REQUEST FOR INSPECTION

Trading & Supply Operations Engineering

Pilipinas Shell Petroleum Corporation
QC-GF-001 Version 2.0 / May 2020

REQUEST NO.: ITP NO.: DATE:

PROJECT NAME:

PROJECT LOCATION:

DATE/TIME OF REQUEST: DATE/TIME OF INSPECTION:

REQUESTED BY: REQUESTED TO:

LOCATION(S) OF INSPECTION / TEST: DURATION OF INSPECTION / TEST:

TYPE OF INSPECTION:

REVIEW WITNESS POINT HOLD POINT APPROVAL FINAL INSPECTION

MECHANICAL PIPING CIVIL STRUCTURAL ELECTRICAL/ INSTRUMENT

DISCIPLINE / SCOPE
OTHERS (PLEASE STATE) _______________________________________________________

NON-DESTRUCTIVE DESTRUCTIVE
INSPECTION / TEST /
EXAMINATION
OTHERS (I.E. VISUAL, DIMENSIONAL, PHYSICAL, TESTING, ETC.) __________________________

DESCRIPTION OF ITEM /
SCOPE / ACTIVITY TO
BE INSPECTED OR
TESTED OR EXAMINED

INSPECTION CONFIRMATION
QA-QC INSPECTOR SIGNATURE CLIENT OR REPRESENTATIVE SIGNATURE

Signature over printed name / Company / Contact Number Signature over printed name / Company / Contact Number

Issuance of this form by the Contractor indicates that the Contractor has reviewed its own work and found to be complete and in
compliance with the Contract Documents.

Normal inspection hours are Monday through Friday from 9 a.m. through 4 p.m. Contractor to provide this form to PSPC or
representative one or two working days before the date the inspection is requested.

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