Quality Control/Assurance Forms

PIF-13-CQA-01 Quality Control Program

PIF-13-CQA-02 Monthly Certificate of Quality Control and Assurance
PIF-13-CQA-03 Weekly of Quality Control and Assurance
PIF-13-CQA-04 Status of Field and Laboratory Tests
PIF-13-CQA-05 Status of Tests
PIF-13-CQA-06 Summary of Field Test
PIF-13-CQA-07 Materials Inspection Report
PIF-13-CQA-08 Report on Concrete Works
 CONTRACTOR'S LETTERHEAD

QUALITY CONTROL PROGRAM

Contract ID:
Contract Name:

LIMITS: LOCATION:
APPROPRIATION/CONTRACT COST SOURCE :
A. TEST TO BE PERFORMED: DATE :
Pay
Item Description UNIT QUANTITY NO. OF TEST (MIN.)
No.

Legend:
IR - Inspection Report
EC - Engr's Cert.
Q - Quality Test
G,P,C, D - Grading, PL & LL, Compaction & Density Tests
CS-Compressive Strength Test
MC - Mill Cert.
MT - Megger Test
PT - Pressure/Leak Tests

Prepared By:

NAME & SIGNATURE

Materials Engineer
Contractor

IO's LETTERHEAD

Reviewed by: Approved :

NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Head of Implementing Office
DPWH & Consultant, if any DPWH
Date: ______________________
Initials : PE, PM, Chief of QAS/QAHD, ADE/ARD

PIF-13-QCA-01 Rev 00
 Republic of the Philippined
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]
[Office Address]

MONTHLY CERTIFICATE QUALITY CONTROL ASSURANCE

CONTRACT ID:
CONTRACT NAME:
LOCATION:
CONTRACTOR :

We hereby certify that we have conducted an inspection and verification on the work accomplishment on the above
mentioned project for the period of __________________.

We further certify that we have found that the quality of materials and workmanship on the following items of work
corresponding to the quantity accomplished conforms with the plans, standard specifications and provisions of the
Contract, viz:

PAY ITEM CONTRACT QUANTITY

PAY ITEM DESCRIPTION UNIT
NO. QUANTITY
PREVIOUS THIS PERIOD TOTAL BALANCE

Note : The aforementioned quantities may serve as reference for payment/billing purposes but may not be equal to the
Statement of Work Accomplished for billing depending on the intended/requested quantity to be billed by the Contractor
evaluated as reasonable for payment

NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Project Engineer
DPWH & Consultant, if any DPWH & Consultant, if any

PIF-13-QCA-02 Rev 00
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]
[Office Address]

WEEKLY CERTIFICATE OF QUALITY CONTROL ASSURANCE

CONTRACT ID:
CONTRACT NAME:
LOCATION:
CONTRACTOR :

We hereby certify that we have conducted an inspection and verification on the work accomplishment on the above
mentioned project for the period of __________________.

We further certify that we have found that the quality of materials and workmanship on the following items of work
corresponding to the quantity accomplished conforms with the plans, standard specifications and provisions of the Contract,
viz:

PAY WEEKLY QUALITY ACCOMPLISHMENT

CONTRACT
ITEM PAY ITEM DESCRIPTION UNIT [Week 1 period] [Week 2 period] [Week 3 period] [Week 4 period]
QUANTITY TOTAL
NO.

NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Project Engineer
DPWH & Consultant, if any DPWH & Consultant, if any

PIF-13-QCA-03 Rev 00
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]
[Office Address]

STATUS OF FIELD AND LABORATORY TEST

As of ____________ to ____________

CONTRACT ID:
CONTRACT NAME:
LOCATION:
CONTRACTOR :

AS ACC0MPLISHMENT NO. OF TEST PERFORMED BALANCE

PAY
TYPE OF TEST OF
ITEM DESCRIPTION UNIT QUANTITY BALANCE THIS Remarks
Previous This Period Total TEST REQUIRE ON FILE TOTAL REQUIRED
NO. PERIOD
D TEST

Prepared by: Verified as to Quantity: Submitted by:

NAME & SIGNATURE NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Project Engineer Chief of QAS/QAHD/Project Manager
DPWH & Consultant, if any DPWH & Consultant, if any DPWH

PIF-13-CQA-04 Rev 00
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]

STATUS O F TEST
As of __________, [Year]
Physical Accomplishment: _________%
CONTRACT ID:
CONTRACT NAME:
LOCATION:
CONTRACTOR :

Pay Contract Min. # Total No. of Test % of Work

Description/Materials Unit
Item No. Quantity Required
On File Balance Accomplished

Prepared by Submitted By:

NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Chief of QAS/QAHD/Project Manager
DPWH & Consultant, if any DPWH

PIF-13-CQA-05 Rev 00
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]
[Office Address]

SUMMARY REPORT OF FIELD TEST

For the Month of ___________, [Year]
Contract ID :
Contract Name and Location :
Contractor:
Contract Duration : Physical Accomplishment : %
a) Contract Effectivity Date: Contract Cost :
b) Contract Expiry Date:

Original Kind Pay Sampled Tested

Lab. No. Kind of Materials Represented Quantity Source of Of Item At Remarks
By Date By Date
Materials Test No.

Prepared by Submitted By:

NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Chief of QAS/QAHD/Project Manager
DPWH & Consultant, if any DPWH

PIF-13-CQA-06 Rev 00
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]

MATERIALS INSPECTION REPORT

CONTRACT ID:
CONTRACT NAME:

LOCATION :
KIND OF MATERIALS:

ITEM NO. INSPECTED: DATE:

PROPOSED USED:

REMARKS/RECOMMENDATION:

Inspected by:

NAME & SIGNATURE NAME & SIGNATURE

Materials Engineer Project Engineer
DPWH & Consultant, if any DPWH & Consultant, if any

PIF-13-CQA-07 Rev 00
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
[IMPLEMENTING OFFICE]
[Office Address]

REPORT OF CONCRETE WORKS

Contract ID:
Contract Name:
Location :
Contractor:

Date & Time of Pouring: Part of Weather:

Class of Spec's Structure
Concrete: Item No. Concreted:
Concrete Brand: Sample Tested Yes Pretested Yes
No No
Condition of Storage:
Actual Batch:
Cement No. of Bags . . . . . . Water, Liters . . . . . . . . . . . .
Fine Aggregates, Kg . . . . . Course Aggregates . . . . . .
Cement used, No. of Bags . Volume of Aggregates, kg. .
Yield, cu.m. . . . . . . . . . . . . . Volume of Concrete Place .

ACTUAL SPEC'S
Cement Factor, bags/cu.m. . . . . . . .
Water, Liters . . . . . . . . . . . . . . . . . .
Slump, mm. . . . . . . . . . . . . . . . . . .
Adjustment made in the field on designated mix to satisfy:
a) Workability b) Water Content C) Cement Content
corrected fine/coarse Corrected cement factor Per yield test
aggregate by absolute bags/cu.m. corrected weight
volume of aggregates
Fine . . . . . . . . . . . . . . . . . . % New Cement Fine . . . . . . . . . . .
Coarse . . . . . . . . . . . . . . . . % Factor: Coarse . . . . . . . . .
Note: To be accomplished for every continous operation. The worksheet for Design of Concrete Mix should
be attached.
Attached the Design Concrete Mix based on a new cement factor
SAMPLES TAKEN

Kind of Sample: Sample Identification:

Quantity Represented, cu.m. Method of curing
in the field:

Sampled By:
(Name & Designation) (Office) (Date)

Prepared by : Noted:

NAME & SIGNATURE NAME & SIGNATURE

Material Engineer Project Engineer
DPWH & Consultant, if any DPWH & Consultant, if any

PIF-13-CQA-08 Rev 00