THANH TRA S XY DNG

THNH PH NNG
on kim tra theo Q..............

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

BIN BN
V/v kim tra hot ng thi cng xy dng cng trnh: .....................................
.................................................................................................................................
Hm nay, vo lc.........gi.......ngy.......thng.......nm 2014 ti: ...............
.................................................................................................................................
on kim tra tin hnh kim tra cng trnh xy dng theo Quyt nh
s......./Q-TTS ngy ...... thng ........nm 2014 ca Chnh Thanh tra S Xy
dng.
I. Thnh phn gm c:
1. on kim tra:
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
2. Ch u t: .............................................................................................
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
3. T vn gim st: .....................................................................................
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
4. n v thi cng: ......................................................................................
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
5. Thnh phn khc:
- ng (b): ........................................... Chc v: ...................................................
- ng (b): ........................................... Chc v: ...................................................
II. Ni dung kim tra:
1. c im tnh hnh:
- Tn cng trnh: .....................................................................................................
- a im xy dng: ..............................................................................................
- Giy php xy dng: ............................................................................................

- Quy m v cp cng trnh: ...................................................................................

- Tng mc u t: ........................................, cng trnh thuc nhm: .................
- Ngy khi cng: .............................., ngy d kin hon thnh: .........................
- Hin trng: ............................................................................................................
2. Cng tc qun l cht lng cng trnh xy dng:
2.1. Giai on kho st xy dng (Ch u t v nh thu kho st):
- Lp v ph duyt nhim v kho st xy dng, phng n k thut kho st
xy dng: ................................................................................................................
- Thc hin gim st kho st xy dng: ................................................................
.................................................................................................................................
- Bo co kt qu kho st xy dng: .....................................................................
.................................................................................................................................
- T chc nghim thu kt qu kho st xy dng: ..................................................
.................................................................................................................................
- Lu tr kt qu kho st xy dng: ......................................................................
.................................................................................................................................
2.2. Giai on thit k xy dng (Ch u t v nh thu thit k):
- Lp v ph duyt nhim v thit k xy dng cng trnh:....................................
.................................................................................................................................
- Vn bn thm tra thit k ca c quan qun l nh nc c thm quyn hoc
ca t chc t vn (nu c): ...................................................................................
.................................................................................................................................
- T chc thm nh, ph duyt thit k k thut, thit k bn v thi cng theo
quy nh: .................................................................................................................
.................................................................................................................................
- T chc nghim thu h s thit k xy dng cng trnh: .....................................
.................................................................................................................................
- T chc lp v ph duyt ch dn k thut cng trnh xy dng: ........................
.................................................................................................................................
- Thuyt minh thit k (gii php kin trc v tnh ton kt cu):..........................
.................................................................................................................................
- Vic p dng tnh ton, thit k theo quy chun, tiu chun p dng i vi
cng trnh: ...............................................................................................................
.................................................................................................................................
- S ph hp v h s thit k gia cc bc thit k:...
.................................................................................................................................
- Vic s dng kt qu kho st trong h s thit
k: .............................................
.................................................................................................................................
- Lp quy trnh bo tr cng trnh theo quy nh ti Ngh nh s 114/2010/NCP v Thng t s 02/2012/TT-BXD: ...................................................................
................................................................................................................................
.

