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ATTACHMENT 7.1
Project Inspection and Test Plan-SITE
CIVIL AND STRUCTURE
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Discipline Legend
H : Hold Point A : AProject Title : P&G PROJECT W : Witness R : R
Job No : p : Perform M : M
Description : Project Inspection and Test Plan-Site
Equipment Tag No. : -
Location : -
a.
b.
c.
d.
e.
a.
b.
c. Dimensional, Welding, NDT, and Coating Inspection Inspect
As applicable WPS/PQR,NDT procedure
- SNO-S-ES-002 Standard Specification for
Stuctural Steel Construction
Comply with sp
Welder Performance test Inspect As applicable WPS/PQR Comply w
8.3 Inspection During Fabrication
WPS/PQR Qualification Test Inspect As applicable WPS/PQR Comply w
8.2 Material Inspection Inspect- SNO-S-TS-001 Specification for structural
steel material Comply w
Chipping and Padding Work Review- SNO-S-ES-002 Standard Specification for
Stuctural Steel ConstructionComply with s
Grouting Work Review- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipmentComply with s
General Structure Erection Work Review- SNO-X-PR-007 Steel Structure Erection
ProcedureComply with s
General Fabrication Work Review-SNO-S-TS-002 Specification Standard for
structural steel fabricationComply with s
8.1 Procedure
Welding Procedure Specification / Procedure
Qualification Record ( WPS/PQR )Review As applicable WPS/PQR Comply with s
8 STEEL STRUCTURE
PROJECT INSPECTION & TES
STEEL STRUCTURE
No. DESCRIPTIONINSPECTION
METHODREFERENCE DOCUMENT ACCEPTANCE
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Discipline Legend
H : Hold Point A :Project Title : P&G PROJECT W : Witness R :
Job No : p : Perform M :
Description : Project Inspection and Test Plan-Site
Equipment Tag No. : -
Location : -
PROJECT INSPECTION & TES
STEEL STRUCTURE
No. DESCRIPTIONINSPECTION
METHODREFERENCE DOCUMENT ACCEPTANC
a.
b.
c.
d.
e.
1.
2.
3.
4.
5.
6.
f.
f.
Steel erection work8.5
Steel Structure Installation Acceptance Inspect- SNO-S-ES-002 Standard Specification for
Stuctural Steel ConstructionComply w
Fire Proofing Inspect- SNO-S-ES-002 Standard Specification for
Stuctural Steel ConstructionComply w
Grout test (compressive strength) Inspect- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipmentComply w
Cleaning prior to placing Inspect- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipmentComply w
Anchor bolts and embedded items Inspect- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipmentComply with
Form-work Inspect- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipmentComply with
Mixing proportion Inspect
- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipment Comply w
Material Inspection Inspect- SNO-C-ES-015 Standard Specification for
Grouting of stuctural and equipmentComply w
Welding and NDT Inspection Inspect
As applicable WPS/PQR,NDT procedure
- SNO-S-ES-002 Standard Specification for
Stuctural Steel Construction
Comply w
Grouting Work
Bolt Tightening Inspect- SNO-S-ES-002 Standard Specification for
Stuctural Steel ConstructionComply w
Plumbness check Inspect Comply with
8.4 Installation
Chipping and Padding check Inspect- SNO-S-ES-002 Standard Specification for
Stuctural Steel ConstructionComply with
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Discipline Legend
H : Hold Point A :Project Title : P&G PROJECT W : Witness R :
Job No : p : Perform M :
Description : Project Inspection and Test Plan-Site
Equipment Tag No. : -
Location : -
PROJECT INSPECTION & TE
STEEL STRUCTURE
No. DESCRIPTIONINSPECTION
METHODREFERENCE DOCUMENT ACCEPTAN
a.
b.
c.
1.
2.
3.
d.
1.
e.
f.
1.
2.
3.
4.
5.
