TOKYU-WIKA JOINT OPERATION

Surface Section CP101 & CP102

Construction of Jakarta Mass Rapid Transit Project

REINFORCEMENT CHECKLIST / CHECKLIST PEMBESIAN

Lot No. /No. lot : Identification No. /Nomer Identifikasi :

Location /Lokasi : Contractor/Subcontraktor/Kontraktor/Subkont.
Type of Element /Type struktur : RebarCheck
Supplier Name /Nama Pabrik Penyuplai Besi :
Required
/Pengecekan NC /
diperlukan C/ Date Remarks
ITEMS TO BE CHECKED /ITEM YANG DI CEK Tidak Initial /Paraf
Yes No Sesuai /tanggal /Keterangan
Sesuai
/ya /tidak
A Survey and Rebar Checks /Pengecekan survei dan pembesian
A.1 Drawing Check/Gambar
A1.1 Drawing status approved for construction /Status Gambar
telah disetujui

A.2. Prepour Survey Check /Pengecekan data ukur sebelum

pengecoran
A.2.1 Alignment of structure checked /Alinyemen struktur sudah
sesuai
A.2.2 Positon and Levels checked /Posisi letak dan elevasi sudah
sesuai
A.3. Rebar check /Pengecekan Pembesian
A.3.1 Bars received from approved supplier / Besi yang
digunakan berasal dari pabrik penyuplai yang disetujui
A.3.2 Bar dimension (dia, length) checked /Dimensi
pembesian(diameter, panjang) sudah sesuai
A.3.3 Bar shape, bend checked /profil dan bengkokan pembesian
sudah sesuai

A.3.4 No. of bars checked /Jumlah pembesian sudah sesuai

A.3.5 Position & spacing of bars checked /Jarak dan posisi
pembesian sudah sesuai

A.3.6 Rebar covers checked /Selimut beton sudah sesuai

A.3.7 Gap for vibrators checked /Celah untuk vibrator sudah

sesuai
A.3.8 Security & cleanliness of bars checked /Perlindungan dan
pembersihan besi sudah sesuai
A.3.9 Splice length checked /Panjang penyambungan pembesian
sudah sesuai
A.3.10 Couplers and bar arrangement checked /pasangan dan
susunan pembesian sudah sesuai
Internal Checked by : Conformed by : Verified by :

( TWJO Civil Engineer ) ( TWJO QC Engineer ) (.....................................)

TWJO-ITP-GEN-0003A-CHK-001revF Page 1 / 4
 TOKYU-WIKA JOINT OPERATION
Surface Section CP101 & CP102
Construction of Jakarta Mass Rapid Transit Project

FORMWORK CHECKLIST / CHECKLIST BEKISTING

Lot No. /No. lot : Identification No. /Nomer Identifikasi :

Location /Lokasi : Contractor/Subcontraktor/Kontraktor/Subkont.
Type of Element /Type struktur : GradeCheck
of Concrete /Mutu Beton
Required
/Pengecekan NC /
diperlukan C/ Date Remarks
ITEMS TO BE CHECKED /ITEM YANG DI CEK Tidak Initial /Paraf
Yes No Sesuai /tanggal /Keterangan
Sesuai
/ya /tidak
A Drawing Check/Cek Gambar
A.1 Drawing Check/Cek Gambar
Drawing status approved for construction /Status Gambar
A1.1
telah disetujui

B. Formwork Accessories Check /Pengecekan bekisting beserta aksesorisnya

B.1 Formwork Check /Pengecekan bekisting

Form work level / line / verticality / position checked

B.1.1
/Elevasi bekisting/garis/verticality/posisi sudah sesuai

B.1.2 Cleanliness checked /pembersihan sudah sesuai

Release oil application checked /penggunaan oli
B.1.3 permukaan bekisting sudah sesuai

Blockouts / openings checked /blockout/bukaan sudah

B.1.4 sesuai

Form Tightness / Sealing checked /Pengencangan

B.1.5 bekisting/seal sudah sesuai

Staging for labour access checked /panggung (tempat) kerja

B.1.6 tersedia sudah di check

B.2 Support check /Pengecekan penyangga(support)

B.2.1 Support placed at appropriate location /Penyangga
ditempatkan pada lokasi yang tepat
B.2.2
Cross bracing placed to avoid shifting of formwork
/Pengaku silang ditempatkan mencegah pergeseran atau
perubahan bekisting
B.2.3
Props (pipe support) positioned in right position /Props(pipa
penyokong) ditempatkan pada posisi yang benar
B.2.4 Props (pipe support) supported on compacted ground
/Props(pipa penyokong) bertumpu pada tanah padat

B.2.5 The Support used to avoid the slurry leakage prepared

/Penyangga disiapkan untuk mencegah kebocoran.
B.3 Dowel and tie bar check /Pengecekan dowel dan tie bar
B.3.1 Position, level and alignment checked /Posisi, elevasi dan
alignment diperiksa
B.3.2 Dimension, spacing and No. of bars checked /Dimensi, jarak
dan jumlah dari besi diperiksa
Internal Checked by : Conformed by : Verified by :

( TWJO Civil Engineer ) ( TWJO QC Engineer ) (.....................................)