- Vic s dng t l vt liu xy khng nung trong h s thit k theo quy nh

ti Thng t s 09/2012/TT-BXD:..
.................................................................................................................................
- Quy cch v khung tn bn v:.........................
- Xc nhn v k tn trn tng bn v thit k ca ngi kim tra thit k::
.......................................................................
- Lu tr h s thit k xy dng: ..........................................................................
.................................................................................................................................
- Cng tc gim st tc gi ca nh thu thit k : .................................................
.................................................................................................................................
2.3. Giai on thi cng xy dng cng trnh:
a. i vi Ch u t:
- Lp h thng qun l cht lng cng trnh xy dng: .......................................
.................................................................................................................................
- Thng bo v nhim v, quyn hn ca cc c nhn trong h thng QLCL ca
ch u t, t vn gim st cho cc nh thu c lin quan: ...................................
.................................................................................................................................
- ng du xc nhn vo bn v thit k thi cng trc khi a ra thi cng: ........
.................................................................................................................................
- T chc gim st thi cng xy dng cng trnh: ..................................................
.................................................................................................................................
- Bo co nh k v tnh hnh cht lng cng trnh: ...........................................
.................................................................................................................................
- Kim tra cht lng vt t, vt liu v thit b lp t vo cng trnh: ................
.................................................................................................................................
- T chc nghim thu cng trnh xy dng: ...........................................................
.................................................................................................................................
- Ph duyt cng gim st thi cng: ................................................................
.................................................................................................................................
- Kim tra s ph hp nng lc ca nh thu thi cng so vi h s d thu v
hp ng xy dng: ................................................................................................
.................................................................................................................................
- Kim tra vic huy ng v b tr nhn lc ca nh thu gim st thi cng trn
cng trng: ...........................................................................................................
.................................................................................................................................
- Kim tra xc nhn bn v hon cng: ..................................................................
b. i vi nh thu gim st thi cng:
- Lp s t chc v cng gim st thi cng:
.................................................................................................................................
- Thc hin gim st thi cng xy dng theo yu cu ca hp ng v cng
c ch u t ph duyt: ................................................................................

................................................................................................................................
.
- Nghim thu cc cng vic do nh thu thi cng thc hin theo yu cu ca hp
ng:....................................
c. i vi Nh thu thi cng:
- Lp h thng qun l cht lng cng trnh xy dng: .......................................
.................................................................................................................................
- Lp v ghi nht k thi cng xy dng cng trnh: ...............................................
.................................................................................................................................
- Thc hin cc th nghim kim tra vt liu, cu kin, vt t, thit b cng trnh,
thit b cng ngh trc khi xy dng v lp t vo cng trnh xy dng: ..........
.................................................................................................................................
- Nghim thu ni b: ...............................................................................................
.................................................................................................................................
- Lp bn v hon cng theo quy nh: ..................................................................
.................................................................................................................................
- Lp h thng quan trc bin dng cng trnh v cng trnh ln cn: ...................
.................................................................................................................................
3. Cng tc m bo an ton, v sinh mi trng ti cng trnh xy
dng:
3.1 i vi Ch u t v T vn gim st:
- Kim tra bin php thi cng ca nh thu thi cng xy dng: .............................
.................................................................................................................................
- Kim tra bin php m bo an ton v sinh mi trng ca nh thu thi cng:
.................................................................................................................................
- T chc thm tra bin php thi cng cng trnh c tng hm:..............................
- Mua bo him cng trnh theo quy nh: .............................................................
3.2. i vi Nh thu thi cng:
Lp
v
ph
duyt
bin
php
t
chc
thi
cng: ......................................................
.................................................................................................................................
- Lp v ph duyt bin php m bo an ton lao ng, v sinh mi
trng: ....................................................................................................................
.............
- Bin php an ton cho cu thp trong ma ma bo: ..........................................
.................................................................................................................................
- T chc tp hun an ton cho ngi lao ng: ....................................................
.................................................................................................................................
- Th an ton cho cc cng nhn lao ng: ............................................................
.................................................................................................................................
- Quyt nh phn cng nhim v cho cc cng nhn li cu, ph cu thp; my
vn thng: ...............................................................................................................