Form Code : SNO-Q-FM-0039 Rev.0
Inspect Comply
Inspect Comply
Inspect Comply
Overlap joint sheet Inspect Comply
Inspect Comply
3. Damage
Inspect all Roofing/Walling & accessories after
installation, Including:
Visual (cleaning) Inspect Comply
Connection metal Sheet ( Sheet to Sheet)
Inspect Comply
Inspect Comply
1. hard Stamping
Inspect Comply
Inspect Comply
Inspect all Roofing/Walling work for:
4. Complete to marking plan
Inspect Comply3. Touch up paint & Cleaning
Inspect Comply
Inspect Comply
2. Tension of Bolts
Aligment of Structure
Inspect All Steel work After erection,including: Inspect Comply
Complete to marking plan Inspect Comply
Touch up paint & Cleaning
Tension of Bolts Inspect Comply
Inspect Comply
3. Paint touch up later concealed areas
Inspect all steel work after Modules Ground
Assembly, Including:
Inspect ComplyInspect Comply2. Damage
Prepare JSEA Inspect Approv
Complete to marking plan
Joint plashing, Silent, Gutter
Inspect Comply
Inspect Comply
2. Quantity
Inspect Comply
1. Hard Stamping Inspect Comply
Inspect all steel work ( Handling Material Process) Inspect Comply
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YYMain Contractor Tripatra-Samsung Consortium Page of
(Client Name) : Attn. Mr.
Project Manager
Gentlemen,
We would like to have your presence for inspection according to the following schedules.
Date and time Place/Area Inspection Item Remarks
Piping Civil Instrument Mechanical
Pipeline Structural Electrical
COMMENT :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0001 Rev.0
Signature
REQUEST FOR INSPECTION
Involvement Party Performed By Approved By Reviewed By TPI (If applicable)Sub-Contractor TSC JOB PMTS
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor Tripatra-Samsung Consortium Page of
Material Arrival Date :
PO.No. / Packing List No :
Mill Certificate
Conform to
- Chemical Composition
- Mechanical Properties
Note:
1) If Necessary
2) Put check mark () on the selected result.
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0002 Rev.0
TPI (If applicable)Sub-Contractor TSC JOB PMTS
Signature
4 Other
Involvement PartyPerformed By Approved By Reviewed By
2
3 Manufacturer Data Sheet1)
1 Visual
Surface Condition
Dimension
EQUIPMENT /MATERIAL RECEIVING INSPECTION
REPORT
NO. INSPECTION ITEMRESULT
2)
RemarksACCEPTED REJECTED
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Location :
1. Type Inspection Item :
Inspection / Test /Examination / Check
2. Inspection Report :
`
3. Remarks :
Supporting document attached
YES NO
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0003 Rev.0
Signature
INSPECTION REPORT
Performed By Approved By Reviewed By
Involvement Party Sub-Contractor TSC JOB PMTS
TPI(If applicable)
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
REFERENCES :
Item Name : Location :
Drawing No. :
Revision :
Sheet : Of
E = East
N = North
Signature
Sign Date
Job TitleForm Code : SNO-Q-FM-0004 Rev.0
Involvement
Party Sub-Contractor TSC JOB PMTS
TPI(If applicable)
Signature
E
E
E
N
N
DESCRIPTION
E
N
No.
N
E
N
N
N
N
E
E
E
E
N
N
N
SURVEY REPORT
Performed By Approved By Reviewed By
RemarksPlan Actual Difference
ElevationCoordinate
Plan Actual Difference
E
E
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
REFERENCES :
Drawing No. : Location :
Revision :
Sheet :
COMMENT :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0005 Rev.0
Approved Reviewed
TPI(If applicable)
Involvement Party
Signature
Sub-Contractor TSC JOB PMTS
Remarks
STABLE EXISTING AREA FOR SUPPORT THE WEIGHT OF HAULING EQUIPMENT
TSCItem of Inspection
Result
Cut off flush of selected trees without
removing its roots
EXISTING AREA / LOW SWAMPY
Other unsatisfactory soil material
removal
Organic soil material removal and
disposal
Accepted Sub-ConRejected
Trees, brush, stump and resting
vegetation removal and disposal.
CLEARING AND GRUBBING INSPECTION REPORT
Performed By Approved By Reviewed by
Quality of Cleaning.
Demolition, relocation, elevation and
protection of existing facilities.
