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REQUEST FOR INSPECTION (RFI)

Project : Project No.

SUBJECT WORK REQUESTED FOR INSPECTION LOCATION RFI No.

REVISION

DATE IN

DATE OUT
Approved Drawing Ref.

PMC REMARKS

INSPECTION RESULTS
Code Status Date Signature
A  Work is accepted

B  Revise & Submit: Work may be accepted subject to incorporation of changes indicated.
C  Work not accepted. Rework, adjust, and, resubmit.
D  Not ready. Resubmit when ready.

CONTRACTOR PMC

This review does not relieve the contractor of his Above subject works have been visually inspected by
Responsibility under the terms & Conditions of the contract nor Authorized the Consultant and found acceptable/ Not acceptable as per the code given
additional compensation with respect to time & cost. above.

We hereby submit/ resubmit for inspection of above subject works and

confirm herewith that above works are completed and ready for inspection as
stated above all in
accordance with the specification, drawings, and consultant instruction.
Contractor to complete the information below.

Name: Name:

Position: Position:

Signature Signature:

Date: Date:
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TRANSMITTAL
No

Office Date:

Project Name/No/Description

To/Address

Attention

We are sending via

The items detailed below

Item No Description Date

Purpose of transmittal

Remarks

If the enclosures received are not listed above, please notify APD at once, at the office indicated above. Please sign and return the duplicate copy of this form and
retain the original for your records.

Issued by (Name) Signature Date

Received by (Name) Signature Date

Job file Copy to

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VARIATION ORDER
Initiated by: Owner PMC Contractor Others

Project # Project Name:

Variation Order Number : Contract Ref :

Job NO: Contract Date :

You are directed to make the following changes in this contract:

The original Contract Price was SR

Net change by previous Variation Orders SR

Contract Price prior to this Variation was SR

The Contract Price will be (increased) (decreased) (Unchanged) by this Variation Order

SR

The new Contract price including this Variation Order will be SR

The Contract Time will be (increased) (decreased) by ( ) days

PMC Contractor Owner

Address: Address: Address:

Signature: Signature: Signature:

Name: Name: Name:

Date: Date: Date:

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NOTICE OF COMMENCEMENT AND SITE HANDOVER

Date : Time :

1. Project Ref :

2. Project Title :

3. Site Location :

4. Client :

5 PMC :

5. Name of the Contractor :

6. Address of the Contractor :

7. Official Date Counted As Day One For

Contract Period

8. Period of Contract :

The aforementioned representatives have inspected the project site, and the contractor hereby certifies
that he has received the site free from any obstacles. Moreover, the consultant has handed over the
contractor fixed point, benchmark, and the border of the project shown in the drawings

It is considered that …………….. 2009 is the date of the Project Site Handing Over to the Contractor.

Comments on Handover

SITE HANDED OVER BY: SITE RECEIVED BY: SITE WITNESSED BY:
(THE CLIENT) (THE CONTRACTOR) (THE PMC)

Name: Name: Name:

Title: Title: Title:
Signature: Signature: Signature:
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MATERIAL SUBMITTAL FORM

Trade : Arch Civil Mech Elect Landscape Others

Project # : ALFANAR HEAD OFFICE & WAREHOUSE EXPANSION

SUBJECT:

Specs. Code & Ref. B.O.Q. Code Ref. Drawing No. Submittal No.

Date Received:

Date Returned:

Sub-contractor
Name: Address:
Address: Phone: Telex:

Manufacturer Supplier/Agent
Name: Name:
Address: Address
Phone: Phone:
Fax: Telex: Fax: Telex:

Information submitted and attached:

Certificates Operation & Maintenance Manual
Technical Brochure Spare Parts List
Manufacturer’s Data & Specs. Warranty
Samples Others (specify)
Contractor’s Comments:

See Attachment

Note: This review does not relieve the contractor of his (Contractor)
responsibilities under the terms & Conditions of the Signature :
contract nor authorize additional compensation with
respect to cost or time.
Date :

PMC Comments:

