#NAME?

ABC Construction Corporation

Project : #NAME?

Date Prepared CIR No.

CHB INSTALLATION REQUEST

REQUESTED BY : Name/ Designation :

Contractor : Signature :

Note : All signatories should print their name and sign.

AREA (Pls. enclose key plan) GRIDLINE/LOCATION DATE OF INSTALLATION STRUCTURE

LEVEL

PREPARED BY CHECKED BY INSPECTED BY

CHECK ITEMS
CONTRACTOR PROJECT SUPERVISOR QC

LINE and GRADE

REINFORCEMENTS

MECHANICAL

ELECTRICAL

PLUMBING

FIRE PROTECTION

ARCHITECTURAL

OTHERS

REMARKS :

Rev. 0 August 27, 2019

CHECKED BY : INSPECTED BY :

PROJECT SUPERVISOR QC

APPROVED BY : NOTED BY:

VP-CONSTRUCTION OPERATIONS

NOTE : This form must be submitted to The QC TEAM, duly accomplished and signed by the corresponding
Contractor's Personnel-in-charge at least 24 hours before actual installation.

Rev. 0 August 27, 2019