Republic of the Philippines

PROVINCE OF
Provincial Capitol
Name of Project : _____________________________________________________________________
Project Location : _____________________________________________________________________

WORK REQUEST
(In triplicate)
For: Requested Work to Start On:
Date: _____________________ Time: _________________
From: (Contractor) Note: Contractor has to submit request in triplicate and with a
minimum of 48 hours in advance of scheduled start.
PAY ITEM REQUESTED:
Item No.: Equipment to be used:
Description: Estimated Quantity to Quantity: Unit:
be Accomplished:
Description of Work Requested:
Submitted by: Received by:
_____________________ ________________________ Date: _______________ Time: _______
Contractor
Inspected by: Findings/Comments: Recommendations:
_________________________
Site Inspector/Project In-charge

_________________________
Surveyor

_________________________
Resident Engineer
Checked by: Recommended Action:
_________________________
MTQA (assigned)
Reviewed by:

Engineer II/In-charge, MTQA Division

Recommending Approval:

Engineer IV/Chief, Maintenance Division

Approved:

Provincial Engineer
Accepted by:
__________________ Date: ______________________ Time: __________
Contractor