REQUEST FOR INSPECTION

Trading & Supply Operations Engineering

Pilipinas Shell Petroleum Corporation
VERSION 1.0 / February 2016

REQUEST NO.:

ITP NO.:

DATE:

PROJECT NAME:

PROJECT LOCATION:

DATE/TIME OF REQUEST:

DATE/TIME OF INSPECTION:

REQUESTED BY:

REQUESTED TO:

LOCATION(S) OF INSPECTION / TEST:

DURATION OF INSPECTION / TEST:

TYPE OF INSPECTION:
REVIEW

WITNESS POINT

MECHANICAL

HOLD POINT

PIPING

APPROVAL

CIVIL

STRUCTURAL

FINAL INSPECTION

ELECTRICAL/ INSTRUMENT

DISCIPLINE / SCOPE
OTHERS (PLEASE STATE) _______________________________________________________

NON-DESTRUCTIVE
INSPECTION / TEST /
EXAMINATION

DESTRUCTIVE

OTHERS (I.E. VISUAL, DIMENSIONAL, PHYSICAL, TESTING, ETC.) __________________________

DESCRIPTION OF ITEM /
SCOPE / ACTIVITY TO
BE INSPECTED OR
TESTED OR EXAMINED
INSPECTION CONFIRMATION
QA-QC INSPECTOR SIGNATURE

Signature over printed name / Company / Contact Number

CLIENT OR REPRESENTATIVE SIGNATURE

Signature over printed name / Company / Contact Number

Issuance of this form by the Contractor indicates that the Contractor has reviewed its own work and found to be complete and in
compliance with the Contract Documents.
Normal inspection hours are Monday through Friday from 9 a.m. through 4 p.m. Contractor to provide this form to PSPC or
representative one or two working days before the date the inspection is requested.
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Version 1.0 / February 2016

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