COMPANY: REPORT No:

 
LOGO PLANT LOCATION:
ITP DOC No:
PROJECT TITLE:
ITP REF:

INSPECTION REPORT BEFORE GROUTING

WEATHER CONDI|TION: GROUT TEMPERATURE

IDENTIFICATION OF MONITORING AND MEASURING DEVICES PAGE 1 OF 1

CHECK LIST ACCEPTED REJECTED N/A
INSPECTION DATE:
REF. DRAWING No: REV
Grout Type / Expiry Date
Verify Intended Mixing mode is acceptable
Verify availability of water measurement mode
Survey Alignment Report Available / Approved
Equipment / Structure Released for Grouting?

INSTALLED STRUCTURE
Confirm Levelling of Base Plate Done
Confirm Alignment & Position of Structure ok
Verify bolt cleanliness and Verticality
Verify Bolt tightening done
Anchor bolt to anchor bolt distance

FOUNDATION SURFACE PREPARATION

Verify surface chipping as required
Verify surface soaked as per requirement
Verify surface free of oil, grease, other materials
Verify pocket Condition is as per requirement

FORMWORK
Verify Material for formwork
Verify the position / Shape
Verify that the form is leak-tight
Verify Chamfer and right elevation

OTHERS
Verify sample moulds for cubes available

RESULT: ACC □ REJECTED □

NOTES : ACC – ACCEPTED N/A – NOT APPLICABLE REJ - REJECTED INSPECTION NOTIFICATION REFERENCE

RFI No.
NOTE: ISSUE DATE:

QC CIVIL INSPECTOR CONTRACTOR QA/QC COORDINATOR CONTRACTOR

NAME  NAME  NAME 

SIGNATURE SIGNATURE SIGNATURE

Date Date Date

Form code: