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Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT


DILG - NAPOLCOM Center, EDSA Corner Quezon Avenue, Quezon City
www.dilg.gov.ph

MONITORING FORM
(FOR ROADS AND BRIDGES)

Date of Inspection: _____________

Proponent LGU : ____________________________


(Municipality/City/Province)
Program / Project : KALSADA/CMGP PAMANA SLRF BUB
ADM
Funding Year : 20___

Project Name : _____________________________________________


_____________________________________________
Project Location : _____________________________________________
Project Description : _____________________________________________
Mode of Implementation : By Contract By Administration
If by Contract, indicate name of Contractor: __________________________________
NG Project Allocation : PhP _______________ Date received: ____________
LGU Equity : PhP _______________
Total Project Allocation : PhP _______________
Contract Amount : PhP _______________
Station Limits : _____________________________________________
Project Description : _____________________________________________
Target Start Date : _________ Target Completion Date : __________
Actual Start Date : _________ Actual Completion Date : __________

Previous Accomplishment : ____________________ (%)


Date of Previous Inspection : ____________________ (%)

Projected Accomplishment as of date of visit : ________ (%)


Actual Accomplishment as of date of visit : ________ (%)
Variance : ________ (%)

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INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
A. FACILITIES FOR THE ENGINEER
Provision of Office and Laboratory for the
Engineer (including provision of suitable
utilities and services such as, but not limited
to electricity, water, supplies, lab equipment,
sewerage, security)
Provision of Service Vehicle for the Engineer
Provision of Assistance to the Engineer
(including use of equipment, instruments,
apparatus, all information and records and
qualified chainmen and laborers required by
the Engineer for inspecting and measuring the
Works
Photographs (taken before, during and after
works)

B. OTHER GENERAL REQUIREMENTS


Installation of Project Billboard as per COA
Circular 2013-004
Provision of Offices, Shops, Stores and
Workmens Accommodation for the
Contractor
Provision of Medical Room and First Aid
Facilities
Conduct of Construction Survey and Staking
(including locating, recording of data such as
horizontal and vertical control points,
elevations, coordinates and calculations
necessary to construct the road project in
accordance with the approved Plan, slope
stakes and references, clearing and grubbing
limits, centerline reestablishment, staking of
culverts, grade finishing, RROW and
construction limit, etc.)

C. WORKMANSHIP
Item 100 Clearing and Grubbing, Item 101
Removal of Structure and Obstruction
Set construction limits
Traffic Management
Proper removal of undisputed stumps roots
and non-perishable solid
objects/structures, vegetation, debris,
tree, and other obstructions (within
carriageway)
Conformance to proper disposal

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INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Item 102 Excavation, Item 103 Structure
Excavation
Conformance with approved/specified
tolerances for lines, grades, cross-section,
elevation, & dimensions (if no longer
correctible), e.g., with in-placed structure)
Adherence to proper construction
methodology
Conformance to proper disposal
Item 104 Embankment, Item 105 Subgrade
Preparation
Proper construction methodology applied
and compaction trials completed prior
before commencing subsequent sections
All culverts, cross drains, ducts, and the
like, ditches, drains and drainage outlets
have been completed
Conformance with approved/specified
tolerances for lines, grades, cross-section,
elevation, & dimensions.
Adherence to compaction procedure and
required equipment
SUB-BASE/BASE COURSE/Item 200,
Aggregate Sub-Base Course, Item 201 Agg.
Base Course, 202 Crushed Aggregate Base
Conformance of in-placed materials to
plans and specifications
Adherence to proper construction
methodology
Conformance with approved/specified
tolerances on lines, grades, cross-section,
thickness, elevation, dimensions & plans.
Conformance to the required compaction
Conformance to required layering
Provision of required stakes
Item 311 Portland Cement Concrete
Pavement (PCCP)
Non-appearance of longitudinal cracks
Conformance to vibration requirement
Conformance to quality of concrete mix
Conformance to requirements of
construction joints (outside middle thirds)
Non-appearance of through cracks
(all types of cracks)
Free of scaling (severe, needs removal
and replacement)

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INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Conformance to the approved/specified
tolerances for thickness, width, length,
slope, and cross-section (>10% deficient)
Non-appearance of honeycomb
Conformance to required size, location &
spacing of tie bars and dowel bars as per
specifications
Three (3) concrete beam test specimens
(150x150x525mm) have been made,
cured and have passed required tests for
every 330sq.m of pavement
Free of spalling
Free of chipped-off edges
Conformance to proper curing procedures
Conformance to required amount of
asphalt sealant on weakened plane joints
(insufficient and excessive application)
Conformance to requirement of pavement
blockings (include depths and widths of
weakened plane joints)
Conformance to proper finishing of
concrete (brooming)
Conformance to formworks requirements
(wooden, defective steel and not applied
with oil/grease)
Item 400-3, Concrete Piles (Bridges)
Conformance of in-placed materials to
plans & specifications
Conformance to splicing requirements
Conformance to the required length, width,
thickness, and/or diameter
Provision of pile shoe
Non-appearance of through cracks
Non-appearance of honeycomb (exposed
rebars/aggregates)
Piles provided with gradation marks
(driven)
Conformance to proper installation, e.g.
conformance to required slope,
embedment, alignment, plumbness
(>20mm/m), elevation, location
(>150mm) & spacing
Item Railings 401-1, 401-3, 401-4, 401-5
Conformance of in-placed materials to
plans & specifications
Conformance to alignment & jointing
requirement

