REQUEST FOR INSPECTION FORM C&S

TO: ______________________________________ Ref. No: ___________________________

Attention: ________________________________ Date: ______________________________
_________________________________________________________________________________
Request By: Received By:
Name: ___________________________________ Name: ______________________________
Company: ________________________________ Company: ___________________________
Time: ________________ Date: _____________ Time: ______________ Date: ___________
The following works are / will be ready for inspection at_____________(time) on___________(date)
CONCRETE REPLACEMENT CHECKLIST
Location
Block : ________________________ Date : ___________________
Zone / grideline : _________________________ Estimated
Conc Vol : ________________m3
Level : _________________________ Grade : ___________________
Structure/element : _________________________ Pour date/time: _______________
Item to be checked before approval is given Signature & Date
Contractor Consultant
Setting Out and Alignment
Foundation (Clean up or Compaction)
Forms – Clean up or coatings (Oil or Sealer)
Foam insulation in place
Steel reinforcement
Water stop
Metal tiles & anchorages
Equipment embedment (anchor bolts, etc)
Polythene sheeting in- place (paving)
Anti-termite
Electrical earthing
Pour clean-up (washed out, blow out)
Lighting for night placement
Vibrator & spares, other auxiliary equipment
Access for concrete trucks
Curing (water or membrane forming)
Opening / Pipe sleeves for fire protection
Opening / Pipe sleeves for communication
Opening / Pipe sleeves for sanitary
Proper installation for electrical conduit
Proper installation for gas supply
We confirm that all the above work were in compliance with the contract document. We request to proceed with the concreting work.
________________________________________ Name : Date :
(Contractor’s Representative)
For Consultant use only
Confirm
_____________________________ _________________________ ________________________
(Architectural Consultant) (M&E Consultant) (C&S Consultant)
Name : Name : Name :
Date : Date : Date :
TO BE COMPLETED BY CONTRACTOR AT COMPLETION OF CONCRETE POUR
Test Cube No :
Concrete batch number :

_________________________________ _______________________________________
Contractor’ s rep C&S RE/COW
Date : Date :