Format for information for inspection of Ongoing /Completed Word

R&b Sub Division : Umergam

R&bDivision : Valsad

PART 1-Work Information(To be filled by) :

1.0 GENERAL Workis: ONGOING COMPLETED

1.1 Date of inspection : 2/3/2020

1.2 NameOfQualityMonitor :- Shree N.G.Rathod

1.2.a :- Borlai main road to Ayatulbhai house to Shankarbhai

NameofRoad house joining Road , Ta- Umergam. Di - Valsad Start chainage :0.0

1.2.b End chainage 1.00

1.3 Package No: (Package-2) MMGSY-2018-19

1.4 Length: 1.00 Km,FlexiblePavement, 1.00 Km.C.C./OtherPavement 00 =Total 1.00 KM

1.5 Technical Sanction Cost: Rs : 2145800.00

1.6 NameofAgency : Ajay H. Thakur of Vapi

1.7 DateofStartoftheWork: 3/2/2019

1.8 Stipulated Date of Completion: 12/1/2019

1.9 ActualDateofCompletion(IfWorkCompleted):- 11/25/2019

1.1 Name of officerPresent: Shree T.A.Patel (AE)

1.11 1.11 Stage: Stage2

2.0 2.0 Provision Made

PART 'A' PROVISION MADE IN THE ABOVE WORK

Clearing & Grubbing , , WMM 150mm , Prime coat, BBC 37.50 mm .Carpet 25.00 mm , Sealcoat 0.18 Cum/10 Sqmt, Asphalt painting, Side
shoulder, Road furniture etc.

PART 'B' POSIOTION OF WORK AT THE TIME OF INSPECTION

Work is completed

3.0 INSPECTIONBYQA/QCORSENIOROFFICERSandACTIONTAKEN (if provision inspection is done)

Date Of Visit Inspected by Observation Action Taken By Office With Date

Road Furniture & Side Shoulder Complied & Rectified

PART-II- Observation of QM for Ongoing/Completed work
1.0 QUALITYARRANGEMENT-Observations(InCaseOfOngingWorkOnly) Observations :-

Engineer Present or NOT

Whether
Whether Field Laboraory Whether Necessary
Sr.No Establishment ( Y/ NO ) EquipmentsAvailable (Y/N)
Equipmentshave been
At Plant Site At Paver Site Used(Y/N)

1. ……………… Yes Yes Yes Yes

*If EngineerofAgencyisNotPresentonSiteThenProposedDissectionasperTenderClause(i.eRs 16500/-Month)

Garding : - S

2.0 ATTENTION TO QUALITY:(in Case Of Ongoing Works Only)

Observation - item 2a:Maintenance Of QC Registers:

Based on executed quantities whether all mandatory tests WhetherQCRegisterpart|maintained as per provisions
Sr No
conducts (YES/PARTLY/NO) (YES/PARTLY/NO)

1 Yes Yes

* Observation -item 2b:verification of test Results(P-Conforms,F-Does Not Conform);

Sr No Name Of Tests Results of the test TestResultasperQC Whether the test

NA NA NA NA

Grading :- NA
3.0GEOMETRICS:TheQMShouldTakeatleasttwomeasurementsin1KMlengthandiffoundthat
theRoadwayandCarriagewayisinadequate QMmaytakemoreobservation.
Observation -item 3 a:Roadway width & Carriageway.

Carriageway
Sr No Chainage Camber Super Elevation Junction Improvement Remarks
Width(m)

N.A N.A N.A N.A N.A N.A

OBSERVATION REGARDING THE QUALITY OF ITEM OF WORK;

4.0 EARTHWORK :
OBSERVATION -item 4 a:Quality of Material for Embankment/Sub Grade:

On Visual Classification Identifythegroupsymbol&Write

Location Quality of Material is acceptable(Y/N)
(Type of soll)

NA NA

Grading : - NA

OBSERVATION -item 4 b:Workmanship for Embankment and sub Grade Construction:

LABTEST(ASPerRecord) Engineer Present or NOT

Field Moisture
Sr No
Content (%)
MDD Field Density Compaction
CBR OMC % Dry Density gm/cc
gm/cc gm/cc Adequate(Y/N)

NA NA NA NA NA NA NA

Grading : - NA
OBSERVATION -item 4 c:Side,Slope And Profile:

