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Jakarta Office, 5F. MidPlaza 2 . Jl. Jend. Sudirman Kav. 10-11 Jakarta 10220, Indonesia
REQUEST FOR SITE INSPECTION ( RFSI )
Report No. : SHIMS-RFSI-KAO KKD IND-07-2013
Sub-Contractor : Kinden Indonesia
Services : Electrical
The following works / tests are ready for inspection / will be conducted
at ________ on April ____, 2013.
DESCRIPTION OF WORKS
Nature of Work : Install cooper plate for lightning protection grounding system.
(Note: Where required, include details of products, labour and equipment to be used)
Submitted by Received by
Signature : Signature :
Name : Name :
Time / Date : Time / Date :
Inspection acceptable / test passed*, with / without* comment. Works are allowed to proceed
Name :
Jakarta Office, 5F. MidPlaza 2 . Jl. Jend. Sudirman Kav. 10-11 Jakarta 10220, Indonesia
SITE GENERAL REPORT
Inspection Date : April 1, 2013. Report No. : SHIMS-M.03-KAO KKD Ind.-13-13
Location : S-Plant area ( SX5-SY23 ). Inspected By : Sonny U.
No. Install copper plate for lightning protection. No. Install copper plate for lightning protection.
1 2
Comfirmed by Comfirmed by
Shimizu Shimizu
(Sign) (Sign)
(Sign) (Sign)
Description : Install copper plate for lightning Description : Inspect and test with Shimizu staff.
protection.
5 6
Comfirmed by Comfirmed by
Shimizu Shimizu
(Sign) (Sign)
Description : Install copper plate for lightning Description : Visual check by shimizu staff.
protection.
7 8
Comfirmed by Comfirmed by
Shimizu Shimizu
(Sign) (Sign)