See Attachment
Status: Discipline Sign & Date Project Manager
Approved 1 Arch
Approved as noted 2 Civil Sign :
Revise and submit 3 Mech Date :
Rejected 4 Elect
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DOCUMENTS SUBMITTAL FORM

Trade : Arch Civil Mech Elect Landscape Others

Submittal type: Project # C15-03

Submittal Ref DWG-5

Rev 0
Shop AS Built Method Time Takeoff Others
Drawing Drawing Statement Schedule Sheets Date 20-06-2015

Response / Action By
Item Document Contract PMC
Document Title Revision
No. Ref Document Ref. Action
Reviewed By
Code
PROPOSED AREA FOR STEEL
1 SD-ST-01 0
BUILDING YARD

Authorized representative of the

This is to certify that all items submitted herewith have been contractor title and signature :
checked by the contractor are in conformance with the [Link] El-Hadeedy (P.M)
requirements of the contract documents and are approved by the
contractor for the works, except as noted below:
SAUDI CYPRIAN CONSTRUCTION CO. LTD.

To Contractor Review Comments / or Refer to attached Comments Sheet:

Action Codes Legend : Notes :

1. Approved No Exceptions Taken Installation shall proceed only when action code is 1 / or 2.
2. Approved As Noted (Make Regarding action code 3, resubmitted shall be within the time limit set in the contract.
Corrections Noted) Review does not relieve the contract from his responsibility of compliance with all
3. Revise and Resubmit requirements of contract documents or authorize additional compensation.
4. Rejected - see Comments

Discipline Signature & Date Project Manager

Arch Name
Civil Signature
Mech
Elect Date
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REQUEST FOR INSPECTION (RFI)

Project #: Project Name:

SUBJECT WORK REQUESTED FOR INSPECTION LOCATION RFI No.

REVISION

DATE IN

DATE OUT
Approved Drawing Ref.

PMC REMARKS

INSPECTION RESULTS
Code Status Date Signature
A  Work is accepted

B  Revise & Submit: Work may be accepted subject to incorporation of changes indicated.
C  Work not accepted. Rework, adjust, and, resubmit.
D  Not ready. Resubmit when ready.

CONTRACTOR PMC

This review does not relieve the contractor of his Above subject works have been visually inspected by
Responsibility under the terms & Conditions of the contract nor Authorized the Consultant and found acceptable/ Not acceptable as per the code given
additional compensation with respect to time & cost. above.

We hereby submit/ resubmit for inspection of above subject works and

confirm herewith that above works are completed and ready for inspection as
stated above all in
accordance with the specification, drawings, and consultant instruction.
Contractor to complete the information below.

Name: Name:

Position: Position:

Signature: Signature:

Date: Date:

Ref: PD.SF006R1 PD.SF006.R1 Request For [Link]

st
Date: January, 1 , 2011
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REQUEST FOR PRE-CONCRETING INSPECTION

Request No. Rev Date

Project Title: Project Ref.

Contractor: Date of Submittal:

Location: Building:

Drawing Ref. Level

CODE SUBJECT ACTIVITY IN PROGRESS

A. Work to Proceed
Date of Pouring :
B. Work can Proceed after Correction of
Deficiencies
Time of Pouring:
C. Work not to Proceed
Description:

INSPECTION REQUEST Contractor PMC CODE INSPECTION INITIALS

COMMENTS DATE
1. Setting out Levels

Reinforcement
2.
(Spacing, Cover, ……..)

3. Mechanical Conduits, openings and

cutouts.

4. Electrical Conduits, openings and

cutouts.

5. Architectural Fixings Openings,

Spacing

6. Form work State Striking Time

7. Others

8. 24 Hr. Notice Request for Pouring

Concrete

Contractor Signature PMC. Signature

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FIELD RECORD OF CONCRETE POURING

Project Ref: Project Title

Contractor: Date:

Location: Building:

Poured Item. Level

Concrete Specs.

