Document : GSB – Form – 110

Revision : 02
STEEL STRUCTURE ELEVATION / ALIGNMENT INSPECTION Page : of
Date : 02 January 2013

CLIENT :
PROJECT :
BUILDING :

DEVIATION ELEVATION
No. LOCATION MARKING INSPECTION DATE REMARK

1 / / mm mm M M
2 / / mm mm M M
3 / / mm mm M M
4 / / mm mm M M
5 / / mm mm M M
6 / / mm mm M M
7 / / mm mm M M
8 / / mm mm M M
9 / / mm mm M M
10 / / mm mm M M
11 / / mm mm M M
12 / / mm mm M M

Note : a. Tolerance recommended b. All the parts that found out of tolerance, Submit by : Approved by :
1. Alignment 1/1000 Height shall be adjusted
2. Elevation + 3 mm * Mark bellow, after adjusted
A Done Adjusted

R Totally Repair ( ________________) ( ________________)

Sign/name/date Sign/name/date