Project : KAO INDONESIA - KKD PROJECT

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

Location : S-Plant area ( SX5, SY1 )

Nature of Work : Install cooper plate for lightning protection grounding system.

Drawing / Sketches No. : SD-E-SH-148, SD-E-SH-149.

Attach Checklist No. : SHIMS-E.01-KAO-13-2013

(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 / TEST RESPONSE

Inspection acceptable / test passed*, with / without* comment. Works are allowed to proceed

Inspection unacceptable / test failed*. Contractor to carry out remedial works

Re-inspection is required / Re-Testing is required

Signature : Shimizu Corporation Date:

Name :

FORM NO.: F-SHIMS-QCME-PO5-RFSI REV.0 ISSUED DATE: 5-09-12

 Project : KAO INDONESIA - KKD PROJECT.

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)

Description : Install copper plate for lightning Description : location of escavation.

protection.
3 4
Comfirmed by Comfirmed by
Shimizu Shimizu

(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)

Description : measurement for grounding Description : Resistance value.

resistance.

FORM NO.: F-SHIMS-QCME-PO5-M.03 REV.0 ISSUED DATE: 05-09-12

 Project :
Jakarta Office, 5F. MidPlaza 2 . Jl. Jend. Sudirman Kav. 10-11 Jakarta 10220, Indonesia

GROUNDING WORK INSPECTION TEST REPORT

Report No. : SHIMS-E.01-KAO-13-2013
Date : Stage 1 - Stage 2 - Stage 3
Location / Gridline : Drwg Reff. :

TYPE OF GROUNDING WORK :- (Mark where applicable)

LV/MV Electrical Grounding Computer / IT System Grounding
LV/MV Frame/Neutral Grounding Telephone / ELV Grounding
Lightning Protection/Structural Grounding Others :-
PARTICULARS OF GROUNDING MATERIAL :- (Delete where not applicable, Ensure )
Type of Joint : Exorthermic Weld / Mechanical Clamp
Grounding Conductor Material Copper / GI / Alum / Others :-
Rod, Coupler and Clamp Type :- : Copper / Steel / Others :-
Grounding Pit Material / Type (Stage 3) : Polymer / R.Concrete, Heavy Duty / Light Dity
Earth Resistance Tester(Calibration Expiry date) : (Exp Date : )
STAGE 1 - Inspection (Exorthemic Weld to Pilecap/Stump Column) :-
1). Ensure Material use according to approved type, specification. YES NO NA
2). Check Welding work are conducted according to Method Statement. YES NO NA
3). Ensure cable is in place, tied properly, lenght is sufficient for next procedure. YES NO NA
4). Record with Photo. Proceed to next stage if requirement of item 1, 2 & 3 complied YES NO NA

STAGE 2- Inspection (Exorthemic Weld to Steel Column base) :-

1). Check Welding work are conducted according to Method Statement. YES NO NA
2). Ensure cable lengh are not too long, cable insulation are intact. YES NO NA
3). Record with Photo. Proceed to next stage if requirement of item 1 & 2 complied YES NO NA

STAGE 3 - Installation of Grounding Rod, Testing of earth resistance :-

1). Ensure location and distance of grounding point as per approved drawing YES NO
2). Test Individual point according to Manual shown in Tester. Ensure all points are not connected
EARTH TEST RESULT :- Total Grounding Point :-
Grounding Depth Resistance Value Grounding Depth Resistance Value
Point of Rod (Ohm) Point of Rod (Ohm)
Earth pit No.1. Earth pit No.3.
Earth pit No.2. Earth pit No.4.
1). Loop all point together with copper wire and conduct test for overall grounding resistance value.
2). Overall Grounding Resistance Value : Ohm. Requirement : < 5 Ohm (standar IEC)
3). Test Result is acceptable or not. * YES NO *Proceed with looping cable and welding work.
4). Check Welding work are conducted according to Method Statement. YES NO NA
5). Keep all record with photo. YES NO
SUB CONTRACTOR SHIMIZU CORPORATION
Tested by : Inspected by : Reviewed by :
1) Name : 1) Name : 2) Name :
Position : ME Engineer Position : ME Engineer Position : Sr. ME Engineer (QAQC)
Date : Date : Date :
Reviewed by :
2) Name : 3) Name :
Position : Project Manager Position : Site ME Manager
Date : Date :
OWNER/CLIENT'S REP. (If Necessary) :
Witnessed by : Position :
Name : Date :

FORM NO.: F-SHIMS-QCME-PO5-E.01 REV.0 ISSUED DATE: 05-09-12