WORK ACCEPTANCE CERTIFICATE

No: ……………………………………………
Request for: Work Completion Acceptance Work Guarantee Acceptance Date:
Filled by Contractor
Company : PT. OKI PULP & PAPER

Contractor : Proposed Schedule for Joint

Work Title : Inpsection (dd/mm/yyyy)

PO/SO No. Attachment :

Contract Price Copy PO/SO Final Report
Schedule As Built Drawing Other:
Realization QC COC ………………………
Note: Manager, (stamp req.) Proposed by,

Guarantee Period (if applicable): …………... day/s Name: Date: Name: Tel:

Filled during Joint Inspection

This is to certify that we had conduct the joint survey of above mentioned work on,
Day: Date: Time: Number of Joint Inspection:
People that involve on this joint inspection are:

Represented Name Signature Remarks

Contractor

QA / QC
Manager

Construction
Manager

Project Manager

End User

with condition: * cross out inapplicable

the work has been completed on site*

since (dd/mm/yy) :
the work guarantee period was over*
And the following conditions are fulfilled :
1. All jobs have been done according to the requirement
(semua pekerjaan telah dilakukan sesuai permintaan)
2. All deficiencies found have been repaired
(semua kekurangan telah diperbaiki)
3. The work is ready for use, testing or operation
(pekerjaan sudah siap dipakai untuk operasional atau testing)
4. Working area has been cleaned from tools, leftover materials and wastes
(area kerja telah dibersihkan dari peralatan, sisa bahan dan sampah-sampah)
Result of Joint Inspection: Accepted Rejected
Comment:

Remark:
- Minimum job title that entitled to approve join inspection is (Deputy) Project Manager
- Contractor should take action to fix all defect found during joint inspection and re-apply work acceptance while all defects had been fixed
- Previous rejected work acceptance should be attached while re-apply new work acceptance
Sheet1: Accounting Dept, Sheet2: Doc, Sheet3: Contractor