Format 4 ~ Part -| NATIONAL RURAL ROADS DEVELOPMENT AGENCY FORMAT FOR INSPECTION OF BRIDGE WORK UNDER PMGSY, Part 1 — Work Information (to be filled by PIU GENERAL: 1.1 Date of Inspection : u) 2 Qe 1.2 Name of NOM NGERAT Guera- ] 1.3 State: Jiaexuawo District : Parana Block FAANAT| ce 14 Name ofthe Road: From [Mirae to SUDA 15 Package No. Ji/7a¢ Through Road No. To Stipagy 1.6 Location of Bridge RD 57596 1.7 Estimated Cost as cleared by Gol Rs. 84-92 _JAKns 1.8 Date of Start 20 [| o7 [20/9 | 1.9 Date of Completion as per Agreement [07] 2020 1.10 Actual date of Compietion( if work is completed) [ 0) [03 [2021 2. PROGRESS _(In case of ongoing works only) Construction programme & Physical progress Item | %of Date of Date of [Actual Delay in | Progréss | Startingas | completion as | Completion | months | per per programme Date _ 1 Programme, — | ay out too/. | Foundation Too Sub-Structure | joo.f, | ae eaeeaee | ele ueaeenaee Supper | structure too}. |. | Protection Werk Approaches too].3. PARTICULARS’ OF THE BRIDGE: High level_| Submersible 3.1 Type of the bridge ; “ ee Open | Raft [well | Pile 3.2 Type of foundation 3.3 No. of Spans / Spans length DL Spans of £224... m. ef 3.4 Width of Bridge :[ 580m 7.50™m J 36 RTL 92959 3.6 HFL/OFL Bo Tham 3.7 Bed level (Lowest) 28°18 m 3.8. Catchment area , Cross Section of Drain at HFL Design discharge 35 794cumoes 3.9 Type of river protection works if any = 3.10 Type of Substructure Ree mos 3.11. Type of Bearing Evasrometerc Brae, 3.12 Type of Superstructure Rec Mrs 3.13 Type of Retums 2 RCC: ReraininGy WA 3.14 Whether approaches are in cutting or filing Fieeng 3.15 Whether Bench Mark and alignment are established near the bridge site (give location andRL) : Nene ae (9/66) 3.16 Type of Railing (SteeVRCC/Others) RCC: 3.17. Type of Wearing coat RCC. 4-30 7 4, QUALITY CONTROL : 4.1 Location of Field Laboratory Fl SL) Dace 4.2 Q.C. Test Records maintained by (Name) AE £19 :D., Daltmgony-f 4.3 Abstract of Q.C. Records maintained by ° (Name) TAB. uy -p. Da lemony -I 4.4 Quality of Concrete executed tb Pe = 4.5 No. of cube tests done 310 - 5. Inspection by NQM/SQM and action taken Sr. | Date of | Inspected by (Name) | Deficiencies | Action taken by PIU with date | No Visit ____ observed T | » dra Semgh 2 20 | Fy Bipin frhor Mishro 3 Er Ayvind ke-Jho a a nT EEE | NateL-066 To Mitaw te St ¢R abth SSTS™) (K22- BC OM PACKAGE NG 7H 7 7 FORMAT 1 - Part Il PART ~ I (to be filled by National Quality Monitor) 4. QUALITY ARRANGEMENTS AND ATTENTION TO QUALITY- Foron-going-work— Observations about Field Laboratory : - [ - | Whether adequate | Whether Field | equipments as per Laboratory -_List the equipments available in field laboratory requirement of | Established Including first Aid-Box work aro-available | (YIN) and are being Lo i. used (Y/N) Observations about Mandatory Tests - The quantities of various items of works and list the tests required. (Refer to abstract of _ QC Register Part-I) sy, | Hem of work executed [ Quantity | Name of / No of tests . Test required ether QC Register Part- | I maintained and test | results monitored as per_ | ____ provisions Yes Partly No | | Based on executed quantities, | | whether all mandatory tests | conducted‘his item is graded SRI/U, write clear reasons and suggestions for SRI Ss | te provement : Grading: FOUNDATION (Stage |) 2. a) ‘Ongoing (Work in progress) papiewe p05) Ye ee ak ‘uu ‘usiso0 orpevedwos jz seoweNL ‘Ayoune wojedwoo fapanap |S waweoi0.uies owen If this item is graded SRI/U, write clear reasons and suggestions for improvernent nwowabueue pom wos 7 ‘200,006 8100310 | en wouieg 40 ‘yen e [aooane nawdios fo Ka pessoa 1H 40 pasojoue ubsap | | -awsooun, | pape ‘ame my { 2-Auaereay | Grading:b) Completed ee Location | Grade of | Compressive | Surface [Workman| Quality | Grade concrete | strength of | acceptability | ship | assessment | awarded | | Concrete by personal | cube as per judgment | | | QC Register | 1 | 6 7 b+ 7 sa — —. k 4 \ 7 7 ‘Grade: ——T | If this item is graded SRI/U, write | S| SRI U clear reasons and suggestions for _| _ improvement 7epreme spas |= | | amas pue | Mounnae pug Buy etgane RIU, write sojoy doom |. sowawobueny item is graded SI reasons and suggestions for ‘improvement : O90 i 20 Arce ony, | Swonnus [= i r j & =o weUIeoIOUIEs | = 3 i —|- & ois t ge | sebe86y | o @ aie eu eal wef a gz fg | eweSa:coy | | Seri wm Pl | | |e | | Se zp wowsg |e j 2 Qo jroo tt | 4 | 3! aRue5 | r] i BE pepe | Lu6iseap ayy | a. | oe lw | | i 20m Jo way, | Grading —— | | W012907b) Completed work | Location | item of | Grade of Compressive | Surface Size & | Weep