PROJECT :

FORM NO. :
F-YLFCCS-QC-10-006
DATE PREPARED REQUEST NO.
REQUEST FOR TESTING
REQUESTED BY : Name/ Designation :
Contractor : ____________________________________ Signature :

NOTE: ALL SIGNATORIES SHOULD PRINT THEIR NAME AND SIGN

LOCATION (PLS. ENCLOSE KEY PLAN) LEVEL

TYPE OF TEST TESTING DATE TESTING TIME COST CHARGEABLE TO

PARTICULARS

INSPECTION SUMMARY (REMARKS / CONDITIONS) CQC Recommendations

CHECKED BY: INSPECTED BY:

Contractor's Superintendent Contractor's QC Engineer

APPROVED BY: NOTED BY:

YLFCCS - QA/QC ELECTRICAL ENGR. YLFCCS - Project Manager

NOTE : THIS FORM MUST BE SUBMITTED TO THE CQC TEAM, DULY ACCOMPLISHED AND SIGNED BY THE CORRESPONDING CONTRACTOR'S
PERSONNEL-IN-CHARGE AT LEAST 24 HOURS BEFORE ACTUAL INSPECTION.