Form No.
: PMO-QUA-BUF-002
PROJECT MANAGEMENT APPLICATION FOR
OFFICE INSPECTION Revision : A0
CONTRACTOR : PT. MITRA SARANA MEMBANGUN CONTRACT NO. : 9100007989
TESTPACK NO. : N/A AFI NO. : RAPI-MSM-AFI-CVL-BM1-APW-CLM
SYSTEM : N/A ISSUE DATE :
ITP NO. : MSM-QC-PR-ITP-007 LOCATION : BOARD MACHINE 1 (BM1)
INSPECTION NOTICE : We requesty or presence according to the following schedule :
INSPECTION DATE : / / STARTING TIME :__________ DURATION : ____________
INSPECTION LEVEL : HOLD POINT SPOT WITNESS OTHER
WORK CATEGORY :
CIVIL STEEL STRUCTURE BUILDING ELECTRICAL
INSULATION / FIRE EQUIPMENT
PIPING PAINTING
PROOFING* INSTALLATION
INSTRUMENTATION STATIC EQUIPMENT OTHERS
ACTIVITY DESCRIPTION : Concrete
GRID / AXIS :
REFERENCE DWG / SPEC :
MSM QC (Name/Sign) RAPI SUPERVISOR (Name/Sign)
DATE: DATE :
INSPECTION REPONSE : (Please Refer to The Applicable ITP for Respetive Inspection Parties Required)
INSPECTION RESULT : ACCEPTED REJECTED*** POSTPONED***
INSPECTION RECORD : NOT REQUIRED REQUIRED ATTACHED
COMMENTS :
MSM QC (Name/Sign) RAPI SUPERVISOR (Name/Sign) RAPI QC (Name/Sign)
REVIEW WITNESS REVIEW WITNESS REVIEW WITNESS
DATE: DATE: DATE:
*** Please comment
Company - Group of companies beloging to Royal Eagle (RGE) at Pangkalan Kerinci
RELEASE FOR CONCRETE Form No: PMO-QUA-BUF-054
PROJECT MANAGEMENT
OFFICE PLACEMENT CHECKLIST Revision: A0
CONTRACTOR: PT. MITRA SARANA MEMBANGUN PROJECT: AUTO PALLET WAREHOUSE
AREA / GRID REFERENCE: DRAWING No.: REV:
DESCRIPTION: CONCRETE SPECIFICATION:
SURVEY REPORT NO.: CHECKLIST No.: DATE:
ITEM NO CHECKLIST DESCRIPTION YES NO* N/A
1 Excavation and bedding
2 Alignment and orientation correct
3 Surface preparation and cleanliness acceptable
4 Formwork is plumb, straight & complete
5 Shoring / re-shoring is acceptable
6 Blinding level is correct
7 Pile head treatment
8 Waterproof membrane is installed correctly
9 Joints and weep holes
10 Reinforcing steel installation correct:
• size
• quantity
• clearance
• laps
11 Embedded hardware installation correct and firm:
• water-stop
• anchor bolts
• box-out
• sleeves
• steel plates
12 Mechanical / electrical embedments correct
13 Curing facilities, requirements:
FIRST INSPECTION SECOND INSPECTION THIRD INSPECTION (Tick Box )
REMARKS / EXCEPTIONS: (* Please comment.)
(Please refer to the applicable ITP for Respective Inspection Parties required)
ACCEPTED BY COMPANY SURVEYOR
This is to certify that necessary Survey has been verified to the satisfactory of Specifications and Contract requirements.
NAME SIGNATURE DATE
RELEASED FOR CONCRETE PLACEMENT
PREPARED & CHECKEDBY:
APPROVED BY: APPROVED BY:
CONTRACTOR COMPANY SUPERVISOR COMPANY QC
QC
REVIEW WITNESS REVIEW WITNESS
DATE: DATE: DATE:
Form No.:PMO-QUA-BUF-056
PROJECT MANAGEMENT CONCRETE PLACEMENT
OFFICE REPORT Revision: A0
CONTRACTOR: PT. MITRA SARANA MEMBANGUN PROJECT: AUTO PALLET WAREHOUSE
AREA / GRID REFERENCE: DRAWING No.: REV:
DESCRIPTION: CONCRETE CONCRETE SPEC:
RELEASE FOR CONCRETE CHECKLIST NO.: REPORT No.: DATE :
CONCRETE SPECIFICATIONS
CONCRETE GRADE MAX. AGGREGATES SIZE ADMIXTURES
METHOD OF PLACEMENT (TICK BOX )
Direct Chute Tremie Pump Excavator Crane Barrow
CONCRETE BATCH, QUANTITY & PLACEMENT DETAILS
DOCKET NO. ARRIVAL TIME START PLACEMENT FINISH PLACEMENT VOLUME M3 REMARKS
TOTAL THIS REPORT:
CARRIED FORWARD:
VIBRATION & CURING DETAILS YES NO N/A
VIBRATION ACCEPTABLE
DESIGN LEVEL CORRECT
CURING METHOD CORRECT
REMARKS / EXCEPTIONS:
ACCEPTED BY CONTRACTOR SUPERVISOR
NAME SIGNATURE DATE
APPROVED BY COMPANY
COMPANY SURVEYOR COMPANY CIVIL CONSTRUCTION COMPANY CIVIL INSPECTOR
NAME NAME NAME
SIGNATURE SIGNATURE SIGNATURE
DATE DATE DATE