UNITATEA ______________________________________________________________________________

ŞANTIER ____________________________________ PUNCT DE LUCRU

____________________________
OBIECTUL______________________________________________________________________________
_

PROCES-VERBAL PENTRU VERIFlCAREA CALITĂŢII

LUCRĂRILOR CE DEVIN ASCUNSE

Nr._____ Data_____________

Faza din lucrare supusă verificării:

__________________________________________________________________________________________
__________________________________________________________________________________________

Elementele de identificare (sector, porţiune, ax, cotă, etc.):

_________________________________________________________________________________________
_________________________________________________________________________________________

Verificările s-au făcut pe baza prevederilor proiectului nr. _____________, planşele nr.
________________ sau a dispoziţiei de şantier nr.______________ din data de
________________________ .
Concluzii:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________

Numele Prenumele
Semnătura

CONSTRUCTOR: _________ ____________ ___________________________

_____________
BENEFICIAR _________ ____________ ___________________________
_____________
 Atestăm refacerea (remedierea) lucrărilor conform prevederilor proiectului.

Data ______________
Numele Prenumele
Semnătura

CONSTRUCTOR: _________ ____________ ___________________________

_____________
BENEFICIAR _________ ____________ ___________________________
_____________