Weather Humidity
Bright Sun Clear Overcast Rain Dust Dry Moder. Humid

Temp. °C Wind
0 - 30 30 - 40 40 - 50 50 up Still Moder. High

Loading Pouring Pouring Remarks

Truck Capacity Qty Slump Concrete No of
Start State Finish
No (m3) (m3) (mm) Temp © Cubes
Time Time Time

Contractor Signature PMC. Signature

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CONCRETE COMPRESSIVE (N/MM2) STRENGTH TEST RESULTS

Project :

Laboratory:

Date Sample Location Laboratory FIeld Temp Slumps

Number 3 Days 7 Days 28 Days 7 Days C mm
Date Result Date Result Date Result Date Result

Laboratory Contractor PMC

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LIST OF DEFICIENCIES
Project : Project No.

Contract: List No.:

To:

Rating: Inspection Date:

A. Works Satisfactory Trade:

B. Works not Satisfactory Level:

C. Works Not Specified Build:

D. Works Rejected Room:

Section/Part:

Gentlemen:
Following the inspection at above date of the facility mentioned, please be advised of the deficiencies noted for your
Corrective measures.

Inspector’s Signature:

Sl No. Location Subject Deficiencies To Be Corrected Remarks/Rating

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NON-CONFORMANCE REPORT
Project :

NCR No. :

Part 1 - For Completion By PMC Engineer

Contractor: Drawing No.:

Location: Spec. No.:

Description of Non-Conformity / Action Required:

Signed by PMC. E. : Date:

Signed by Contractor: Date:

Part 2 - Contractor Response

Proposed Date of Corrective Action:

Signed by Contractor : Date:

Signed by PMC. : Date:

Action Taken: Accept Reject

Action Completed:
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Snag list
Project # Project Name.

Contract: List No.: ( )

To:

Rating: Inspection Date:

A. Works Satisfactory Trade:

B. Works not Satisfactory Level:

C. Works Not Specified Build:

D. Works Rejected Room:

Section/Part:

Gentlemen:
Following the inspection at above date of the facility mentioned, please be advised of the deficiencies noted for your corrective measures.

Inspector’s Signature:

Item No. Room No. Subject Deficiencies To Be Corrected Remarks/Rating

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CERTIFICATE OF PRELIMINARY HANDOVER

Project Ref.

Project Title:

Owner:

Contractor:

Contract For:

Contract Date:

Date of Substantial Completion:

The work performed under this contract has been inspected by authorized representative of the Owner, Contractor, and Engineer-
Architect, and the project (or specified part of the Project, as indicated above) is hereby declared to be substantially completed on
the above date.
Definition of Substantial Completion
The date of substantial completion of a project or specified area of a project is the date when the construction is sufficiently
completed, in accordance with contract documents, as modified by any change orders agreed to by the parties, so that the Owner
can occupy or utilize the project or specified area of the project for the use for which it was intended, and contractor has supplied all
the contract documents (As-built), Warranties…etc. and completed and tested all the works under the contract including the remedy
of any defects.

With the acceptance of the following parties;

By:
Contractor Name of Authorized Representative Date
Title: Project Manager

By
PMC Name of Authorized Representative Date
Title: Project Manager

The Owner accepts the projects area of the project as substantially complete and will assume full possession of the project or
designated area of the project at ------ (time), on (date). The responsibility for utilities, security, and insurance under the
contract documents shall be as set forth under “Remarks” below:

By:
Owner Name of Authorized Representative Date

Remarks:
(1) The security, insurance and the utilities under the contract document shall fall under owner.
(2) The performance bond guarantee shall be effective and valid until the end of the maintenance period i.e. one year from the
above referred date of substantial completion.
 Client: (PMC) : Contractor:

Project :
Project No. :

Payment Certificate
Contract /PO Ref. :
Contract Name :
Contractor Name :

Certificate No : Certificate Type : Interim Final

For the Period Ending: Submittal Date :

INITIAL CONTRACT DATA

Original Contract Value : SAR
Approved Variations : SAR
Revised Contract Value : - SAR

PAYMENT DETAILS:

Value of Work Done A) As per Original Contract : SAR

B) As per Approved Variations : SAR
C) Material on Site (If Applicable) : SAR
D) Total Value of Works : - SAR

Less E) Recovery of Advanced Payment : % of (A+C) = SAR

F) Retentions : % of (D) = - SAR
G) Other Deductions : SAR
H) Total Deductions : - SAR

I) Total Amount Certified : (D) - (H) - SAR

J) Less Amount Previously Certified SAR
Net Amount Due - SAR

Submitted by Contractor : ……………………………………… Date : ………………………….