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INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Free of Corrosion
Free of rust
Free from damage to painting and
galvanized coating
Adequacy of bolts and nuts
Conformance to finishing requirement
Conformance to required quality of mortar
mix, CHB, stones, aggregates & boulders
Non-appearance of cracks
Sufficiency of mortar
Conformance to required quality of
concrete mix

Item 404 Reinforcing Steel


Materials have passed strength test
Order list and bending diagram approved
by Engineer

Reinforcing steel stored above the surface


of the ground using platform or other
supports
Reinforcing steel properly placed, spliced
and fastened
Quantities properly calculated

Item 405 Structural Concrete


Materials (cement, sand, gravel, water,
reinforcing) have passed quality or
strength test
Three (3) concrete cylinder test specimens
(150x300mm) have been made, cured and
have passed required tests for every 75
cu.m. of concrete or fraction thereof placed
each day
Quantities properly calculated

Item 407 Concrete Structures


Materials (cement, sand, gravel, water,
reinforcing) have passed quality or
strength test
Three (3) concrete cylinder test specimens
(150x300mm) have been made, cured and
have passed required tests for every 75
cu.m. of concrete or fraction thereof placed
each day
Alignment and dimensions in accordance
with plans

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INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Quantities properly calculated
Item 500 Pipe Culverts and Storm Drain
Conformance to the required/approved
tolerance for slope, alignment, elevation
and dimensions
Non-appearance of cracks, honeycombs,
chipping of edges
Compliance to joint mortar mixing
proportions
Sufficient collaring and flushing
Compliance to the required thickness,
compaction & materials requirement of
gravel bedding
Compliance to the required thickness &
compaction of backfill
Conformance to trenching requirements
Free from debris, siltation, etc.
Item 505, 506, & 507
Non-appearance of through cracks
Conformance to specifications (size, type,
weight, etc. of boulders)
Sufficient grout/mortar
Observance to proper placing of
stones/boulders
Conformance to the approved/required
tolerance for slope and thickness
Compliance to the specified compaction
and preparation of bedding
Adequate and proper spacing of weepholes
Compliance to design mix of mortar
Conformance with approved tolerance for
lines, grades, cross-sections and
elevations.
Item 508
Conformance to the required size of
boulders
Observance to proper placement of
stones/boulders
Conformance to the approved/required
tolerance for length, slope, and thickness
Item 510 (Concrete Slope Protection)
Non-appearance of honeycomb (exposed
rebars/aggregates)
Non-appearance of through cracks
Non-appearance of honeycomb
Conformance to the required curing
Proper vibration

6 of 10
INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Proper finishes/plastering
Non-appearance of corrosion on steel bars
Forms applied with specified form oil
Conformance to the required splicing and
installation of rebars
Adequate and proper spacing of weepholes
Item 603-1, 603-2 (Steel and Concrete Guard
Rail)
Conformance to the required/approved
tolerance for lines, grades and dimensions
(>6%)
Sufficient paint
Sufficient galvanizing
Non-appearance of rust on steel
Conformance with the design and location
as shown on the plans
Conformance to required installation
(lapping, provision of bolts, nuts, &
washers)

Item 603-4 Masonry


Conformance to the required quality of
mixture
Conformance to the required quality of
CHB, stones and boulders
Conformance to the requires/approved
tolerance for lines, grades and dimensions
Non-appearance of cracks
Conformance to the design and location as
shown on the plans
Item 604 Fencing, Item 605 Road Sign, Item
606 Pavement Markings, Item 607 Reflective
Pavement Studs
Conformance to the required materials for
road signs pavement markings and
reflective pavement studs
Proper preparation of pavement surface
prior to paint application (Item 606)
Conformance to provisions stipulated in
the DPWH Standard Specifications for
Public Works & Highways, Vol. II, 2013
Non-appearance of Cracking, peeling off
of paints
Item 900 Formworks
Conformance to the required type of
formworks in accordance with approved
shop/working drawings

7 of 10
INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Forms coated with mould oil as required
Sufficient bracing/support provided
Free of loose knots, splits, cracks, etc.
Provision of required concrete or steel
spacer
Conformance to dimensions, location,
plumbness and alignment
Provision of camber during construction
stage
Item 901 Reinforcing Steel Bars
Conformance of in-placed materials to
plans and specifications
Non-appearance of corrosion on steel
reinforcement
Non-appearance of rust on steel
reinforcement
Conformance to approved bar cutting
schedule, proper spacing, anchorage,
adequate reinforcements
Non-appearance of oil, paint and other
deleterious materials on reinforcements
Conformance to jointing requirement, i.e.
splicing, welding, etc.
Conformance to the required installation of
ducktube e.g. (spacing, location and
distance)
Conformance to the required steel plate
and lock
Conformance to the number of bundles of
tendons and number of pieces of bundles
of tendons
Item 902 Concrete Works
Non-appearance of through cracks
Non-appearance of honeycomb or spalling
(no exposed rebars/aggregates)
Free from sagging or bulging
Conformance to the required quality of
concrete mix
Provision of camber for RCDG
(Reinforced Concrete for Deck Higher)
Free from chirping off of concrete cover
Proper and adequate vibration
Conformance to finishing/plastering
requirement
Conformance to the required concrete
cover for rebars

