Inspection Test & Plan: Pondasi Bangunan NOMOR: I-QAC-027/100.19

INSPECTION TEST & PLAN
PONDASI BANGUNAN
NOMOR: I-QAC-027/100.19
PEKERJAAN PONDASI BANGUNAN
PT PGAS SOLUTION
No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 1 dari 8
LEMBAR PENGESAHAN
Disetujui di Jakarta
Pada Tanggal: Juni 2021
Disusun Oleh: Oleh
Specialist QA EPC Kepala Divisi Manajemen Proyek EPC
L. Harsi Suryawan Yaqub

PT PGAS SOLUTION
LEMBAR REVISI
REV. TANGGAL HAL. STATUS KETERANGAN
A 10 Mei 2021 - - -
PT PGAS SOLUTION
DAFTAR ISI
LEMBAR PENGESAHAN ............................................................................................................... 1

LEMBAR REVISI ............................................................................................................................ 2
DAFTAR ISI .................................................................................................................................... 3
1. TUJUAN .................................................................................................................................. 4
2. LINGKUP KERJA..................................................................................................................... 4
3. REFERENSI ............................................................................................................................ 4
4. SINGKATAN ............................................................................................................................ 4
5. KETENTUAN UMUM ............................................................................................................... 5
6. RENCANA INSPEKSI DAN PENGAJUAN ............................................................................... 5
7. RISIKO POTENSIAL................................................................................................................ 5
8. LAMPIRAN .............................................................................................................................. 6
Lampiran-1...................................................................................................................................... 7
Lampiran-2...................................................................................................................................... 8
PT PGAS SOLUTION
1. TUJUAN
Memberikan panduan umum mengenai Inspection and Test Plan pada pekerjaan pondasi
bangunan yang berada di jaringan pipa gas bumi beserta fasilitas pendukungnya.
2. LINGKUP KERJA
Dokumen ini berisi persyaratan minimum pekerjaan pekerjaan tanah meliputi meliputi pekerjaan
piling work, bored pile, dan pekerjaan pondasi.
3. REFERENSI
3.1. ACI 301 Specifications for Structural Concrete for Building
3.2. ACI 304 Recommended Practice for Measuring, Mixing, Transporting and
Placing Concrete
3.3. ACI 308 Recommended Practice for Curing Concrete
3.4. ACI 311.5R Batch Plant Inspection and Field Testing or Ready Mixed Concrete
3.5. ACI 318 Building Code Requirements for Reinforced Concrete
3.6. ASTM A82 Wire, Plain Steel for Concrete Reinforcement
3.7. ASTM C33 Specification for Concrete Aggregates
3.8. ASTM C39 Test Method for Compressive Strength of Cylindrical Concrete
3.9. ASTM C40 Standard Practice for Soil Exploration and Sampling by Auger Borings
3.10. ASTM C94 Ready mixed Concrete
3.11. ASTM C150 Standard Test Method for Density of Unit Weight of Soil in Place by
Sand Cone Method
3.12. ASTM C260 Standard Test Method for Standard Penetration Test (SPT)
3.13. ASTM C136 Standard Test Method for Sieve Analysis of Fine and Coarse
Aggregates
3.14. ASTM C138 Standard Test Method for Unit Weight, Yield, Air Content (Gravimetric)
of Concrete
3.15. ASTM C143 Test Method for Slump of Portland Cement Concrete
3.16. ASTM C494 Specification for Chemical Admixtures for Concrete
3.17. SNI 2847:2019 Persyaratan Beton Struktural Untuk Bangunan Gedung dan
Penjelasan
3.18. SNI 2052:2017 Baja Tulangan Beton
3.19. SNI 7974:2013 Spesifikasi Air Pencampur Dalam Produksi Beton Semen Hidraulis
4. SINGKATAN
4.1. ACI American Concrete Institute
4.2. ASTM American Standard Testing and Material
4.3. SNI Standar Nasional Indonesia
PT PGAS SOLUTION
5. KETENTUAN UMUM
Istilah tingkat pemeriksaan yang digunakan dalam Rencana Inspeksi dan Pengujian untuk
semua pihak adalah seperti dibawah ini:
“ I ” Inspect : Pemeriksaan wajib terhadap pekerjaan yang telah diselesaikan seperti
yang ditunjukkan pasa symbol “I” pada Rencana Inspeksi dan
Pengujian. Kegiatan bisa berupa cek visiual, test, pengukuran
dimensional.
“P” Provide / : Tanggung jawab untuk menyiapkan pengujian / inspeksi atau
Perform menyiapkan dokumen (Prosedur, Instruksi Kerja, Laporan Inspeksi, dll.)
“M” Monitor : Kegiatan yang dilakukan berkelanjutan dan terjadwal, tanpa
pemberitahuan/undangan terlebih dahulu. Memantau kegiatan yang
dimaksudkan untuk proses verifikasi, bukan inspeksi / pengujian barang
/ material.
W ” Witness : Sebuah kegiatan yang membutuhkan kehadiran Inspektur atau
perwakilan yang ditunjuk pada proses kegiatan inspeksi / pengujian. Jika
Inspektur atau perwakilan tersebut tidak hadir pada saat kegiatan
inspeksi / pengujian, kegiatan dapat dilanjutkan tanpa Inspektur atau
perwakilan yang ditunjuk.
“SW” Spot : Sebuah kegiatan yang dilakukan oleh Inspektur atau perwakilan secara
Witness acak pasa proses kegiatan produksi atau instalasi. Dalam hal ini
kegiatan dapat dilakukan tanpa kehadiran Inspektur atau perwakilannya.
“ R “ Review : Review dan evaluasi laporan, prosedur, kualifikasi dan memverifikasi
kesesuaian terhadap spesifikasi.
“A “ Approval : Persetujuan dokumentasi sebelum memulai tahap berikutnya,
persetujuan ini menyangkut dokumen dan laporan.
“ H “ Hold : Sebuah titik yang membutuhkan kehadiran Inspektur atau
perwakilannya pada proses kegiatan inspeksi / pengujian pekerjaan
hanya dapat dilanjutkan jika sudah ada persetujuan dari Inspektur atau
perwakilannya.
6. RENCANA INSPEKSI DAN PENGAJUAN