Approved by Const. Manager : ……………………………………… Date : ………………………….

Approved by Project Manager : ……………………………………… Date : ………………………….

Approved Manager, Projects Dept : ……………………………………… Date : ………………………….

Ref: PD.SF015R1
Date: Jan, 1st, 2011
 Client: (PMC) : Contractor:

CHANGE REQUEST
No.
Rev
Date
PROJECT: CONTRACT / PO REF. :
PROJECT NO .
CHANGE REQUESTED BY : Owner PMC Contractor Others

Detailes of the Proposed Change :

Related Documents:
Drawing Ref :
Specification Ref :
Others:

Justification ( Use attachments as necessary) :

Estimated Cost/Schedule Impact ( Use attachments as necessary) :

Cost Impact: Yes No Time Impact: Yes No

Amount : Duration :
CM
Recommended Not Recommended

Name: Signature: Date:

PM
Recommended/Approved Rejected

PM Name: Signature: Date:

Manager, Projects Dept.

Recommended/Approved Rejected

Name: Signature: Date:

OWNER
Approved (Proceed with VO if any) Rejected (Cancel CR)

OWNER Representative: Signature: Date:

[Link].SF016.R1
Date : Jan, 1st, 2011 PD .SF016.R1 CHANGE [Link]
 Forms Control Sheet
Last Updated 1/1/2011

Form No of to be Initiated
Form Ref Form Name Remarks
Legend Pages By
General PMC/Contractor

PD.SF001 ‐ Pre Construction Meeting Agenda 1 PMC

Notice of Commencment and Site
PD.SF002 NOC 1 PMC
Handover
PD.SF003 SWR Start Work Request 1 Contractor
PD.SF004 MSF Material Submital Form 1 Contractor
PD.SF005 DSF Documents Submital Form 1 Contractor
PD.SF006 RFI Request for Inspection * 1 Contractor
PD.SF007 RCI Request fo Pre Concreting Inspection 1 Contractor
PD.SF008 FRC Field Record oF Concrete Pouring 1 Contractor
PD.SF009 CTR Concrete Compressive Test Results 1 Contractor
PD.SF010 MIR Materials Inspection Request 1 Contractor
PD.SF011 DCR Daily Construction Report 3 Contractor
PD.SF012 FM Field Memo 1 ANY
PD.SF013 IS Inquiry Sheet 1 Contractor
PD.SF014 TR Transmittal 1 ANY
PD.SF016 CR Change Request 1 Contractor
PD.SF015 PC Payment Certificate Form 1 Contractor
PD.SF017 VO Variation Order 1 PMC
PD.SF018 LOD List of Deficiencies 1 PMC
PD.SF019 NCR Non‐Conformance Report 1 PMC
PD.SF020 ACR Accident Report 1 Contractor
PD.SF021 CVR Saftey Violation Report rev 1 PMC
PD.SF022 OTR Overtime Request 1 Contractor
PD.SF023 SSI Site Saftey Inspection 1 PMC
PD.SF024 ‐ Snag List 1 PMC
PD.SF025 ‐ Quantity Takeoff Sheet 1 Contractor
PD.SF026 ‐ Certificate of Preliminary Handover 1 PMC
 Client: (PMC) : PD Contractor:

START WORK REQUEST

Project # : Project Name:
WORK DESCRIPTION GRID & LOCATION :

REQUEST NO : DATE :
SHOP DRAWING REFERENCE:

APPROVED SCHEDULE DATE:

START COMPLETION
Actual Activity Start

CONTRACTORS
REVIEWED BY DATE CONSULTANT INITIAL DATE CONSULTANT REMARKS
INITIAL

ARCHITECTURAL

CIVIL

STRUCTURAL

ELECTRICAL

PLUMBING

MECHANICAL

SURVEY

(BY CONTRACTOR) (BY PMC)

GENERAL COMMENTS:
WE HEREBY SUBMIT/RESUBMIT OUR WORK REQUEST TO START WITH THE
ABOVE MENTIONED WORK IN ACCORDANCE WITH THE SPECIFICATION,
SHOP DRAWINGS & CONSULTANT INSTRUCTION.

CONTRACTOR AGREES TO WORK IN PARALLEL WITH OTHER

CONTRACTORS, IF BOTH WORKS ARE NOT EFFECTED & ALSO
CONSIDERING SAFETY AT WORK

ENGINEER IN-CHARGE DATE APPROVED

DISAPPROVED
NOTED:
PROJECT MANAGER
PROJECT ENGINEER/PROJECT MANAGER

DATE: DATE :

REF : [Link]
DATE : Jan, 1st, 2011 PD.SF003.R1 START WORK [Link]
Client: (PMC) : PD Contractor:

MATERIALS INSPECTION REQUEST

TRADE : Arch Civil Mech Elect Landscape Others

PROJECT Ref : MIR NO. :

PROJECT : DATE :

QUANTITY : UNIT : DATE OF DELIVERY :

SPECIFICATION :

REFERENCES :

SOURCE & PLACE OF ORIGIN :

MATERIAL SUBMITTAL REF. NO. :

ACTIVITY :

LOCATION / SCOPE OF WORK :

REMARKS:

CONTRACTOR'S REPRESENTATIVE : DATE :

APPROVAL STATUS COMMENTS :

1 APPROVED
2 APPROVED AS NOTED
3 RESUBMIT AFTER CORRECTIONS
4 REJECTED

CONSTRUCTION MANAGER DATE :

PROJECT MANAGER DATE :

Notes:
A- Installation shall proceed only when Action Code is 1 / or 2.
B- Quantity verification to be substantiated by the Contractor.
C- Inspection does not relieve the Contractor from responsibility of compliance with all requirements of Contract documents.
D- Contractor must mention the delivered materials at suitable stores as per manufacturer recommended conditions.

RECEIVED BY CONTRACTOR : DATE :

Ref: PD.SF010.R1
Date: Jan, 1st, 2011 PD.SF010.R1 Materials Inspection [Link]
Client: (PMC) : PD Contractor:

Project Ref :
Project Name :
DAILY CONSTRUCTION REPORT
DCR No. :
Date: :
TO : M/s. S S M T W TH F
Day
CC: M/s

PAGE1/3
0 - 30 30 - 40 40 - 50 50 up Bright Sun Clear Overcast Rain Dust
Temp. °C Weather

Still Moder. High Dry Moder. Humid Still Moder. High

Sea Humidity Wind

Machinery & Equipments Used

No. On Down Total working

No Description Size Area Remarks
Site Time Hours

Material Delivered to Site

Ticket BOQ No Origin /

Time Description
No
(Page/item Quantity Units Area Manufacturer
Remarks
No)

Submitted by Date

Ref: PD SF07 rev01

Date: Jan, 1st, 2011
Client: (PMC) : PD Contractor:

Project Ref :
Project Name :
DAILY CONSTRUCTION REPORT
DCR No. :
Date: :
TO : M/s. S S M T W TH F
CC: M/s Day

PAGE 2/3
Manpower available at site

Staff Labor Daily Total

Occupation Occupation Skilled Unskilled Units Hours
Contract Actual
Project Manager Carpenter
Construction Manager Steel Fixer
Planning Engineer Masons
MEP Coordinator Concrete Finishers
Sector Engineer Plasterer
QA / QC Painter
Q/S Labors
Site Engineer Labors for scaffolding
General Foreman General Labors
Carp. Foreman Mechanic
S/Fixer. Foreman Electrician
Safety Offcer Plumber
Secretary Operators
Surveyors Driver
Assistant Surveyor Storekeeper
Draftsman Time Keeper
Office Boy/Watchman

