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REQUEST OF WORK EXECUTION

PROJECT :
SCOPE OF WORK : STR / ARS / ME / ELC / ELTN
NO : .. / RWE / .. / ..
DATE : ..
...
WORK TYPE : ATTACHMENT

Inspection Form
Shop Drawing
Method Statement

LOCATION OF THE WORK (Key Plan attached)

REFERENCE
No. Specification Details : Page No :
No. For Construction Drawing :
No. Material Approval :
No. Method Statement :
No. Shop Drawing :

COMPONENTS OF THE WORKS


Manpower Qty Main Material Qty Supporting Material Qty Main Equipment Qty Supporting Equipment Qty

TIME

EXPECTED REALISATION
TIME OF EXPECTED INSPECTION date. ... hour .... date. .... hour ....
TIME OF WORK EXECUTION date. ... hour .... date ..... hour ....

Checked & Approved by Owner, Submitted by Main-Contractor


PT Sumber Cipta Griya Utama PT Acset Indonusa

(..) (..)
Site Engineer QC

FEEDBACK
INSPECTOR Owner APPROVED REJECTED C.SIGN
STRUCTURE ..
ARCHITECTURE ..
ME&P ..
HSE ..

COMMENTS : (REASONS WHY APPROVED / REJECTEDI)


QMS/DCC/FML-PRO/15 (R.01 - 13012012)

368096372.xls
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