Cilacap RFCC Project
BRICK AND BLOCK WORK
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Project / No.
Report No.
Area / Unit
Date
Location
Sub. Cont
No.
1
Result
Check Item
Accept
Reject
of
Remarks
Brick and Block Work
1.1 Material
1.2 Layer Number of one Day
1.3 Requirements for Reinforcement and Tie
1.4 Location of Door and Window
Notes :
Prepared By
Inspected By
SUBCONTRACTOR
ADHI-GS E&C
Witnessed By
PERTAMINA/PMC
Name :
Name :
Name :
Date :
Date :
Date :
Form No: BL-01
Cilacap RFCC Project
WATER PROOFING
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Project / No.
Report No.
Area / Unit
Date
Location
Sub. Cont
No.
1
Result
Check Item
Accept
Reject
of
Remarks
Water Proofing
1.1 Material
1.2 Dry Surface for Laying Proofing
1.3 Overlap for joint
1.4 Laying of Insulation Board
Notes :
Prepared By
Inspected By
SUBCONTRACTOR
ADHI-GS E&C
Witnessed By
PERTAMINA/PMC
Name :
Name :
Name :
Date :
Date :
Date :
Form No: BL-02
Cilacap RFCC Project
DOOR, WINDOW AND PARTITION
Project / No.
Report No.
Area / Unit
Date
Location
Sub. Cont
No.
Page :
Result
Check Item
Accept
Reject
of
Remarks
Door, Window, Partition (Wood, Aluminium, and other
non Wood Material)
1.1 Type and Size
1.2 Fixed Condition of Glass
1.3 Cleaning
1.4 Functional Test
Notes :
Prepared By
Inspected By
SUBCONTRACTOR
ADHI-GS E&C
Witnessed By
PERTAMINA/PMC
Name :
Name :
Name :
Date :
Date :
Date :
Form No: BL-03
Cilacap RFCC Project
WALL, CEILING & FLOOR FINISHING
Project / No.
Report No.
Area / Unit
Date
Location
Sub. Cont
No.
1
Page :
Result
Check Item
Accept
Reject
of
Remarks
Water Proofing
1.1 Material
1.2 Dry Surface for Laying Proofing
1.3 Overlap for joint
1.4 Laying of Insulation Board
Notes :
Prepared By
Inspected By
SUBCONTRACTOR
ADHI-GS E&C
Witnessed By
PERTAMINA/PMC
Name :
Name :
Name :
Date :
Date :
Date :
Form No: BL-04
Cilacap RFCC Project
CARPENTER AND JOINER
Page :
Project / No.
Report No.
Area / Unit
Date
Location
Sub. Cont
No.
1
Result
Check Item
Accept
Reject
of
Remarks
Carpenter and Joiner
1.1 Material
1.2 Setting Position
1.3 Joint Type
1.4 Appearance of Finish
Notes :
Prepared By
Inspected By
SUBCONTRACTOR
ADHI-GS E&C
Witnessed By
PERTAMINA/PMC
Name :
Name :
Name :
Date :
Date :
Date :
Form No: BL-05
Cilacap RFCC Project
ROOFING AND CLADING
Page :
Project / No.
Report No.
Area / Unit
Date
Location
Sub. Cont
No.
1
Result
Check Item
Accept
Reject
of
Remarks
Roofing and Cladding
1.1 Material
1.2 Setting Position
1.3 Joint Type
1.4 Appearance of Finish
Notes :
Prepared By
Inspected By
SUBCONTRACTOR
ADHI-GS E&C
Witnessed By
PERTAMINA/PMC
Name :
Name :
Name :
Date :
Date :
Date :
Form No: BL-06