M· sè BM:11.

05
TỔNG CÔNG TY LILAMA VIỆT NAM
LÇn ban hµnh 01
CÔNG TY CỔ PHẦN LILAMA 3
Ngµy ban hµnh 15/9/2008

............Ngµy...........th¸ng........ n¨m.........

Biªn b¶n NghiÖm thu c«ng viÖc gia c«ng chÕ t¹o
Biªn b¶n sè………

C«ng tr×nh :
I. §èi tîng nghiÖm thu : ………………………………….
II. .Thµnh phÇn trùc tiÕp nghiÖm thu :

 §¹i diÖn Chñ ®Çu t: ....................................................................................................

¤ng: ...................................... Chøc vô: ...........................
¤ng: ...................................... Chøc vô: ...........................
¤ng...................................... Chøc vô: ...........................

 §¹i diÖn t vÊn gi¸m s¸t:.

¤ng: ...................................... Chøc vô: ...........................
¤ng: ...................................... Chøc vô: ...........................
¤ng...................................... Chøc vô: ...........................

 §¹i diÖn t vÊn thiÕt kÕ (nÕu cã) :

¤ng: ...................................... Chøc vô: ...........................
¤ng: ...................................... Chøc vô: ...........................
¤ng...................................... Chøc vô: ...........................

 §¹i diÖn Nhµ thÇu thi c«ng:

¤ng: ...................................... Chøc vô: ...........................
¤ng: ...................................... Chøc vô: ...........................
¤ng...................................... Chøc vô: ...........................

III. Thêi gian nghiÖm thu/ Inspection Time:

B¾t ®Çu.............................. Ngµy................ Th¸ng............ N¨m................
KÕt thóc.......................... Ngµy................ Th¸ng............ N¨m................
§Þa ®iÓm

IV.®¸nh gi¸ c«ng viÖc gia c«ng chÕ t¹o ®É thùc hiÖn :

1. Xem xÐt c¸c hå s¬, tµi liÖu sau:

- Hå s¬ tµi liÖu thiÕt kÕ:
........................................................................
........................................................................
- Tiªu chuÈn kü thuËt ¸p dông khi thi c«ng, kiÓm tra vµ nghiÖm thu:
........................................................................
........................................................................
- C¸c biªn b¶n kiÓm tra tõng phÇn
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NhËn
xÐt chÊt lîng, khèi lîng ®· thùc hiÖn:
- ChÊt lîng thi c«ng so víi thiÕt kÕ ®îc duyÖt
........................................................................
2. Nh÷ng söa ®æi so víi thiÕt kÕ ®· ®îc phª duyÖt:
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V. KÕt luËn:
§ång ý hay kh«ng ®ång ý nghiÖm thu c«ng t¸c gia c«ng chÕ t¹o thiÕt bÞ ®Ó ®a vµo l¾p
®Æt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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C¸c phô lôc kÌm theo:
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X¸c nhËn cña c¸c bªn.(Ký vµ ghi râ hä tªn, chøc vô)

§¹i diÖn chñ ®Çu t §¹i diÖn t vÊn gi¸m s¸t

t vÊn thiÕt kÕ (nÕu cã) §¹i diÖn nhµ thÇu