Operation Handover Inspection Form

(From Project to Operation)

Handover Status : Accept

Accept with Punchlist

Reject

CLUSTER : KOMPLEK GRIYA PERMATA INDAH 3 REGENCY

CITY : Banjarmasin

Jakarta,
Project Operation

(………………………………………) (………………………………………)
 Quality Checklist
KOMPLEK GRIYA PERMATA INDAH 3 REGENCY
þ = Yes
ý = No

A. DATA CLUSTER

NO. DESCRIPTION STATUS REMARK

O NO N/
1 MANAJEMEN CORE Soft Copy
O
K K
NO A
N/
2 KML JALUR FO FTTH Soft Copy
O
K NO
K N/
A
3 DATA HOMEPASS ID Soft Copy
O
K O
K N/
A
4 AS BUILD DRAWING Copy BAST Report Vendor vs Project
O
K O
K N/
A
5 DATA PENGUKURAN OPM Soft Copy
O
K O
K A
6 DOKUMENTASI N/A Copy BAST Report Vendor vs Project
K K
B. PEKERJAAN JASA SIPIL

B.1 PEMASANGAN FDT

NO. DESCRIPTION JUMLAH SATUAN STATUS REMARK
O NO N/
1 FDT(Outdoor) 48 Unit
O
K NO
K N/
A
2 Splicing FDT(Outdoor) 48 12 Core
O
K K
NO N/
A
3 FDT(Outdoor) 288 Unit
K
O NO
K A
N/
4 Splicing FDT(Outdoor) 288 Core
K K A
O N N/
5 Pembuatan Pondasi FDT 144 Unit
K OK A

O NO N/
6 Pembuatan Pondasi FDT 288 Unit
K K A

O NO N/
7 Grounding 1 titik rod pada FDT Unit
K K A

B.2 PEMASANGAN FAT

NO. DESCRIPTION JUMLAH SATUAN STATUS REMARK
O NO N/
1 FAT kapasitas 16 core 8 Unit
O
K NO
K N/
A
2 Pedestal FAT Unit
O
K NO
K N/
A
3 HH FAT Unit
O
K NO
K N/
A
4 Plate Strip 12x21mm Unit
K K A
B.3 PEMASANGAN TIANG BESI
NO. DESCRIPTION JUMLAH SATUAN STATUS REMARK
O NO N/
1 Tiang Besi 7m - Berat 68 kg 20 Unit
O
K K
NO A
N/
2 Tiang Besi 7m - Berat 93 kg Unit
O
K NO
K N/
A
3 Tiang Besi 9m - Berat 105 kg Unit
K K A
O NO N/
4 Aksesoris Tiang Besi Unit
K K A
O NO N/
5 Stang Slack Kabel Udara Unit
K K A
B.4 PEKERJAAN GALIAN
NO. DESCRIPTION JUMLAH SATUAN STATUS REMARK
O NO N/
1 Galian Tanah Terbuka (Open Cut) Meter
K
O K
NO A
N/
1 Galian Aspal Meter
O
K NO
K N/
A
2 Boring manual/rojok/rojok alur Meter
O
K NO
K N/
A
3 Boring manual/rojok/rojok alur Meter
O
K NO
K N/
A
4 Boring manual/rojok/rojok alur Meter
O
K NO
K A
N/
5 Boring mesin Meter
O
K NO
K N/
A
6 Boring mesin Meter
O
K NO
K N/
A
7 Boring mesin Meter
O
K K
NO N/
A
8 Subduct HDPE 40/34mm Meter
O
K NO
K N/
A
9 Subduct HDPE 9 ways Meter
K K A
O NO N/
10 Subduct HDPE 40/33mm Meter
K K A
O NO N/
11 Subduct HDPE 9 ways Meter
K K A

O NO N/
12 Subduct HDPE 40/33mm Meter
K K A
 O NO N/
13 Subduct HDPE 9 ways Meter
K K A
O NO N/
14 Handhole Concrete Unit
O
K K
NO A
N/
15 Precast Manhole Unit
K
O NO
K N/
A
16 Precast Manhole Unit
O
K NO
K N/
A
17 Precast Manhole Unit
O
K NO
K N/
A
18 Pipa Galvanis 2" tebal 2.7mm Meter
O
K NO
K N/
A
19 Pipa PVC Merk Wavin 2" Meter
K K A
 B.5 PENARIKAN KABEL FO
NO. DESCRIPTION JUMLAH SATUAN STATUS REMARK
O NO N/
1 Kabel FO 48 core 1200 Meter
K
O K
NO N/
A
2 Kabel FO 32 core Meter
O
K NO
K N/
A
3 Kabel FO 24 core 800 Meter
O
K NO
K N/
A
4 Kabel FO 4 core Meter
K K A
B.6 PEMASANGAN AKSESORIS
NO. DESCRIPTION JUMLAH SATUAN STATUS REMARK
O NO N/
1 Joint Closure 24 Core (NWC/FCST/3M) Unit
K
O K
NO A
N/
2 Splicing Joint Closure 24 Core Core
O
K NO
K N/
A
3 Joint Closure 48 Core (NWC/FCST/3M) Unit
O
K NO
K N/
A
4 Splicing Joint Closure 48 Core Core
O
K NO
K A
N/
5 Joint Closure 96 Core (NWC/FCST/3M) Unit
O
K NO
K N/
A
6 Splicing Joint Closure 96 Core Core
K
O NO
K N/
A
7 OTB Indoor 96 Core - 3U (NWC/FCST/3M) Unit
O
K NO
K N/
A
8 Splicing OTB Indoor 96 Core Core
O
K K
NO N/
A
9 Clamp Galvanized Unit
O
K NO
K N/
A
10 Riser Pipe (pipa besi 1.5") Meter
K K A
V. PUNCHLIST

NO DESCRIPTION Remark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
 ACTUAL/STANDARD PHOTOS
FDT(Outdoor) 144 FDT(Outdoor) 288

N/A N/A

Comment Comment

Splicing FDT(Outdoor) 144 Splicing FDT(Outdoor) 288

N/A N/A

Comment Comment

Pembuatan Pondasi FDT 144 Pembuatan Pondasi FDT 288

N/A N/A

Comment Comment
 ACTUAL/STANDARD PHOTOS
Grounding 1 titik rod pada FDT FAT kapasitas 16 core

N/A N/A

Comment Comment

Pedestal FAT

N/A N/A

Comment Comment

N/A N/A

Comment Comment
 ACTUAL/ASSET PHOTOS

N/A N/A

Comment Comment

N/A N/A

Comment Comment `

N/A N/A

Comment Comment