Total 0 0 Total 0 0 0

Submitted by Date

Ref: PD SF07 rev01

Date: Jan, 1st, 2011
Client: (PMC) : PD Contractor:

Project Ref :
Project Name :
DAILY CONSTRUCTION REPORT
DCR No. :
Date: :
TO : M/s. S S M T W TH F
CC: M/s Day

PAGE:3/3
SITE ACTIVITIES

A-Activities in Progress

Date
Activity # Act. Description Area % Comp. Remarks
Started Completed

B-Activities Planned for the Next Day

Site Visitors
Compa Company
Time Visitor's Name Reason for Visit Remarks
ny Represented

Submitted by Date

PMC Comments

Ref: PD SF07 rev01

Date: Jan, 1st, 2011
Client: (PMC): Contractor:

INQUIRY SHEET
Project Ref . C15-03 ISH No. 001
Project . HEAD OFFICE & WAREHOUSE EXPANSION Rev . 0
Package Date 02/08/2016

From: [Link] emad To: SAUDI DESIGNERS

Attn: [Link]
Clarification Pertaining
Discipline:
Arch Mech Civil x Electrical HVAC Others (state)

Location Areas:
Drawing Ref:
Specs Ref.:
BOQ Ref.:
Please review the following:
About Lightning Protection System The flat Soild Soft Tinned Copper Conductor Please Cheack The Colour

Date: Contractor:

PMC. Reply:

Date: Project Manager

 Client: (PMC) : PD Contractor:

ACCIDENT REPORT
No.
Date
Project: Project Ref. :

FROM : TO :

Name of Reporter:
Company: Position:
Date: Time: Location:

Details of Injured Person

Person Injured: Age:
Person's Civil ID No.: Person's Home Tel. No.:
Person's Home Address: Area: Block: Street: Bldg/ Flat:
Person's Nature of Injury: Hospital Doctor Visit Fatality

Brief Details of Injury/ Damage, Details of Incident & Sketch if Appropriate

Details:

Was there a witness? ( tick box ) Yes No

Was a Method Statement submitted in relation to work? ( tick box ) Yes No
Was the Method Statement adequate for safety? ( tick box ) Yes No
Was the Method Statement properly implemented? ( tick box ) Yes No

PROPERTY
Property Description:
Property Owner:
Address: Area: Block: Street: Bldg/ Flat:
Nature of Damage:
Extent of Damage:

As a result of this accident was the person absent the following day? Yes No
Contractor's Site Manager Remarks:

Describe action taken to prevent a reoccurrence of this accident:

Signature of Reporter: Date:

Received by Date:

Ref: PD.SF020.R1
Date: Jan, 1st, 2011 PD.SF020.R1Accident [Link]
Client: (PMC) : PD Contractor:

SAFETY VIOLATION REPORT

Project Ref: : DATE :

Project Name : TIME :

SAFETY DISCREPANCIES NOTED :

1 Construction Fencing 8 Electrical 15 Site Condition
T E M

2 Excavation / Earthwork 9 Protective Apparel 16 Equipment Certification

3 Demolition 10 Fire Protection / Prevention 17 Safety Equipments
4 Scaffolding / Formworks 11 Compressed Gas / Cylinder 18 Motor Vehicles
5 Access Facilities 12 Hand / Power Tools 19 Unsafe Conditions / Acts
I

6 Lifting / Hoisting / Gears 13 Health / Welf / Sanitation 20 Hot Work / Weld / Burning
7 Equipment / Machinery 14 First Aid / Medical 21 Others

REMARKS :
ITEM LOCATION DISCREPANCIES

ORIGINATORS Project Manager

FROM CONTRACTOR DATE :

TIME :
ACTION TAKEN ON ABOVE DISCREPANCIES :
ITEM ACTION

CONTRACTOR'S SAFETY OFFICER CONTRACTOR'S PROJECT MANAGER

CORRECTIVE ACTION(S) BY CONTRACTOR Distribution : Client

TO BE ACCOMPLISHED WITHIN (24) HOURS, PMC
RETURN COPY TO P.M.'S OFFICE WITH Contractor
ACTION TAKEN.
Client: (PMC):

