OWNER

CONSULTAN SUPERVISION

CONTRACTOR

Construction of Housing in Aceh Besar, Aceh Jaya and Nias

Contract No: AJ/HCON/07/0010
Location : Desa Bak Paoh - Lamno - Naggroe Aceh Darussalam

FORMULIR INSPEKSI PENYELESAIAN RUMAH PENERIMA BANTUAN

BENEFICIARY HOUSE COMPLETION INSPECTION FORM
Penerima Bantuan

ALI BASYAH

Beneficiary

Nomor Plot : CM-037, 7B (WO,28)

Plot

Number

Desa : CRAK MONG

relocation

Village

A: Inspeksi bersama penerima bantuan

B: Jadwal Perbaikan Kerja

Inspection with Beneficiary

Remedial Work

Schedule of

C: Pekerjaan Selesai
Work Completed

Tanggal Inspeksi
Inspection Date

Hal
Detil Kerusakan

Perbaikan Kerja yg dilaksanakan

Details of Defects :

Target

Remedial Work Required

Tanggal selesai

No

Completion Date

Inspeksi Selesai
Completion Inspection

Tanggal
Date

Disetujui

Approved

by

I
tem

Saya penerima bantuan

Uraian

the beneficiary

Remarks

pemilikan rumah
a menerima
accept possession of the house
setuju utk menyediakan jalan bagi kontraktor untuk

b memperbaiki daftar kerusakan

Saya menjamin bahwa seluruh perbaikan

kerusakan sesuai dgn inspeksi
kelengkapan rumah dan telah selesai dgn
memuaskan
I

agree

to provide access to the contractor to remedy the listed defects

telah membaca dan mengerti Prosedur untuk melaporkan

c Kerusakan bangunan

certify that all remedial work required following the

House Completion Inspection has been completed
satisfactorily

have read and

understood the Procedure for reporting construction defects (Form
QA/10.3)

saya mengerti bahwa diharuskan memberi laporan

d kerusakan sebelum _________*)

understand I must report any defects before __________*)

Ditanda tangani oleh :

Signed

Tanda tangan

Nama

ECF
Disetujui Kontraktor

Contractor Agreed

Contractor Agreed

Contractor

Signed

Name :

Tanda tangan :

Signed

Name

Tanda tangan

Nama :

Sign :
Nama:

Ketua Tim ECF

Name :

ECF Team Leader

Tanda tangan :

ECF

Tanggal :

Sign :

Distribution :

ECF ; SPM ; Field Office ; File

11 bulan sejak tanggal inspeksi

*)

11 Month from Inspection

Date

Date :

Contractor ; SPM ; File.

SPM; Field Office; File

Compatibility Report for Handover checkl list 12.2.xls

Run on 13/06/2008 19:27
The following features in this workbook are not supported by earlier versions of
Excel. These features may be lost or degraded when you save this workbook in
an earlier file format.
# of occurrences
71
Defined Names

Minor loss of fidelity

Some formulas in this workbook are linked to other workbooks that are
closed. When these formulas are recalculated in earlier versions of Excel
without opening the linked workbooks, characters beyond the 255-character
limit cannot be returned.