Setiap inspeksi atau pengujian harus dilakukan dengan hati – hati untuk memeriksa apakah
pekerjaan yang dilakukan oleh tim kontruksi stelah sesuai dengan standard, kode, spesifikasi
proyek, gambar dan persyaratan kontrak. Rencana inspeksi dan pengujian yang akan dilakukan
di lapangan sesuai dengan yang dilampirkan dalam dokumen ini.
Semua kegiatan inspeksi dan pengujian harus didokumentasikan pada format report yang telah
disetujui agar menghasilkan catatan mutu yang dapat dipertanggung jawabkan.
7. RISIKO POTENSIAL
Risiko Potensial pada pekerjaan pekerjaan pondasi adalah sebagai berikut:
No. Tujuan Risiko Potensial dan Rencana Mitigasi
1. Mendapatkan kualitas Risiko Potensial:

beton sesuai dengan Campuran beton terlalu kering atau terlalu basah
spesifikasi
PT PGAS SOLUTION
No. Tujuan Risiko Potensial dan Rencana Mitigasi
Rencana Mitigasi:
Hindari perjalanan campuran beton yang terlalu tinggi dan
atau terlalu jauh serta membuat rancangan campuran yang
memadai, dengan atau tanpa bahan admixture.
2. Menghindari Risiko Potensial:
terjadinya cacat Terjadinya retak (shrinkage cracking) pada beton setelah
setelah dilakukan dilakukan pengecoran beton
pengecoran
Rencana Mitigasi:
Perlu menggunakan curing compound seperti Sodium silicate
based material & Wax based material untuk memperkecil
resiko shrinkage cracking.
3. Menghindari Risiko Potensial:
kegagalan saat Mesin pemancang (pile divers) roboh
melakukan
pemancangan Rencana Mitigasi:
Mesin pemancang (pile divers) harus ditumpu oleh dasar yang
kuat seperti balok kayu yang berat, bantalan beton atau
pondasi penguat lainnya. Mesin pemancang juga harus diberi
tali atau rantai penguat secukupnya.
4. Mencegah terjadinya Risiko Potensial:
kecelakaan kerja Pekerja tertimpa tiang pancang saat diangkat menggunakan
excavator
Rencana Mitigasi:
Pada saat pekerjaan pengangkatan tiang pancang harus
dilakukan oleh operator yang ahli. Pada saat pengangkatan,
lokasi di sekitar pekerjaan harus steril tidak boleh ada pekerja
di area tersebut.
8. LAMPIRAN
Lampiran – 1 Inspection and Test Plan Pondasi Bangunan
Lampiran – 2 Contoh Form Laporan Inspeksi
PT PGAS SOLUTION
Lampiran-1
Inspection and Test Plan Pekerjaan Pondasi bangunan
JOB No : REV
DOC. NO. :
Logo A
Pemberi Kerja INSPECTION AND TEST PLAN PONDASI BANGUNAN
DATE : BY CHD APVD
RESPONSIBILITY REMARKS
NO KEGIATAN INSPEKSI / ITEM UJI METODE INSPEKSI REF. DOCUMENT LEVEL OF ACCEPTANCE / REFERENCE VERIFIED DOCUMENT PEMBERI
PGAS PI MIGAS
KERJA
1 PEKERJAAN PEMANCANGAN
1.1. PERSIAPAN
1 Metode Konstruksi (peralatan konstruksi, kriteria pemancangan, peralatan, dll) Review App. Procedure & Eng. Spec. App. Procedure & Eng. Spec. Approved Procedure P,I R,A
Approved WPS MIGAS and