TWJO-ITP-GEN-0003B-CHK-001revF Page 2 / 4
 TOKYU-WIKA JOINT OPERATION
Surface Section CP101 & CP102
Construction of Jakarta Mass Rapid Transit Project

CONCRETE POUR CHECKLIST / CHECKLIST PENGECORAN

Lot No. /No. lot : Identification No. /Nomer Identifikasi :

Location /Lokasi : Contractor/Subcontraktor/Kontraktor/Subkont.
Type of Element /Type struktur : GradeCheck
of Concrete /Mutu Beton
Required
/Pengecekan NC /
diperlukan C/ Date Remarks
ITEMS TO BE CHECKED /ITEM YANG DI CEK Tidak Initial /Paraf
Yes No Sesuai /tanggal /Keterangan
Sesuai
/ya /tidak

A Drawing Check/Cek Gambar

Drawing status approved for construction /Status Gambar

A.1
telah disetujui

B. Reinforcement & Formwork Check /Cek Pembesian dan

Bekisting

Approved Reinforcement & Formwork Check /Cek

B.1
Pembesian dan Bekisting sudah disetujui
C During Concrete Check /Pengecekan selama pekerjaan
pengecoran
C.1 Approved mix / supplier used /Campuran beton disetujui
untuk digunakan
C.2 Slump, Temperature, Cube Sampling checked /Pengecekan
slump, temperatur, sampel cylinder
C.3 Method of Tremie installation verified against MS /metode
instalasi tremie sesuai penjelasan Metode Kerja

C.4
Concrete pump, pipes, hopper condition checked /Kondisi
pipa, ember cor (hopper) , concrete pump di check
C.5 Internal Vibrators - no., condition, gap checked /Internal
vibrator-(jumlah, kondisi, celah dikontrol)
C.6 External Vibrators - no., condition, gap checked /External
vibrator-(jumlah, kondisi, celah dikontrol)
C.7
Concrete drop height checked. (shoud be ≤ 1.5 m) /Tinggi
jatuh beton sudah sesuai(sebaiknya kurang dari 1,5 meter)
(Tick both boxes if initial inspection is unsatisfactory) /beri tanda NCR : Perlu tindakan Complies : Not comply :
pada box bila inspeksi awal tidak memuaskan perbaikan Sesuai Tidak sesuai
Prepared and conformed by TWJO Civil Engineer: Verified by :

Name : Signature : Name : Signature :

D Post Concrete Check /Pengecekan setelah pekerjaan

pengecoran

D.1 Concrete surface finish checked /Penyelesaian permukaan

beton dikontrol
D.2 Curing checked /Perawatan beton(curing) dilakukan

D.3 Concrete remedials checked (if applicable) /Perbaikan

beton bila dibutuhkan

Internal Checked and conformed by TWJO Civil Engineer

Name /Nama Tanda tangan

TWJO-ITP-GEN-0003C-CHK-001revF Page 3 / 4
 TOKYU-WIKA JOINT OPERATION
Surface Section CP101 & CP102
Construction of Jakarta Mass Rapid Transit Project

ANCHOR AND BLOCKOUT CHECKLIST / CHECKLIST ANGKUR DAN BLOCKOUT

Lot No. /No. lot : Identification No. /Nomer Identifikasi :

Location /Lokasi : Contractor/Subcontraktor/Kontraktor/Subkont.
Type of Element /Type struktur : GradeCheck
of Concrete /Mutu Beton
Required
/Pengecekan NC /
diperlukan C/ Date Remarks
ITEMS TO BE CHECKED /ITEM YANG DI CEK Tidak Initial /Paraf
Yes No Sesuai /tanggal /Keterangan
Sesuai
/ya /tidak

A Drawing Check/Gambar

A1
Drawing status approved for construction /Status Gambar
telah disetujui

B Anchor Checks /Pengecekan Angkur

Anchor dimension (dia, length) checked /Dimensi
B1 angkur(diameter, panjang) sudah sesuai

Anchor shape, bend checked /profil dan bengkokan angkur

B2
sudah sesuai

Positon and Levels checked /Posisi letak dan elevasi sudah

B3 sesuai

B4 No. of Anchor checked /Jumlah angkur sudah sesuai

Position, Condition & length of anhcor thread checked

B5
/Jarak, kondisi dan posisi drat angkur sudah sesuai

Anchor accessories checked / Angkur aksesoris sudah

B6
sesuai

Brace of Anchor checked / pengaku dari angkur sudah

B7
sesuai

C Block Out Checks /Pengecekan block out

Material for Block out checked / Material untuk block out

C1
sudah sesuai

Position, dimension and level of block out checked / Posisi,

C2
dimensi dan leve block out sudah sesuai

Support of block out checked / pengaku dari block out

C3 sudah sesuai

Internal Checked Conformed by : Verified by :

TWJO by : SubContractor by* :

( TWJO Civil Engineer ) ( Subcontractor Engineer ) ( TWJO QC Engineer ) ( ............................ )

Note : * only for Pier Head Works

TWJO-ITP-GEN-0003D-CHK-001revF Page 4 of 4