Cilacap RFCC Project

BRICK AND BLOCK WORK

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Project / No.

Report No.

Area / Unit

Date

Location

Sub. Cont

No.
1

Result

Check Item

Accept

Reject

of

Remarks

Brick and Block Work

1.1 Material
1.2 Layer Number of one Day
1.3 Requirements for Reinforcement and Tie
1.4 Location of Door and Window

Notes :

Prepared By

Inspected By

SUBCONTRACTOR

ADHI-GS E&C

Witnessed By

PERTAMINA/PMC

Name :

Name :

Name :

Date :

Date :

Date :
Form No: BL-01

Cilacap RFCC Project

WATER PROOFING

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Project / No.

Report No.

Area / Unit

Date

Location

Sub. Cont

No.
1

Result

Check Item

Accept

Reject

of

Remarks

Water Proofing
1.1 Material
1.2 Dry Surface for Laying Proofing
1.3 Overlap for joint
1.4 Laying of Insulation Board

Notes :

Prepared By

Inspected By

SUBCONTRACTOR

ADHI-GS E&C

Witnessed By

PERTAMINA/PMC

Name :

Name :

Name :

Date :

Date :

Date :
Form No: BL-02

Cilacap RFCC Project

DOOR, WINDOW AND PARTITION
Project / No.

Report No.

Area / Unit

Date

Location

Sub. Cont

No.

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Result

Check Item

Accept

Reject

of

Remarks

Door, Window, Partition (Wood, Aluminium, and other

non Wood Material)
1.1 Type and Size
1.2 Fixed Condition of Glass
1.3 Cleaning
1.4 Functional Test

Notes :

Prepared By

Inspected By

SUBCONTRACTOR

ADHI-GS E&C

Witnessed By

PERTAMINA/PMC

Name :

Name :

Name :

Date :

Date :

Date :
Form No: BL-03

Cilacap RFCC Project

WALL, CEILING & FLOOR FINISHING
Project / No.

Report No.

Area / Unit

Date

Location

Sub. Cont

No.
1

Page :

Result

Check Item

Accept

Reject

of

Remarks

Water Proofing
1.1 Material
1.2 Dry Surface for Laying Proofing
1.3 Overlap for joint
1.4 Laying of Insulation Board

Notes :

Prepared By

Inspected By

SUBCONTRACTOR

ADHI-GS E&C

Witnessed By

PERTAMINA/PMC

Name :

Name :

Name :

Date :

Date :

Date :
Form No: BL-04

Cilacap RFCC Project

CARPENTER AND JOINER

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Project / No.

Report No.

Area / Unit

Date

Location

Sub. Cont

No.
1

Result

Check Item

Accept

Reject

of

Remarks

Carpenter and Joiner

1.1 Material
1.2 Setting Position
1.3 Joint Type
1.4 Appearance of Finish

Notes :

Prepared By

Inspected By

SUBCONTRACTOR

ADHI-GS E&C

Witnessed By

PERTAMINA/PMC

Name :

Name :

Name :

Date :

Date :

Date :
Form No: BL-05

Cilacap RFCC Project

ROOFING AND CLADING

Page :

Project / No.

Report No.

Area / Unit

Date

Location

Sub. Cont

No.
1

Result

Check Item

Accept

Reject

of

Remarks

Roofing and Cladding

1.1 Material
1.2 Setting Position
1.3 Joint Type
1.4 Appearance of Finish

Notes :

Prepared By

Inspected By

SUBCONTRACTOR

ADHI-GS E&C

Witnessed By

PERTAMINA/PMC

Name :

Name :

Name :

Date :

Date :

Date :
Form No: BL-06