2 Tes kualifikasi WPS & Welder (jika diperlukan) Review App. Drawing, Data Sheet & Eng. Spec. App. Drawing, Data Sheet & Eng. Spec. P,I R,A
MIGAS certificate for welder
3 Koordinat pengaturan pemancangan dengan survei Dimensional App. Drawing App. Drawing Inspection Report P,I SW,A
4 Urutan Piling Visual, Check App. Drawing, Data Sheet & Eng. Spec. App. Drawing, Data Sheet & Eng. Spec. Inspection Report P,I R
5 Metode Joint Review App. Procedure & Eng. Spec. App. Procedure & Eng. Spec. Inspection Report P,I R,A
6 Kualitas Bahan Tiang Pancang Visual, Dimensional App. Procedure & Eng. Spec. App. Procedure & Eng. Spec. Inspection Report P,I R,A
7 Jumlah & Ukuran Tiang Pancang Visual, Dimensional App. Procedure & Eng. Spec. App. Procedure & Eng. Spec. Inspection Report P,I R
8 Consumable Visual, Check App. Procedure & Eng. Spec. App. Procedure & Eng. Spec. Inspection Report P,I R
1.2. PEMANCANGAN
1 Lokasi dan kemiringan tiang pancang Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I SW,A
2 Pengelasan Visual, Check App. Procedure App. Procedure Inspection Report P,I SW,A
3 Periksa sambungan las. (WPS + Tukang Las) Visual, Check App. Procedure App. Procedure Inspection Report P,I R,A
4 Penetrasi dan Top Elevation Dimensional App. Procedure App. Procedure Inspection Report P,I R
5 Peninggian kepala tiang terputus Dimensional App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
6 Perawatan Pile Cap Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report R
7 Survei pile off-set Dimensional App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I W,A
1.3. PENGUJIAN DAN PEMANTAUAN
1 Metode Tes Review App. Engineering Spec. App. Engineering Spec. Approved Procedure P,I R,A
2 Identifikasi titik akan diuji Visual App. Engineering Spec. App. Engineering Spec. Approved Procedure P,I R,A
3 Eksekusi Uji Test App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R,A
1.4. INSPEKSI FINAL
1 Final Inspeksi Review App. Procedure & Eng. Spec. App. Procedure & Eng. Spec. Inspection Report P,I R,A
2 TIANG BOR
2.1. PERSIAPAN
1 Pembongkaran fasilitas yang ada Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
2 Investigasi fasilitas bawah tanah yang ada Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
3 Penentuan titik lokasi pengeboran Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
2.2. PEKERJAAN TIANG BOR
1 Pembongkaran fasilitas yang ada Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
2 Keamanan terkait pekerjaan pengeboran Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
3 Pengeringan Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
4 Pekerjaan Penulangan Beton Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
5 Pekerjaan Beton Visual, Check App. Drawing, Procedure & Eng. Spec. App. Drawing, Procedure & Eng. Spec. Inspection Report P,I R
3 FONDASI DAN PEKERJAAN PRE-CAST