holes | Riding | Grade work tee strength of | acceptability | Shape | Adequacy returns | awarde Concrete as per (For cube design | abutment | | Acpedee) and return) 4 5 6 8 9 s | 24-uple 5 |< If this item is graded SRIU, write clear | reasons and suggestions for improvement : _ | 2 aieSUPERSTRUCTURE (Stage III) 4. ibm Ongoing (Work in progress) a) pepieme apei yum Supyayo \queweoio}uieys Roe ‘oa a aD 40 Aangervont Workmanship : | is item is graded SIU, write cle}r reasons and suggestions for ement » Suneanys suuou piepuels ua jo} |. so somodord jo uoneDyHeA, quaweos9juIeN i vs U s | SRI ‘Quality of material vo | awed ‘y919U09 Jo perp juBisep XIN yom yo wai voq2007 -—<- Grading:\ b) Completed work i { Evelgse | of | #8), 3 2 |< ls bk a8 ge) Ss l= |g lei g |e a BF lek C 10 a. © al 8 C \s WA) bes i NM Ma YW Grading: If this item is graded SRI/U, write clear | feasons and suggestions for . +r ape wee Hees ~rfgLimprovernent— Li ol Qubhen peels'on Weck need ti pu ayem >| 5. Contraction joint according to IS Code (i) Type — (i) Spacing YIN Wn A (ii) Cross Section YIN 6. Results of load test according to IS YIN If yes, comment required & copy of test result shall be enclosed. N o7. APPROACHES (Stage Il & II) 74 Embankment Location | Suitability of soil | Compaction Side slopes | Shoulders | Grade |" | 4 5 é If this item is graded SRIU write clear reasons and suggestions for | | improvement | 7.2. Sub Base (G.S.B.) Location | Suitability of | Thickness as compared to | Compaction | Grade | | Material design Uae] | var ehetah \ . | | 1 2 3 4 | 5 | 7 T 1 | | | | | | ] If this item is graded SRI/U, write S| SRI | u clear reasons and suggestions for ps ii | improvement : ~ Ls — NA —7.3 Base Course (Non Bituminous (WBM) and Bituminous (MPM) | Location | Suitability of | Thickness as comparedto | Compaction | Grade | Material design | 1 2 3 [ = L | | en ee [ Grading: 7 Ty IF this item is graded SRIU, write | S| SRI u clear reasons and suggestions for improvement : | MA) en 74 WearingCourse DohMM OaPC- | Location | Suitability of | Thickness as Surface | Camber Grade Material | compared to regularity design | | at : 2 3 : eo 7 : | Ail ¢ S$ Si] sf] g pide | Grading: ] If this item is graded SRIU_ write | S sri} ou clear reasons and suggestions for improvement J te8 ROAD FURNITURE AND MARKINGS : Observations: : Quality of Road Furniture and Markings : (All stages) Main information Board va No Fixed Citizen Information Board Fixed If this item is graded as U, write clear reasons and suggestions for improvement (a? Observations: : Quality of Road Furniture and Markings : (Stage II!) 84 Logo Boards fixed UYes | _No 8.2 Guard stones fixed on (Ave T wo | approaches : 83 Mandatory and caution | - ae orege en | S U__ | this item is graded as U, write clear reasons Grade : and suggestions for improvement9 Whether the work has been completed /is in progress as per work programme or the delay has occurred. If delay has occurred, whether the liquidated damages have been withheld or recovered weal too Warn dilan at a Gye meall, Ms = ie brea Appears 7, oar aot ae work has been completed within the sanctioned cost, if not, 10 what is the action taken by the PIU (in case of completed works); Observations about the action taken by the PIU on the observations of i" inspecting officers including SQMs and NQMs. (Clearly offer commenis about the action taken on the observations of Departmental. Officers, State Quality _Monitors and National ae ) | The ust tar Ws12 Comments about difference in observations made by NQMs / SQMs in earlier inspections (the NOM shall study the earlier inspection reports of NOMS / SQMs, if any and offer this clear comments about the differences in observations, if any.) - - NA . | pC a hes | Ot Deb 13 Other Observations, if any: (1). (2). (3).14, Overall Grading of works: The overall grading calculated on the basis of item and'sub-item wise grading is given below. The overall grading shall be ‘U' if any of the grading of item no 2,3 or 4 is ‘U’. Overall grading stall be ‘SRP if item no. 2,3,4 are graded as ‘S' and any of the item no. 1,5,6 are graded as ‘U’ or ‘SRI’. If all the items are graded as ‘S’, the overall grading will be*s’. Item No. | Sub item for observation | Awarded Grade! \No.t ~S7SRI/U NAL I | Quality arrangements TtemNo.2 Fou [ STSRITU yy HtemNo.3 | Sub “| AM STSRIIU & | “Item No. 4 ‘Superstructure ~~~ SS SRIVU (7 | Item No. 5 Approaches eSISRIIU bed Item No. 6 | Road furniture & marking | Overall grading Signature of N engl Sion oms Neer Gul Er, Neeraj Gupta, NOM M.E,(STR), CE. (Retd) PND Hr. NRRDA, New Deli-66 Date Name ..'