F - ABCD - 43FLBLDG - 01

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ABC Construction Corporation TYPE YOUR PROJECT NAME
Project :

Date Prepared CPR No.

CONCRETE POURING REQUEST

REQUESTED BY : Name/ Designation :

Contractor : Signature :

PRE REQUISITE PRE CONCRETING INSPECTION

INSPECTION Inspected & Approved per PCIR# INSPECTED BY
Certified by Date Inspected

Note : All signatures should print their names and sign.

AREA (Pls. enclose key plan) GRIDLINE/LOCATION LEVEL STRUCTURE

METHOD OF PLACING EQUIPMENT TO BE USED BATCH PLANT SOURCE

POURING TIME TIME

DATE START FINISH

DESIGN MIX ESTIMATE VOLUME (CUM) PROJECTED

ACTUAL VOL. POURED (CUM) ACTUAL

INSPECTION CERTIFIED &

PREPARED BY CHECKED BY INSPECTED BY
APPROVED BY
CHECK ITEMS
VP-CONSTRUCTION
CONTRACTOR PROJECT SUPERVISOR QC
OPERATIONS

LINE and GRADE

REINFORCEMENTS
FORMWORKS
MECHANICAL
ELECTRICAL
PLUMBING
FIRE PROTECTION
ARCHITECTURAL
ALUM. WINDOWS
OTHERS

REMARKS :

CHECKED BY : RECOMMENDING APPROVAL:

PROJECT SUPERVISOR QC

APPROVED BY : NOTED BY:

VP-CONSTRUCTION OPERATIONS

NOTE : This form must be submitted to The QC TEAM, duly accomplished including the Pre-Concreting Inspection Report and signed by the corresponding Contractor's
Personnel-in-Charge at least 2 hours before actual pouring.

Rev. 0 August 27, 2019