3.1. PERSIAPAN
1 Metode Konstruksi Review App. Drawing & Eng. Spec. App. Drawing & Eng. Spec. Approved Procedure P,I R,A
2 Mix Design Review App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R
3 Trial Mix Visual, Review App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R
4 Semen Portland Certificate ASTM C 150 App. Engineering Spec. Inspection Report P,I R
5 Agregat Halus Sieve Analysis ASTM C 33 App. Engineering Spec. Inspection Report P,I R
6 Agregat kasar Sieve Analysis ASTM C33 App. Engineering Spec. Inspection Report P,I R
7 Kotoran Organik dari agregat Test ASTM C 40 App. Engineering Spec. Inspection Report P,I R
8 Air Chemical Test BS 3148, BS 2690 App. Engineering Spec. Inspection Report P,I R
9 Admixture Visual, Review ASTM C 260 App. Engineering Spec. Inspection Report P,I R
10 Besi Beton Tensile test App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R
3.2. INSTALASI
1 Penggalian Visual, Dimensional App. Drawing App. Drawing Inspection Report P,I R
2 Visual inspection of Shutter Visual App. Drawing App. Drawing Inspection Report P,I R
JOB No : REV
DOC. NO. :
Logo A
Pemberi Kerja INSPECTION AND TEST PLAN PONDASI BANGUNAN
DATE : BY CHD APVD
RESPONSIBILITY REMARKS
NO KEGIATAN INSPEKSI / ITEM UJI METODE INSPEKSI REF. DOCUMENT LEVEL OF ACCEPTANCE / REFERENCE VERIFIED DOCUMENT PEMBERI
PGAS PI MIGAS
KERJA
3 Pemeriksaan Besi Penulangan Visual, Dimensional App. Drawing App. Drawing Inspection Report P,I R
4 Inspection of Form Work Visual, Dimensional App. Drawing App. Drawing Inspection Report P,I R
5 Ukur sisipan / Anchor Bolt Dimensional App. Drawing App. Drawing Inspection Report P,I R
6 Pouring Concrete (drop height, proper vibration, thickness) Visual, Dimensional App. Drawing App. Drawing Inspection Report P,I R
3.3 PENGUJIAN DAN PEMANTAUAN
1 Uji Slump untuk tekan Test App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R,A
2 Ambil Sampel Uji Beton Visual App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R,A
3 Ukur Kekuatan Tekan Test App. Engineering Spec. App. Engineering Spec. Inspection Report P,I R,A
4 Visually Inspection Surface Finish Visual App. Drawing App. Drawing Inspection Report P,I R,A
5 Pemeriksaan Akhir Fondasi Visual, Dimensional App. Drawing App. Drawing Inspection Report P,I R,A
PT PGAS SOLUTION
Lampiran-2
Contoh Form Laporan Inspeksi
Logo
Pemberi Kerja PROJECT TITLE
Contract No.
REINFORCING BAR INSTALLATION
Equipment No. : System No. :
Ref. Drawing : Sub System No. :
Area : Location :
NO ITEM TO BE CHECKED RESULT Remark

YES NO N/A
1 Size/Length/Quality
2 Bending Radius / Shape
3 Spacing B/W Re-bars
4 Lap Splacing ( Length / Location )
5 Extra Length
6 Hook ( Extra Length / Shape )

Hoop / Stirrup ( Shape / Location / Pitch /
7
Hook )
8 Starter Bar ( Shape / Length / Location )
9 Concrete Cover
10 Slab ( Direction / & Lower )
11 Reinforcing for Opening
12 Column / Beam ( Untorsionality )
13 Quality of Cleaning
Remarks :
PT PGAS SOLUTION PEMBERI KERJA
Print Name
Signature
Date
Logo
Contract No.
TRIAL MIX OF CONCRETE

Area : Location :
Construction site
Construction section
Requirements
Impermeability to Water Class of concrete

High frost resistance Required strength kg/cm 2
High frost and de-icing salt resistance Consistency k
Resistance against chemical attacks Slump 5 to 10 cm
Cement content kg/m 3
Fair faced concrete Water-cement ratio =
Pumpable concrete Max. size of aggregate mm
Early strength Air Content vol. - %
Concrete with low heat evolution Time for workability hours
Aggregate Type/Manufacturer/Quarry/Borrowpit
Cement manufacturing plant
Type / class of strength

Additive manufacturer
Type / Name
Grading curve No. k-value :
Govering water cement ratio W/Z Density kg/dm3 Volume dm 3 / m3

