1 Survey
- Planning Drawing
Location, number, stability and protection
1.1 Visual Check and Dimensional - Existing Utility Drawing
of coordinate and Benchmark
- Location Map
- Job Safety Analisys (JS
1.2 Stake Out Dimensional
- Work Permit
A Preparation
A1 Receiving material/component
B Fabrication
- Visual Inspection
Drawing, WPS/P
+ Fit-up & welding (if any)
- Visual Inspection
- Visual Inspection
Drawing, WPS/P
+ Fit-up & welding (if any)
- Visual Inspection
Inspection Test Plan (IT
- Visual Inspection
Drawing, WPS/P
+ Fit-up & welding (if any)
- Visual Inspection
4 Hot dipped galvanizing + Hot dipped galvanizing for steel, rebar, and pipe.
Drawing
- Visual Inspection
4 Finishing Visual
D Installation
- Visual Inspection
2 Finishing + Finishing
- Visual Inspection
Geotextile
Geotextile Woven
Installation
3.b Excavation
3.b.1 Preparation
3.b.2 Excavation
3.b.2.1 Depth and width of excavation Dimensional Drawing
Line, slope and grades according to
3.b.2.2 Survey
approved drawing
3.b.2.3 Protection of slope, accepted Visual
3.b.2.4 Surface Visual
3.b.2.5 Cleaning Visual
Subgrade Compacted
Inspection Test Plan (IT
3.c.1 Preparation
Compaction Test :
3.e.1 Preparation
4 Concrete Road
4.a. Preparation
4.e.1. Preparation
4.e.2. Installation
Location, shape, sizes, numbers, cleaning
4.e.2.1 Visual & Dimensional
and spacing of bars
4.e.2.2 Length and location of lap splice Visual & Dimensional
Rigidity of rebar assembly to withstand
4.e.2.3 Visual
concrete pouring
Strong condition (to prevent corrosion and
4.e.2.4 Visual
deformation)
4.e.2.5 Prohibiting item (ex: welding) Visual
4.f.1 Preparation
4.f.2. Installation
LEGEND:
Inspection Test Plan (IT
MRR
AWS D1.1 H W
Storage Procedure H W
Refer to Drawing & Cross
Drawing Survey report
check with Surveyor
H R
MTR
H R
Drawing, WPS/PQR AWS D1.1
H R
VWR
H R
H R
MTR
H R
Drawing, WPS/PQR AWS D1.1
H R
VWR
H R
Test Plan (ITP)
H R
Drawing Painting report
H W
Specification Standard
Drawing, Dimension, Alignment
H R
AWS D1.1 MTR, VWR
Drawing, WPS/PQR H W
H R
Bolting Report
H R
H R
DIMENSIONAL REPORT
H W
Drawing QI-S.0.02
QI-S.0.02
QI-S.0.02
QI-S.0.02
QI-S.0.02
6%
Test Plan (ITP)
QI-S.0.03
30% Procudure
"D" AND
IEW = VERIFICATION
COMMENT/ BY REPORT/
per 1000 m3 Procudure
VERIFIKASI DARI
MERIKSA DAN KOMENTAR LAPORAN
Check Survey Elevation QI-S.0.03
Procudure
Correct Survey Data
QI-C.2.01
QI-C.2.01
QI-C.2.02
QI-C.2.02
QI-C.2.02
QI-C.2.02
QI-C.2.02
Placing Duration (time),
Vibrator, Finnish as per
requerment
QI-C.2.02
Punchlist
Each Post Concrete Pouring
Work
Punchlist
Punchlist
Mill Certificate
QI-C.2.03
QI-C.2.03
QI-C.2.03
Specification Standard
QI-C.2.03
Drawing, Alignment
QI-C.2.03
QI-C.2.03
QI-C.2.02
QI-C.2.02
Attn :
Project Title :
Gentlemen,
We would like to have your presence for inspection according to the following schedules.
Comments :
Signature
Date
QI - S.0.01
Doc. No
Project no :
Subject : SURVEY DATA REPORT
Project :
Location :
Ref. Drawing :
Description :
COORD. FINAL CUT & FILL (SUB GRADE) COORD. SUB BASE B DIFFERENT ELEVATION
NO POINT DIFF.
