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SAMPLE CHECKLIST

1 Respective Material Transmittal Reference number: CPC07d-MT-PLM-0003 REV 1

2 Item Description: UPVC puddle pipe (no-leak flange)

3 Manufacturer name:

Weltech Vision Trading Co. W.L.L.

4 Supplier Name:

Weltech Vision Trading Co. W.L.L.

5 Specification reference:

Section 19, Part 1, item no.9, subclause E

ü
6 Is the entire set of components/parts constituting a complete sample attached to the
same display board and securely fixed? YES NO

7 Are all the components/parts in the sample board clearly identified with a label/tag
showing the component description/name and catalogue reference number ? ü YES NO

8 Is the supplier name and contact details posted on the sample board?
ü YES NO

Is the brand name and/or manufacturer name embossed or engraved on the sample
ü YES
9
items? NO

10 Are all the fields/provisions in the sample submittal form duly filled up and checked
by a QA/QC Personnel? ü YES NO

11 Is the sample submittal tag signed off by the contractors`s representative?


ü YES NO

12 Is the sample logged in the samples register along with all the relevant details?
ü YES NO

Contractor's QA/QC Manager Name and signature: Contractor's Authorized Representative Name and
Signature:

-------------------------------- Date: ______________ _________________ Date: ______________

© KEO International Consultants


CPC05-F30-Rev. 26-May-14
10/17/2018

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