JOB PMTS
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of From KP ... To KP
REFERENCES :
Drawing No. : Location :
Revision :
Sheet :
Name
Sign Date
Job Title
Form Code : SNO-Q-FM-0006 Rev.0
Involvement
Party Sub-Contractor TSC JOB PMTS
TPI
(If applicable)
COMMENT
Quality Cleaning of Bottom Surface
Dewatering
Safety regarding excavation works,
confirmed and Protection of Slope
Depth of Excavation, confirmed
Result
Sub-Con TSC JOB PMTSAccepted
ReviewedApproved
Rejected
Investigation of Existing under-ground
Facilities
Demolition or Protection of Existing Facility
RemarksItem of Inspection
Signature
EXCAVATION INSPECTION REPORT
Performed By Approved By Reviewed By
Line, Slope and Grades according to
approved drawing
Setout location, based on shop drawing andendorsed Benchmark
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
REFERENCES :
Drawing No. : Location :
Revision :
Sheet :
Legend Supporting document attachedLS : Lime StoneCLY : Clay Silt YES NO
SCLY : Sandy Clay
COMMENT
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0007 Rev.0
b.
4 VISUAL SOIL MATERIAL PLASTICITY
5 COHESIVENESS OF SOIL MATERIAL
Cohesive / Little Cohesive / Loose
Cohesive / Little Cohesive / Loose
a.
NO INSPECTION ITEMS
LS / CLY / SCLY
LS / CLY / SCLY
DISTRIBUTION QUALITY OF MATERIAL2
QUALITY OF MATERIAL USED1
REMARKS(Sub-Con) TSC JOB PMTS
REVIEWEDAPPROVED
TPI
a.
b.
c.
LS / CLY / SCLY
3 VISUAL SOIL MATERIAL GRADATION
7 SLOPE PROTECTION
6 CLEANING ( REMOFAL OF TRASH, DEBRIS )
c. Cohesive / Little Cohesive / Loose
BACKFILL MATERIAL INSPECTION REPORT
Performed by Approved by Reviewed By
Signature
Involvement
Party Sub-Contractor TSC JOB PMTS
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
REFERENCES :
Drawing No. : Location :
Revision :
Sheet :
Total Unit : pc(s)
Running Unit : pc(s)
Stand Unit : pc(s)
Total Unit : pc(s)
Running Unit : pc(s)
Stand Unit : pc(s)
COMMENT
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0008 Rev.0
Rejected
Accepted
Water Quantity Due to Wet
Compaction Check
Water Source Check
Accepted
TSC JOB PMTSREMARKS
Rejected
NO INSPECTION ITEMS
Fill material quality
2
1
Accepted
RESULT
Rejected (Sub-Con)
REVIEWEDAPPROVED
Optimum water content
Vibratory Compactors
8
7 Compactor trip number
EQUIPMENT
COMPACTION INSPECTION REPORT
Approved By Reviewed By
Sheep Foot Compactors
Area location marking for layer
thickness
Soil spreading methods
Thickness of loose soil
Water spreading methods
Compaction test number for
covered area
3
4
5
6
Signature
Sub-Contractor TSC JOB PMTS
Involvement
Party
TPI
(If applicable)
Performed By
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page
Date Of Test
Test No.
Type of Layer
Location Of Test
Weight of Sand + Cone + Jar ( before ) gram a
Weight of Sand + Cone + Jar ( after ) gram b
Weight of Sand in Hole + Cone gram c
Weight of Sand in Cone gram d
Weight of Sand in Hole gram e=c-d
Unit Weight of Sand gram/cm3
fVolume Of Hole cm3 g=e/f
Weight of Wet Soil + Container gram i
Weight of Dry Soil + Container gram j
Weight of Water gram k=i-j
Weight of Container gram l
Weight of Dry Soil gram m=j-l
Moisture Content % n=(k/m)x100
Weight of Soil from Hole + Container gram o
Weight of Container gram p
Weight of Soil from Hole gram q=o-p
WET DENSITY gram/cm3 r=q/g
DRY DENSITY gram/cm3 s=r/(1+(n/100))
Maximum LAB DENSITY gram/cm3 t
Optimum Moisture Content % u
Present Compaction % v=(s/t)x100
Remarks :
Name
Sign Date
Job Title
Form Code : SNO Q FM 0009 1 Rev 0
13
14
9
1 2
Container No.UNIT FORMULAMOISTURE CONTENT DETERMENATION
VOLUME DETERMINATION UNIT FORMULA
Container No.