YES NO N.A

1.Layer thickness of Spreading not Greater than 200mm. N.A

2.Rolling done by vibratory roller. N.A

3.Field Test, FDD ,& FMC is done or not. N.A

4.Register of Earthwork is Maintained or not N.A

5.Line Level,Profile,Camber& Side slope is maintained or not N.A

Grading :- NA

Sub-Base(GSB II)
Observation-QualityofmaterialandWorkmanship: IfMixmaterialisused(MixDesignisdoneornot)NO

LAB TEST (AS Per Record) Whether

Suitable
Compaction is
from
Adequate(Y/N)
Confirm s to plasticity Observedhickness Prescribed thickness
L:OCATION
Grading (Y/N) angle PI of Layer ( In mm ) Provided ( Y/N )
& LL
MDD (Y/N)
CBR OMC %
gm/cc FDD FMC

N.A N.A N.A N.A N.A N.A N.A N.A N.A N.A

Grading : - N.A

6.0 Base Course

Observation - item No 6. Quality of material and Workmanship of WBM;

Volume of
Filler material is
Aggregate filler material Whether Adequate
Location Thickness of each Thickness is non- plasic to
confirms percent of compactionis done Remarks
(Km) layer of WBM(MM) Adequate(Y/N) desired extent
Grading (Y/N ) coarse (Y/N)
(Y/N)
aggregate

NA NA NA NA NA NA NA

Grading :- NA
Observation - item No 6.(b) Quality of material and Workmanship of WMM;
IfMixmaterialisused(MixDesignisdoneornot)NO

Volume of
Filler material is
Aggregate filler material Whether Adequate
Location Thickness of each Thickness is non- plasic to
confirms percent of compactionis done Remarks
(Km) layer of WMM Adequate(Y/N) desired extent
Grading (Y/N ) coarse (Y/N)
(Y/N)
aggregate

N.A N.A N.A N.A N.A N.A N.A N.A

Grading :- N.A

7.0.BituminousCourse:PremixCarpet/SurfaceDressing/BM/BUSG/SealCoat/MSS;
QualityofMaterialAndWorkmanshipofBTLayer(InCaseofongoingWorks):

Whether Coarse
Write Mixing Temperature and Whether it
Sr No Location Aggregate confirm to WhethertheBinderisof approvedgrade(Y/N)
is in Permissible limits.(Y/N)
( Y/N)

N.A N.A N.A N.A N.A

7.0A Plant Site

Yes NO N/A

1.0 Laboratory at plant Site Established N.A

2.0 Test Perform at Plant Site Lab N.A

2.1 Binder Content With Gradation N.A

2.2 Dry Mix Gradation N.A

2.3 Aggregate Test N.A

2.4 Bitumen Test N.A

2.5 Regular Temperature Check/Record N.A

3.0 Calibration of Asphalt Tank is done N.A

4.0 Temperature for Asphalt Mix Material N.A

4.1 Temperature for Asphalt Tank N.A

5.0 Technical Person for Testing Available or Not N.A

6.0 Vibrator Sensor Plate for Over Size Material N.A

7.0 B : Paver Site

Yes NO N/A

1.Required Roller is Available on site N.A

2.Temperature Of Mix Material at Laying N.A

2.1 Camber Board Available or Not Y

2.2 Site Cleaning is Properly Done Y

2.3 Technical Staff / Sufficient Labour Available Y

2.4 Spreading of Tack Coat N.A

7.0 C : Bitumen Extraction Tests Performed at Plant Site at the time inspection:

Wt of Mix % % Asphalt
Wt of Mix Without % Asphalt w.r.t
with Asphalt Wt.ofAsphalt(gm) Asphalt w.r.t Mix reqd.asper Remarks Pass/Fail
Asphalt(gm) Aggregate
(gm) Specification

N.A N.A N.A N.A N.A N.A N.A

 Grading :- NA

8.0 Observations-WorkmanshipofBTlayer(Incaseofcompletedworks):(PaverSite)FOR : BBC

Thickness
Whether Surface Write laying
evennessis within andwhether it is in
Sr No Location (Km) acceptable limit permissible limit Remarks
Whether
Thickness in (Y/N) (Y/N)
Thickness is
mm
adequate(Y/N)