Required water content, W
Required cement content, Z
Air Content
Aggregate total
Composition for 1 m3 Composition for m3
Materials weight of Weight of

weight of mpist
Percentage Volume Spec. gravity aggregate aggregate Surface moisture
aggregate
s.s.d. s.s.d.
aggregate % dm 3 / m3 kg / dm3 kg / m3 kg % kg kg
Cement
Water
Weight of Fresh Concrete
Concrete admixtures
Ultra fine concrete = kg/m 3 Cement = kg/m 3 Aggregate < 0.25 mm kg/m 3 Concrete additive = kg/m 3
Print Name
Signature
Date
Logo
Contract No.
POURING CONCRETE
Area : Location :
Test / Inspection Items
FORMWORK REBAR
Orientation Size
Location ( Coord. ) Spacing
size Clearance
Elevation Cleanliness
Clean & Oiled
Chamfer
Bracing
EMBEDMENTS MISCELLANEOUS
Anchor Bolts ( Diameter, Length & Type ) Blockouts

Anchor Bolts ( Location & Projection ) Type of Finish
Anchor Bolts Sleeves Curing Method
Thread Protection Const. Joints
Angle Iron HOT / COLD Weather Condition
Inserts Plate Sets/Test Specimen
pipes Truck Tickets
Conduit Water Stop
Ground Wire
Template (Location and Projection)
Remarks :
Print Name
Signature
Date
23 of 38
Logo
Contract No.
POURING CONCRETE RECORD

Description : Sub System No. :
Area : Location :
Cemen Type : ……………………………………………………………………………..
Specified Strength of Concrete : …………………………………Kg/cm2 ( …………psi )
Request No. / Delivery Time Slump Poured Total

Date Area / Block
Vol. Order Batch Plan On Site (cm) Vol. (m3) (m3)
Remarks :
PT PGAS Solution Pemberi Kerja
Print Name
Signature
Date
Date :
Logo Form Number
Pemberi Kerja
PROJECT TITLE Page : of
Doc.No :
Subject : COMPRESSIVE STRENGTH TEST Project No. :
1. General
Placing Date / Time :

Design Compressive Strength : ( Kg/cm2) (28 days)
Concrete Class : ( MPa )
Placing Location / Purpose :
2. Test Result of Concrete
1. Fresh Concrete Test

Slump : ( cm )
Air Content : (%)
Fresh Concrete Temperature : ( 0C )
Ambient Temperature : ( 0C )
Test Cylinder Number :
2. Compressive Strength Test
7 Day Strength 28 Day Strength

Specimen No. Strength Unit WT Strength Unit WT
Test Date Test Date
(kg/cm2) (t/m3) (kg/cm2) (t/m3)
* Test Machine No. :
3. Test Result
Acceptable
Not Acceptable
PT. PGAS SOLUTION PEMBERI KERJA

Print Name
Signature
Date
Date :
Logo
Pemberi Kerja
Form Number
PROJECT TITLE Page: of
Doc. No
Project no :
Subject : PILING SURVEY DATA
Project :
Location :
Ref. Drawing :
COORDINATE DIFFERENCE ACTUAL PLUMBNESS ( % )

AFTER CUTTING
NO PILE NO DESIGN ACTUAL PILE REMARKS
N E CUTTING LENGTH 0O 90O
N E N E ELEVATION
Print Name
Signature
Date
Date :
Logo
Pemberi Kerja Form Number
Page: of
PROJECT TITLE
Doc. No
Project no :
Subject : PILING SITE REPORT
Project : Location :
Total Nos : Ref. Drawing :
Cummulative :
NO PILE RIG NO. NO. OF SECTION TOTAL TOP OF PILE PENETRATION TO 10 BLOW FOR HAMMER REMARKS
REF. NO. 1 2 3 4 REV. ELEV. LENGTH AGL BGL GL SET TC SIZE FINAL TIP
WELDED
(M) (M) (M) (M) (M) ELEVATION
Print Name
Signature
Date
Date :
Logo
Pemberi Kerja
Form Number
Doc. No :
Project no :
Subject : WELDING & COATING RECORD FOR PILING
Area : Ref. Drawing :
WPS No. : Weather :
JOINT WELDING
PILE REF. NO. TIME WELDER INSPECTION RESULT REMARKS
NO. ELECTRODE
Inspection Method :
V : Visual
Print Name
Signature
Date
Date ;
Logo
Pemberi Kerja
Form Number
Doc.No
Project No. :
Subject : PILE LOADING TEST RECORD
Test Pile No. : Date of Testing :
Dated Installed : Test Load :
Size of Pile : Ground Level :
Working Load :
Length af Pile :
Description of Test :
Date / Test Load SETTLEMENT READING (mm) LEVEL READ Average