- Chng ch hnh ngh ca cc cng nhn vn hnh cc my mc, thit

b: ............................................................................................................................
.....
- Kim nh cc my mc, thit b phc v xy dng: ...........................................
.................................................................................................................................
- Mua cc loi bo him theo quy nh: .................................................................
.................................................................................................................................
- Vic thit k, tnh ton kt cu gin gio theo Ch thi s 03/CT-BXD ngy
11/11/2013 ca B Xy dng: ................................................................................
.................................................................................................................................
- Lp v ph duyt Tng mt bng cng trng xy dng: ...................................
.................................................................................................................................
3.3. T chc trin khai ti cng trng:
- Treo bin bo ti cng trng: .............................................................................
- Trang b phng tin bo h lao ng cho ngi lao ng trn cng trng: ....
.................................................................................................................................
- Phng tin che chn ti v tr cu thang, ban cng, b nc ngm, phm vi
hot cng ca my mc, thit b: ............................................................................
.................................................................................................................................
- H thng li bao che cho ton b cng trnh: ....................................................
.................................................................................................................................
- Treo bin bo an ton, bin bo nguy him v ni quy ti cng
trng: ....................................................................................................................
.............
- Tp kt vt liu ng ni quy nh: .....................................................................
.................................................................................................................................
- V sinh mi trng (h thng x nc thi v thu gom, vn chuyn cht thi..):
.................................................................................................................................
4. iu kin nng lc ca cc bn tham gia xy dng cng trnh:
a. i vi nh thu kho st xy dng:
- Hp ng kho st xy dng: ..............................................................................
- Giy php kinh doanh: .........................................................................................
.................................................................................................................................
- Quyt nh c cn b thc hin kho st, ch nhim kho st: ......................
.................................................................................................................................
- Ch nhim kho st (h, tn; s nm kinh nghim; bng cp chuyn mn;
chng ch hnh ngh): ............................................................................................
.................................................................................................................................
b. i vi nh thu thit k xy dng:
- Hp ng thit k xy dng: ................................................................................
- Giy php kinh doanh: .........................................................................................
.................................................................................................................................
- Quyt nh c cn b thc hin thit k, ch tr thit k: ...............................

.................................................................................................................................
- Ch tr thit k (h, tn; s nm kinh nghim; bng cp chuyn mn; chng ch
hnh ngh): .............................................................................................................
.................................................................................................................................
- Cn b gim st tc gi (h, tn; s nm kinh nghim; bng cp chuyn
mn): .......................................................................................................................
..........
a. i vi nh thu thi cng xy dng:
- Giy php kinh doanh: .........................................................................................
.................................................................................................................................
- Hp ng thi cng xy dng cng trnh: .............................................................
.................................................................................................................................
- Quyt nh thnh lp ban ch huy cng trng: ...................................................
.................................................................................................................................
- Ch huy trng cng trng (h, tn; s nm kinh nghim; bng cp chuyn
mn):........................................................................................................................
.................................................................................................................................
- Cn b k thut, cn b gim st k thut (h, tn; s nm kinh nghim; bng
cp chuyn mn): ...................................................................................................
.................................................................................................................................
b. i vi Nh thu T vn gim st:
- Giy php kinh doanh: .........................................................................................
.................................................................................................................................
- Hp ng t vn gim st: ...................................................................................
.................................................................................................................................
- Quyt nh c cn b gim st trc tip ti cng trnh: .......................................
.................................................................................................................................
- Chng ch hnh ngh ca cn b gim st: ..........................................................
.................................................................................................................................
- Mua bo him trch nhim ngh nghip: .............................................................
.................................................................................................................................
c. i vi Nh thu T vn qun l d n:
- Giy php kinh doanh: .........................................................................................
.................................................................................................................................
- Hp ng t vn qun l d n: ...........................................................................
.................................................................................................................................
- Quyt nh thnh lp Ban QLDA: .......................................................................
.................................................................................................................................
- Gim c qun l d n (h, tn; s nm kinh nghim; bng cp chuyn mn):
.................................................................................................................................
- Chng nhn nghip v QLDA ca cc cn b trong ban QLDA: .......................
.................................................................................................................................
- Mua bo him trch nhim ngh nghip: .............................................................

d. Trng hp Ch u t t t chc thi cng, gim st thi cng xy dng

cng trnh, iu hnh d n th phi c iu kin nng lc ph hp vi im a, b,
c khon 4 nu trn.
5. Cc ni dung khc:
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................

.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
III. Kt lun:
Yu cu ch u t v cc bn tham gia xy dng cng trnh khc phc
ngay cc thiu st m on kim tra nu trong bin bn. Thi hn khc phc
chm nht n ngy........thng...... nm 2014.
Cn c ni dung bin bn v kt qu khc phc ca cc bn lin quan,
on kim tra s c Bo co kt qu kim tra trnh Chnh Thanh tra S ban
hnh Kt lun kim tra theo quy nh.
Bui kim tra kt thc vo lc.......gi.......cng ngy v bin bn c
c li cho cc thnh vin tham gia nghe v thng nht k tn.
Bin bn c lp thnh.........bn, c ni dung v gi tr nh nhau v giao
cho ch u t 01 bn v cc bn c lin quan mi bn 01 bn./.
Ch u t

Ban QLDA

on kim tra

Nh thu thi cng

T vn gim st

Thnh phn khc