SITE SAFETY INSPECTION

SSI Ref. _____________________ Contract Name :

Date : _____________________ Contractor :

Inspection Team : _______________________

Name Company Position

Possible Actual
Very Poor to Excellent Score Score
Page 1 of 4 1 2 3 4 5
1 SAFETY ADMINISTRATION
1.1 Management Communications (Bulletins/Memo's) 10
1.2 Toolbox Talks 20
1.3 Management Inspection 20
1.4 Task Talks 10
1.5 Specialised Training 10
1.6 Notice Boards & Publicity 10
1.7 Supervisory Roles (Defined) 20
1.8 Follow Up/ Remedial Actions 10
1.9 Communication of Rules / Regs 10
SAFETY ADMINISTRATION ASSESSMENT 120

2 HEALTH & WELFARE

2.1 Drinking Water & Cups 20
2.2 Toilet Facilities 15
2.3 Washing Facilities 15
2.4 First Aid & Medical Facilities 20
HEALTH & WELFARE ASSESSMENT 70

3 EMERGENCY PROCEDURE
3.1 Rescue Equipment 10
3.2 Emergency Transportation 20
3.3 Emergency Communication 20
3.4 Muster Points 15
3.5 Alarms/Wind Socks 15
3.6 Fire Equipment 20
EMERGENCY PROCEDURE ASSESSMENT 100

4 ACCESS & EGRESS WORKING PLACES

4.1 Ladders Inspected 10
4.2 Ladders Used 20
4.3 Ramps / General Access 15
4.4 Stairways Properly Built 15
4.5 Scaffolds Erection 20
4.6 Guard-rails / Kick Plates 20
4.7 House Keeping 20
ACCESS/EGRESS WORKING PLACES ASSESSMENT 120

Ref: PD.SF023.R1
Date: Jan, 1st, 2011 PD.SF023.R1 Saftey Inspection [Link]
Client: (PMC):

SITE SAFETY INSPECTION

SSI Ref. _____________________ Contract Name :

Date : _____________________ Contractor :

Possible Actual
Very Poor to Excellent Score Score
Page 2 of 4 1 2 3 4 5
5 PERSONAL PROTECTIVE EQUIPMENT
5.1 Head Protection 20
5.2 Eye Protection 20
5.3 Foot Protection 20
5.4 Hearing Protection 20
5.5 Respiratory Protection 20
5.6 Hand Protection 20
5.7 Safety Harnesses 20
5.8 Specialist Protection 20
PERSONAL PROTECTIVE EQUIPMENT ASSESSMENT 160

6 EXCAVATIONS
6.1 Sloped/Benched/Shored 15
6.2 Barriers / Warnings 15
6.3 Spoil Clearance 10
6.4 Access / Egress 15
6.5 Man / Machine Interface 15
6.6 Adjacent Structures 15
6.7 UG Utilities Protected 15
EXCAVATIONS ASSESSMENT 100

7 LIFTING, PLANT & EQUIPMENT

7.1 Cranes General Condition 20
7.2 Hoists / Winches 20
7.3 Excavators 10
7.4 Condition of Wire Ropes 10
7.5 Certified Equipments 20
7.6 Condition of Shackles/Hooks 10
7.7 Storage of Lifting Equipment 10
7.8 Vehicle Condition 10
7.9 Back up Alarms 10
7.1 Tyres, Brakes & Lights 10
7.11 Competent & Approved Operators 20
LIFTING, PLANT & EQUIPMENT ASSESSMENT 155

8 ELECTRICAL SYSTEMS
8.1 Temporary Electrics 20
8.2 Residual Current Devices / Earth Leakage Breakers 20
8.3 Warning Signs Posted 10
8.4 Cable Management 10
8.5 Fittings & Connections 20
ELECTRICAL SYSTEMS ASSESSMENT 80

Ref: PD.SF023.R1
Date: Jan, 1st, 2011 PD.SF023.R1 Saftey Inspection [Link]
Client: (PMC):

