Form No : GIR-001
Revision : 1
GROUTING CHECKLIST
CONTRACTOR : [Link] GLOBAL PERKASA PROJECT :HSM # 2 Krakatau Steel
GROUT MANUFACTURER : SIKA GROUT.215 NEW DRAWING No : REV : 1
EQUIP. TAG NO : DATE :
DESCRIPTION :
PRE-GROUTING ITEMS CHECKLIST YES NO N/A
Concrete Surface is Prepared and Roughened for grout
Joining area have been properly treated
Sleeves are clean and clear
Displaced air can be vented
Formwork is properly fitted and chamfer* (if applicable)
Curing facilities
Specific procedure / Instruction requarement from Equipment Manufacturer
HSM2-A-000-R-WS-9002-A
(Please Specify) _________________________________________________________________________
GROUT TYPE / MIX DESIGN
Type 1…. Cement / Sand Type 3…. Dry Pack
Type 2…. Non-Shrink Other ______________________
Checks Mixing Tools Manufacturer Instrution ______________________
Ultimate Strength, Specified : 700 kg/cm² Actual : ______ kg/cm² Proposed Grouting Date :
APPROVED FOR GROUTING NAME SIGNATURE DATE
[Link] QAQC INSPECTOR
AFTER-GROUTING ITEMS CHECKLIST YES NO N/A
Grouting is completed and Visual Inspection after formwork removed.
Hammer test for complete grout filling on base / embedded plate after curing
REMARKS / EXCEPTIONS :
* Sample for test 9 pcs ( 5cm x 5cm x 5cm )
PREPARED & CHECKED BY APPROVED BY AKCNOWLEDGE BY
[Link] GLOBAL PERKASA [Link] ENGINEERING [Link] STEEL
Name : Name : Name :
Date : Date : Date :