8 of 10
INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Conformance to the batching, mixing,
transporting and discharge time
requirements
Conformance to placing requirement that
will not result segregation of aggregates,
cold joints and misalignment
Conformance to the jointing requirement
Proper curing
Conformance to the required dimensions,
lines, grades/elevation locations and crown
(for pier)
Non-appearance of water ponding on
bearing plates
Conformance to elevation of expansion
joints

D. MATERIALS
Materials complied and passed test
requirements with Philippine National
Standard (PNS)/Import Commodity
Certificate (ICC) and/or specified
type/class/brand
Materials are correctly stored and handled
to prevent damage, deterioration and theft
Non-conforming materials are identified
and segregated against inadvertent use
Evidence is supplied to verify that
specified materials were used in the
project
Materials records are clearly legible,
complete, traceable to project and readily
available

E. SAFETY AND HEALTH


Appropriate personal protective equipment
(e.g. helmets, safety shoes, safety
belt/lifeline, eye protection, ear plug, dust
mask, etc.) provided and worn by all
workers/staff
Heavy equipment operated by
certified/qualified operators only
Critical construction work done by
certified/qualified skilled workers only
Heavy equipment are tested and certified
to be in good running condition

9 of 10
INDICATOR YES NO REMARKS OR
RECOMMENDATIONS
Safety practices and procedures in general
construction observed and implemented
at construction site (electrical, fire
protection, lighting, construction of safe
walkways, protection from falling
materials, shoring, scaffolding, etc.)
First aid cabinets are fully equipped and
readily available for treatment of
sicknesses and injuries
SH signs are clearly visible to construction
staff, workers and public
F. RESOURCES DEPLOYMENT
Pledged materials as per updated
PERT/CPM or Program of Work were
delivered at site on time.
Pledged materials as per updated
PERT/CPM or Program of Work were
delivered at site on time.
Pledged manpower as per updated
PERT/CPM or Program of Work were
mobilized at site on time.
Presence of Materials Engineer
G. OTHER CONTRACT DOCUMENTS
Contract Plans available on site
Contractors Organizational Chart available
on site
Materials Log Book
Approved Variation Order (if any)
Approved Contract Time Extension (if
any)
Shop Drawings for VO (if any)
Site instructions
Approved work request
Minutes of the meetings and attendance
sheet
H. TIME
On or ahead of schedule per approved Bar
chart & s-curve
Delayed physical accomplishment per
approved bar chart & s-curve
a. If delayed (5% or less) Cause of delay:

Delay fault of:

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Action Taken/Corrective
Measures:

b. If delayed (more than 5% - less than 15%) Cause of delay:

Delay fault of:

Action Taken/Corrective
Measures:

c. If delayed 15% or more Cause of delay:

Delay fault of:

Recommended Actions:

List of documents to be secured during inspection/monitoring:


1. Contract documents
2. Correspondence
3. Approved construction plans
4. PERT/CPM, Bar chart/S-curve
5. Test result conducted (Materials/Concrete Sample/FDT, etc.)
6. Updated Statement of Work Accomplishment (SWA)
7. Approved Variation Order/Time Extension/Suspension (if any)

11 of 10
Prepared by:
LGU Representative present Contractor Representative present (DILG Inspectorate Team)
during the inspection: during the inspection: during the inspection:

_____________________ ______________________ _____________________

_____________________ ______________________ ______________________

_____________________ ______________________ ______________________

Noted by:
______________________
(Project Manager/PDMU Chief)

Comments / Suggestions for the Monitoring Form (for Roads and Bridges)
- Include tick box for program and funding year
- Include date of inspection
- Include tick box for mode of implementation
- If by contract, provide space for name of contractor
- Include project allocation, contract amount, LGU equity
- Include previous accomplishment (and date inspected)
- Insert a general requirements e.g. project billboard, facility for the engr.
- Indicate page number
- Delete the word no in some of the indicators
- Header and footer per page
- Include names of inspectorate teams
o DILG
o LGU
o Contractor
- Check the letter head (address and email address of the user or DILG-CO?)
- To be used for small ticket road projects only (5M and below)
- From DILG-RO: include name of LGU Representative and Contractor Representative
during the visit and let them sign this form (Conforme / Concurred)
- From DILG-CO: It is better if we do not require the LGU and Contractor
Representative to sign because we still need to conduct QA, after QA, only then we
can officially transmit the findings to the LGU
- From DILG-CO: We can include the names of the LGU and Contractor
Representative, however, they do not need to sign on the document as Conforme /
Concurred

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