:
Weltech Vision Trading Co. W.L.L.
5 Specification reference:
Section 19, Part 1, item no.9, subclause E
ü
6 Is the entire set of components/parts constituting a complete sample attached to the
same display board and securely fixed? YES NO
7 Are all the components/parts in the sample board clearly identified with a label/tag
showing the component description/name and catalogue reference number ? ü YES NO
8 Is the supplier name and contact details posted on the sample board?
ü YES NO
Is the brand name and/or manufacturer name embossed or engraved on the sample
ü YES
9
items? NO
10 Are all the fields/provisions in the sample submittal form duly filled up and checked
by a QA/QC Personnel? ü YES NO
11 Is the sample submittal tag signed off by the contractors`s representative?
ü YES NO
12 Is the sample logged in the samples register along with all the relevant details?
ü YES NO
Contractor's QA/QC Manager Name and signature: Contractor's Authorized Representative Name and
Signature:
-------------------------------- Date: ______________ _________________ Date: ______________
© KEO International Consultants
CPC05-F30-Rev. 26-May-14
10/17/2018