Time (Tons) Dial No. 1 Dial No. 2 Dial No. 3 Dial No. 4 Scale A Scale B Settlement (mm)
Remarks

Print Name
Signature
Date
Date :
Logo
Pemberi Kerja
Form Number
Doc.No
Project No.
Subject : BORE PILE
A. General
1. Project : 7. Elev. Of Casing :

2. Area : Ground Level :
3. Location : Elev. Of PCO :
4. Ref. Dwg. : h1 :
5. Pile No. : h2 :
6. Diameter : h3 :
ACCEPTED
Description Remarks
Date Signature
B. Drilling
1. Preparation Top of Casing

2. Coordinate GL
3. Slurry mud ( Bentonite )
4. Install Casing ( 14 m )
PCO
C. Reinforcement
1. Size Dia. 19 h1
2. Lap Splacing min 40D
h2
3. Starter Bar h3
4. Hoop / Stirup Dia.10 @150
D. Concreting
1. Tremi Installation
2. Pouring Concrete fc 210/V
3. Removal of Casing
E. Compressive Strength Test Result
Acceptable
Not Acceptable
Print Name
Signature
Date

Inspection Test & Plan: Pondasi Bangunan NOMOR: I-QAC-027/100.19

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INSPECTION TEST & PLAN

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 1 dari 8

L. Harsi Suryawan Yaqub

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 2 dari 8

REV. TANGGAL HAL. STATUS KETERANGAN

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 3 dari 8

LEMBAR PENGESAHAN ............................................................................................................... 1

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 4 dari 8

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 5 dari 8

6. RENCANA INSPEKSI DAN PENGAJUAN

No. Tujuan Risiko Potensial dan Rencana Mitigasi

1. Mendapatkan kualitas Risiko Potensial:

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 6 dari 8

No. Tujuan Risiko Potensial dan Rencana Mitigasi

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 8 dari 9

Approved WPS MIGAS and

3 FONDASI DAN PEKERJAAN PRE-CAST

No Dok: I-QAC-026/100.19 Rev.: A Tgl. Berlaku: Juni 2021 Hal. : 9 dari 9

NO ITEM TO BE CHECKED RESULT Remark

2 Bending Radius / Shape

3 Spacing B/W Re-bars

4 Lap Splacing ( Length / Location )

6 Hook ( Extra Length / Shape )

8 Starter Bar ( Shape / Length / Location )

10 Slab ( Direction / & Lower )

11 Reinforcing for Opening

12 Column / Beam ( Untorsionality )

PT PGAS SOLUTION PEMBERI KERJA

TRIAL MIX OF CONCRETE

Impermeability to Water Class of concrete

Type / class of strength

Grading curve No. k-value :

Govering water cement ratio W/Z Density kg/dm3 Volume dm 3 / m3

Composition for 1 m3 Composition for m3

Materials weight of Weight of

PT PGAS SOLUTION PEMBERI KERJA

Test / Inspection Items

Anchor Bolts ( Diameter, Length & Type ) Blockouts

PT PGAS SOLUTION PEMBERI KERJA

POURING CONCRETE RECORD

Cemen Type : ……………………………………………………………………………..

Specified Strength of Concrete : …………………………………Kg/cm2 ( …………psi )

Request No. / Delivery Time Slump Poured Total

PT PGAS Solution Pemberi Kerja

Subject : COMPRESSIVE STRENGTH TEST Project No. :

Placing Date / Time :

2. Test Result of Concrete

1. Fresh Concrete Test

2. Compressive Strength Test

7 Day Strength 28 Day Strength

* Test Machine No. :

PT. PGAS SOLUTION PEMBERI KERJA

COORDINATE DIFFERENCE ACTUAL PLUMBNESS ( % )

PT. PGAS SOLUTION PEMBERI KERJA

PT. PGAS SOLUTION PEMBERI KERJA

PT. PGAS SOLUTION PEMBERI KERJA

Date / Test Load SETTLEMENT READING (mm) LEVEL READ Average

PT. PGAS SOLUTION PEMBERI KERJA

1. Project : 7. Elev. Of Casing :

1. Preparation Top of Casing

E. Compressive Strength Test Result

PT. PGAS SOLUTION PEMBERI KERJA

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