Report No.

Concrete repair defects inspection sheet HCMC Urban Railway Construction Project Ben
/ Biên bản nghiệm thu sửa chữa khuyết tật Thanh – Suoi Tien Section (Line 1)
bê tông. Contract Package-3: E&M, Rolling Stock, Track
Work, Maintenance

Sub - System Name Trackwork Manufacturing quality plan N MQP-TK-001-A

Supplier/ Manufacturer: P.S. Mitsubishi Construction

NCR Ref No.

Item description
Quantity of sleeper: Elevated: Number:
Ballast: Number:
Underground: Number:
Inspection Date

Used measuring and test equip

ITEM ACTIVITY PASSED FAILED REMARKS

1 Verify the repair method has been approved * *

Check the surface has been proper chipped off to the sound
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concrete level and cleaned * *
Check the bonding agent has been applied as per
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specification * *
4 Proper formwork (if any) been provided * *
5 Verify proper mixing of repair material has been carried out * *
Check the placing application of repair material done as per
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specification * *
7 Curing compound has been applied as per required * *
8 Check if the surface has been finished to match the existing * *
Verify required strength of repaired materials have been
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reached prior to storage/ shipping out * *
10 Check the work is acceptable and the NCR can be closed * *
2. Comments Remark/ Ghi chú:

3. Conclusion/ Kết Luận: all the above activities in the checklist fully complied

Acceptance (Nghiệm thu): □ Accepted (Chấp thuận) Not accepted (không chấp thuận)
 PERFORMED BY CHECKED BY APPROVED BY
Position Position Position
Name Name Name

Date Date Date

tion Project Ben
1)
ng Stock, Track

MQP-TK-001-A

REMARKS
VED BY
 Sleeper coding indentification works report
/ Báo cáo công tác nghiệm thu số hiệu .

Sub - System Name Trackwork

Supplier/ Manufacturer: P.S. Mitsubishi Construction

Quantity of sleeper:
Lot 1 [E] (00001~01000)
(to be reported every Lot)

Reference benchmarks
From: Km
(Chainage, precast segment No. etc,…)

Inspection Date 9/18/2018

Slightly faded out

Totally Visible (can be immediately Partly missing
SN. identified on site)

Sleeper Code FW No. Sleeper Code FW No. Sleeper Code FW No.

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 Report No.

HCMC Urban Railway Construction Project Ben Thanh – Suoi Tien Section (Line 1)
Contract Package-3: E&M, Rolling Stock, Track Work, Maintenance

To: Km

Completely
disappeared REMARKS
(Chainage, precast segment No. etc...)

FW