N.A N.A N.A N.A N.A N.A N.A

Grading :- NA

8.0. B Observations - Workmanship of BT layer(In case of completed works):(Paver Site) FOR : Carpet

Thickness
Whether Surface Write laying
evennessis within andwhether it is in
Sr No Location (Km) acceptable limit permissible limit Remarks
Whether
Thickness in (Y/N) (Y/N)
Thickness is
mm
adequate(Y/N)

N.A N.A N.A N.A N.A N.A N.A

Grading :- NA

8.0 C Observations-WorkmanshipofBTlayer(Incaseofcompletedworks):(PaverSite)FOR:Sealcoat

Thickness
Whether Surface Write laying
evennessis within andwhether it is in
Sr No Location (Km) acceptable limit permissible limit Remarks
Whether
Thickness in (Y/N) (Y/N)
Thickness is
mm
adequate(Y/N)

N.A N.A N.A N.A N.A N.A N.A

Grading :- NA
9.0 Observations - item No.8,Quality of Shoulders(In Case of completed Works.)

Whether Quality of Material is as Per

Sr No Location Shoulder Material Whether Camber is Maintained(Y/N)
Specification

1 0/370 Hard Murrum Y Y

10.0 Cross Drainage Works:

Whether general Quality of Workmanship

Whether general Quality of the
is Acceptable.
Sr No Location Type Of CD material is acceptable (Y/N)
(Y/N)

NA NA NA NA NA

Grading :- NA

11.0 CC Pavements

Thickness

General Quality of material is General Quality of workmanship

Sr No Location (Km)
acceptable. (Y/N) acceptable(Y/N)
Thickness in Acceptable
mm (Y/N))

NA NA NA NA NA NA

Grading :- NA

12.0 Road Furniture and Marking:

A Fixed Or Not Quality as per Specification

Village Name Board YES YES

Road Sign Board No

Junction Board No

Guard Stone/indicator Stone: No

200M Stone Fixed: YES YES

Km Stone Fixed YES YES

Logo Board YES YES

Main Information Board YES YES

Citizen Informatory Board No

 Grading :- S

13.0 Other Observation, If Any

14 .COMPLIANCE FOR FOLLOWING OBSERVATIONA REREQUIRES

1 ) Para Nos. N.A

15.0 GeneralObservationofSQL(Including the observations made during the interaction with PIU Staff and
contractor's/Consultant's Engineers):

Work is completed with Satisfaction.

15.1 Observation about deficiency in project preparation (Give details observation about deficiencies in generalanditems
whichhavebeenleftbutarerequiredaspersitecondition)

-> NA

15.2 Whether thework has been complete or is in progress as perwork program or delay has occurred.if delay has occurred,whether the
liquidated damages have beenwithhold or recovered

-> Yes

15.3Whethertheworkhasbeencompletedwithinthesanctioncost,ifnotwhatistheactiontakenbythe PIU(incaseofcompleteworks).

-> Yes

15.4Observation about the action taken by PIU on the inspecting officers including SQMs and NQMs.(Clearly offer comments about the
action on the observation f Department officers,State Quality Monitors)

-> NA

15.5 CommentaboutdifferenceinobservationmadebyNQMs/SQMsinearlierinspection(theNQMShall
StudyearlierinspectionreportofNOMs/SQMs.ifAnyadnhisClearCommentsaboutthedifferencesin observation,if any)

-> NA

Grading :- S

Agency Rating : A

Signature: Signature:

OfficerPresent:Shree T.A. Patel (A.E.) Shree N.G.Rathod

 Overall Grading ofWork

The overall grading calculated on the basis of item and sub item wise grading is given below:

Sr.no Item Sub Item Awarded Grading

1 Quality Arrangements ------- S

(a) Maintenance of QC register S

2 Attention to Quality
(b) Verification of tests results S

3 Geometric (a) Roadway width & Carriageway S

(a) Quality of Material NA

4 Earthwork (b) Testing of Material NA

(c) Workmanship NA

5 Sub Base – GSB ----- NA

(a) Base Course - WBM NA

6 Base Course
(b)Base Course - WMM NA

Quality of Material NA

(a) Information and tests at plant site NA

7 Bituminous Course
(b) Information and tests at paver site NA

(c) Bitumen Extraction test NA

(a) Bituminous Course A NA

8 Bituminous Course (b) Bituminous Course B NA

(c)Bituminous Course C NA

9 Side shoulder ------- S

10 Cross Drainage Works ------- NA

11 C.C. Pavements ------- NA

12 Road Furniture ------- S

Overall Grading S