Pending Item

KONTRAKTOR : PT. JARINGAN SOLUSI TEKNIK

Form Lokasi : Banper Area : Kal-Sel Nomor
Proyek : Collocation CMI - SF
A Tanggal : 1

Before After

Keterangan : Permintaan dari SF Pondasi RBS/BTS Di Keterangan : Pondasi Setelah di tinggikan

tinggikan

Before After
Keterangan : Penambahan Support Tray Horizontal Keterangan : Penambahan Support Tray Horizontal

Before After
Pengaman Kaca Panel Kwh Di lepas Pengaman Kaca Panel Kwh Di lepas
Keterangan : Keterangan :
untuk pencatatan meter oleh PLN untuk pencatatan meter oleh PLN

PROJECT PEMBANGUNAN MINI CME COLOCATION

PT. CMI - SF
 Pending Item
KONTRAKTOR : PT. JARINGAN SOLUSI TEKNIK
Form Lokasi : Banper Area : Kal-Sel Nomor
Proyek : Collocation CMI - SF
B Tanggal : 2

Before After
Keterangan : Keterangan :

Before After
Keterangan : Keterangan :

Before After
Keterangan : Keterangan :

PROJECT PEMBANGUNAN MINI CME COLOCATION

PT. CMI - SF
 Pending Item
KONTRAKTOR : PT. JARINGAN SOLUSI TEKNIK
Form Lokasi : Banper Area : Kal-Sel Nomor
Proyek : Collocation CMI - SF
c Tanggal : 3

Before After
Keterangan : Keterangan :

Before After
Keterangan : Keterangan :

Before After
Keterangan : Keterangan :

PROJECT PEMBANGUNAN MINI CME COLOCATION

PT. CMI - SF
 CO-LOCATION SITE ACCEPTANCE
Site ID: Submit Date: Contractor Logo
Site Name: Project:

APPLICABLE FOR STACKING SHELTER WORK

SITE INFORMATION

Site ID :
Site Name :
Site Address :
Installed By :
Material Supplied By :
Tower Upgrade Type :
Inspection Date :
Carrier :
RFI Date as per Colo Tracker :

INSPECTION CHECK LIST

NO INSPECTION ITEM ACCEPTANCE REMARKS
CRITERIA
YES NO N/A
1 FOUNDATION (CIVIL WORKS)
a Type of foundation
b Dimension
- Base Conform
- Column Conform
- Depth Conform
c Concrete
Provided / Within the
- Concrete Strength Certificate specification

- Concrete Surface Good

d Anchor
- Diameter Conform
- Grouting Good / Smooth / Done
- Placement Firmly fixed / Conform
- Level Good / Level / Conform
e Finishing Works
- Soil Compacting Done / Neat / Conform
- Site Cleaning Clean / Neat
2 STEEL STRUCTURE
a Steel material
Mill Certificate provided /
Within the specification /
Complete and Conform to
- Wide Flange (H-Beam and I-Beam) and Angle Steel design / Not Bend or
Camber / Galvanized

Tightened within torque

- Bolt, Nut, Plate Washer and Spring Washer spec / Complete /
Galvanized / HTB

- Chequered Plate Conform / Galvanized

b Installation Conform / All member
properly
Minimumconnected and
85µm / Certified
c Galvanizing Test
New / Conform / Precise /
d Holes Galvanized
Conform / Galvanized /
e Welding Neat / No porosity
Conform / Galvanized /
f Stairs Neat

g Painting Conform / Once / Neat

3 CLEANNESS AND TIDINESS
a No trash and garbage arround and inside of site
b No excess materials left

REVIEWED AND APPROVED BY: ACCEPTANCE TEST BY: ACCEPTANCE TEST BY:
PT. PROTELINDO O&M Contractor Name

Name: Name: Name:

Place and Date: Place and Date: Place and Date:

Version : 2 QC PROTELINDO
Page: 1 of 2
Revision : 1 Eng-QC-TU-Site Acceptance-Form-001 Form Issued Date: 31-Jul-08