SITE SAFETY INSPECTION

SSI Ref. _____________________ Contract Name :

Date : _____________________ Contractor :

Possible Actual
Very Poor to Excellent Score Score
Page 3 of 4 1 2 3 4 5
9 COMPRESSED GASES
9.1 Proper Storage (Separation) 10
9.2 Condition of Cylinders 10
9.3 Colour coding 10
9.4 Warning Signs 10
9.5 Flashback Arrestors 10
9.6 Fire Extinguisher 10
9.7 Cylinders Secured (Chained / Trolley) 10
9.8 Hose Condition 10
9.9 Sparks Containment 10
COMPRESSED GASES ASSESSMENT 90

10 HAND & POWER TOOLS

10.1 Correct Tools Provided / Used 10
10.2 Storage 10
10.3 Cartridge Operated Tools 10
10.4 Trained Operators 10
10.5 Correct Voltage 10
10.6 Maintenance 10
10.7 Cable / Hose Condition 10
HAND & POWER TOOLS ASSESSMENT 70

11 WORKING AT HEIGHT
11.1 Erection Properly Supervised 20
11.2 Lines / Anchor Points Provided 10
11.3 PPE / Harnesses used 10
11.4 Safe Access 10
11.5 Weather Limitations 10
11.6 Tag Lines Used 10
WORKING AT HEIGHT 70
Page 4 of 4
12 ENVIRONMENTAL CONDITIONS
12.1 Noise Control 15
12.2 Road Maintenance 15
12.3 Pollution Controls 15
12.4 Dust Suppression 15
12.5 Heat Exhaustion 20
12.6 Environmental Protection 20
ENVIRONMENTAL CONDITIONS ASSESSMENT 100

Ref: PD.SF023.R1
Date: Jan, 1st, 2011 PD.SF023.R1 Saftey Inspection [Link]
Client: (PMC):

SITE SAFETY INSPECTION

SSI Ref. _____________________ Contract Name :

Date : _____________________ Contractor :

Possible Actual
Very Poor to Excellent Score Score
Page 4 of 4 1 2 3 4 5
13 PAINTING / GRIT BLASTING
13.1 Ventilation 15
13.2 Containment / Screening 15
13.3 Earthing 10
13.4 Communications 15
13.5 Flammable Materials 10
13.6 PPE 15
PAINTING / GRIT BLASTING ASSESSMENT 80

14 HOUSEKEEPING
14.1 Good Site Layout 20
14.2 Materials Stacked 15
14.3 Laydown Areas / Material Storage 20
14.4 Timber Denailed 15
14.5 Walkways / Working Platforms kept clear 20
14.6 Housekeeping Arrangements Effective 20
HOUSEKEEPING ASSESSMENT 110

15 SPECIALIST ACTIVITIES
15.1 Pressure Testing (Barriers/Signs etc) 20
15.2 Radiography 20
15.3 Heavy Lifts 20
15.4 Hazardous Substances 20
15.5 Other
SPECIALIST ACTIVITIES ASSESSMENT 80

16 LINE MANAGEMENT
16.1 Adequate Supervision 20
16.2 Commitment 20
16.3 Near Miss Reporting 15
16.4 Incident Follow Up 15
16.5 Safety Awareness 20
16.6 Toolbox Talks 20
LINE MANAGEMENT ASSESSMENT 110

Ref: PD.SF023.R1
Date: Jan, 1st, 2011 PD.SF023.R1 Saftey Inspection [Link]
 Ref.: PD.SF025R1 DATE January, 1st, 2011

Client: (PMC) : PD Contractor:

Quantity Takeoff sheet

Project # :
Project Name :
BOQ Section :
BOQ Page :
BOQ item :
Sub item :
Unit :
Item description :

Sr. + Floor Location / Discription No of Dimensions Addition Deduction Total

Remarks
- PCs Length Width Hieght
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

Sub Total 0.00

PMC notes

____________________________________________________
Submitted By Contractor Approved By PMC
Name : Name : __________
Signature : Signature : _______
Date : Date :____________