Consultant's

Logo Request for Work Activity

PMD | Construction Management

Date:
Project/
Contract No:
Contractor:
Location:

Description of Work
Pipe Interconnection with Water Interruption Valve Insertion with Water Interruption Plant Shutdown: (Please specify.)
Flushing & Disinfection Leak Repair with Water Interruption Electrical Works: (Please specify.)
Decommissioning with Water Interruption Repair of Equipment: (Please specify.) Others: (Please specify.)

1. REQUEST (To be filled up by contractor. Request must be submitted ___ days before the schedule date of the activity.)
I hereby request to proceed with the work activity and I certify that works have been prepared Checklist of Minimum Required Documents
in accordance with the requirements of the approved Drawings and Technical Specifications. I Please check the needed documents and put “N/A” if not.
also understand that only authorized representatives from End User/s are allowed to operate Hourly Schedule of Activities
Work Methodology
any existing valves/ equipment if the work activity necessitates so. Manpower and Equipment Schedule
Approved Drawings
Submitted by: Materials List (with report from QA if applicable)
Risk Assessment, Mitigation & Contingency Plans
Coordination Meeting Minutes
Name & Signature/Date Equipment Inspection Report (for Refurbishment
Project Manager Work)
Others: (Please specify.)
Contractor
2. APPROVAL
A joint inspection was conducted on (Specify Date, Day & Time) to confirm the readiness for the above work activity.
The location has been confirmed to be ready & complying with the requirements of the approved Drawings and Technical Specifications.
Contractor is hereby allowed to proceed with the activity/ies on (Specify Date, Day & Time).

Approved by:

Name & Signature/Date Name & Signature/Date

CM/PM – Consultant/ Head, PMD-Construction Unit Head, Department/Business Unit
Project Implementer End User/s

Remarks:
______________________________________________________________________________________________
______________________________________________________________________________________________
3. CONFIRMATION
This is to confirm that the work activity was completed on (Specify Date, Day & Time) and was done in accordance with the approved
Drawings & Technical Specifications and agreed Work Methodology.

Confirmed by:

Name & Signature/Date Name & Signature/Date Name & Signature/Date

Contractor Project Implementer End User/s

PMD-OP-CON- MAYNILAD WATER SERVICES, INC. MWSS COMPLEX, KATIPUNAN AVE., BALARA 1105 QUEZON CITY, PHILIPPINES
01F60CS
Revision 0 TEL. NO. +632 981 3481; 981 3484 or 981 3486
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