N E N E N E SUB GRADE BASE B
Note :
Print Name
Signature
Date
Date
Page
of
REMARKS
PT. Pertamina Hulu Energi WMO
Subject :
Project :
Location :
Ref. BM :
N E Z N E Z N
10
11
12
13
14
15
16
17
18
19
20
Print Name
Signature
Date
Date
QI - S.0.02-01
Doc. No Page
of
Project no :
DIFFERENT
E Z
PT. PETRONESIA BENIMEL PT. PHE WMO
QI
Doc. No
Project no
Subject : SURVEY DATA REPORT
Project :
Location :
Ref. Drawing :
Signature
Date
Date
QI - S.0.02
Doc. No Page
of
Project no :
ACTUAL
REMARKS
7 8
of
Project No.
Subject : TRIAL MIX OF CONCRETE
Construction site
Construction section
Requirements
Impermeability to Water Class of concrete B 25
High frost resistance Required strength kg/cm2
High frost and de-icing salt resistance Consistency k
Resistance against chemical attacks Slump 5 to 10 cm
Cement content kg/m3
Fair faced concrete Water-cement ratio =
Pumpable concrete Max. size of aggregate mm
Early strength Air Content vol. - %
Concrete with low heat evolution Time for workability hours
Aggregate Type/Manufacturer/Quarry/Borrowpit
Cement manufacturing plant
Type / class of strength
Additive manufacturer
Type / Name
Cement
Water
Weight of Fresh Concrete
Concrete admixtures
Ultra fine concrete = kg/m3 Cement = kg/m3 Aggregate < 0.25 mm kg/m
Concrete
3
additive = kg/m3
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Date
QI - C.2.02
Doc. No Page
of
Project no :
Subject : POURING CONCRETE
FORMWORK REBAR
Orientation Size
Location ( Coord. ) Spacing
size Clearance
Elevation Cleanliness
Clean & Oiled
Chamfer
Bracing
EMBEDMENTS MISCELLANEOUS
Remarks :
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Date
QI - C.2.03
Doc. No Page
of
Project no :
Subject : POURING CONCRETE SLAB
Project : Location :
RESULT
NO ITEM TO CHECK DATE & SIGN REMARKS
YES N/A
1 Size/Length/Quality
5 Extra Length
9 Concrete Cover
13 Quality of Cleaning
Remarks :
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Subject : POURING CONCRETE RECORD
Project :
Location :
Cement Type :
Print Name
Signature
Date
Date OF
O
QI - C.2.04
Doc. No. Page
of
Project No. :
of
Project No.
Subject : COMPRESSIVE STRENGTH TEST
1. General
3. Test Result
Acceptable
Not Acceptable
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Date :
QI-C.2.08
Doc No. Page :
TOTAL
WITNESSED BY REPORTED BY
PT. PETRONESIA BENIMEL PT.Pertamina Hulu Energi WMO SUB KONTRAKTOR
Project : Location :
RESULT
NO ITEM TO CHECK DATE & SIGN REMARKS
YES N/A
11
12
13
14
15
Remarks :
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Date
QI - C.5.01
Doc. No Page
of
Project no :
Subject : ROAD & PAVEMENT
Project : Location :
RESULT
NO ITEM TO CHECK DATE & SIGN REMARKS
YES N/A
I BASE COURSE B
5 Final survey
Remarks :
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Date
QI - C.7.01
Doc. No Page
of
Project : Location :
0 0
¼ 0,0125
½ 0,025
1 0,05
1½ 0,075
2 0,1
3 0,15
4 0,2
6 0,3
8 0,4
10 0,5
READING
C B R VALUE
Remarks :
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
Subject : FIELD CBR TEST (SNI 1738-2011)
Project : Location :
READING
C B R VALUE
ss
Remarks :
Print Name
Signature
Date
Date
QI - C.7.01
Doc. No Page
of
lbf
50.282 lbf/div.
SKET
Remarks :
SUB KONTRAKTOR PT. PETRONESIA BENIMEL PT. Pertamina Hulu Energi WMO
Print Name
Signature
Date
FORM DATA SURVEY-CROSS SECTION
Subject :
Project : Location :
Owner : Reference Drawing :
CROSS SECTION-SKETCH