COMPANY NAME

STRUCTURAL BACKFILL REPORT

PROJECT
CLIENT
Report No. Date of Inspection
Ref.Drawing No.
Location of work
Work done TIME : from to
S.No. Description of Activity YES NO N/A Remarks
Checks ( Before start of Backfill Activity )
01 Tie Rod hole filling done
02 Were the Surface Defects, if any, repaired/rectified and accepted
03 Was the Backfill Material approved for filling
Checks ( During Backfilling Process )
01 Was the permissible layer(s) height marked on the structure clearly
02 Was the previous layer Density checked and results recorded
Is the present Layer Material free from roots, organic matter and any other foreign
03
material etc.
04 No Loose,Segregation of material found
05 Is the Area uniform and compacted properly including edges
06 In-Situ Density checked & accepted
07 Cleared to proceed with the next layer
Comments, if any :

COMPANY ENGINEER CLIENT ENGINEER

Name Name
Sign Sign
Date Date
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