Vibro smooth drum = ..X 2 passing Vibro smooth drum = ..X 2 passing
A B
Sheep foot = .X 2 passing Sheep foot = ..X 2 passing
1
2
3
4
Container No. Container No.
1
5
5
4
3
76
2
6
DENSITY DETERMENATION UNIT FORMULA21
7
8
10
11
12
FIELD DENSITY TEST (SAND CONE METHOD)
Performed By Approved By Reviewed ByInvolvement Party
Signature
Sub-Contractor TSC JOB PMTS
TPI(If Applica
(sub
log
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page o
Min soil Density :
Compactor Trip :
Compactor Trip :
Name
Sign DateJob Title
Form Code : SNO-Q-FM-0009-2 Rev.0
RENo.Date of
Test
DRY
DENSITY
(gr/cm3)
WET
DENSITY
(gr/cm3)
WATER
CONTENT
(gr/cm3)
LOOSE SOIL
THICKNESS (mm)TEST NO / LAYER / ELEVATION RESULT (%)
SUMMARY SAND CONE TEST REPORT
Involvement PartySub-Contractor TSC JOB PMTS
TPI(If Applicabl
Signature
Performed by Approved by Reviewed By
(sub
log
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No : Hammer Type :
Point No : Weight of RAM :
Total Length of Pile : Type of Pile :
Location :
JUDGEMENT
The piles under tested are
ACCEPTED REJECTED
according to selected standards, code and specification.
Attachment
1)
2)
3)
Name
Sign Date
Job Title
Form Code: SNO-Q-FM-0010 Rev.0
Signature
Sub-Contractor TSC JOB PMTS
PILE DRIVING ANALYZER (PDA) TEST REPORT
Perform By Approved By Reviewed ByInvolvement Party
TPI(If applicable)
Test
Load
PointDate / Time Pile StatementNo
Reading
Static Load
Capacity
Pile
Stress
Pile Energy
TransferPile
Integrity
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of PILE SPECIFICATION ITEM NO. :
Number : LOCATION :
Diameter : PILE DRIVING TYPE :
Length : HAMMER SPECIFICATION
Weight : Type :
Weight :
DRIVING Drop Height :
Start/ End : CUSHION
Delay : Material Type :
Splicing Joint I : Thickness :
Joint II : Final Set : cm / blow
Joint III : Settlement : cm/blow
PENETRATION
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0011-1 Rev.0
Signature
31
50
Approved By50
44
Performed By Reviewed By
50
50
50
1
50
14
PENETRATION
Involvement PartyTPI
(If applicable)TSCSub-Contractor JOB PMTS
50
50
50
3
50
50 50
15
16
50
5 18
4 17
50
29
50
30
50
41
DRIVING RECORD
13
m cm
2
50
28
5050
4027
0
PENETRATION BLOW
COUNTm cm
BLOW
COUNTm cm
26
50
39
5050
BLOW COUNTPENETRATION BLOW
COUNTm cm
50
50
50
50
50
50
50
50
43
50
42
50
45
46
47
48
49
50
50
50
50
50
50
PILE DRIVING RECORD
50
50 50
6
7
8
9
10
11
12
50
50
50
50
50
50
50
50
50
50
50
50
51
19
20
23
24
21
22
25
32
33
34
35
36
37
38
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Form Code : SNO-Q-FM-0011-2 Rev.0
PILE DRIVING RECORD
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page
1 :
2 :
2 :
3 :
3 :
4 :
4 :
5 :
NOTES :
1) FORMAT MM/DD/YY
2) FORMAT HH:SS
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0012 Rev.0
APPROVED REVIEW
Signature
Involvement PartyT
(If appSub-Contractor TSC JOB PMTS
Accepted Rejected SUB-CON TSC
WELDING INSPECTION
JOINT
NO
WEATHER
CONDITION JOB PM
RESULTDATE
1)START /
FINISH2)PILE NUMBERPOINT NO.
WELDING INSPECTION REPORT (PILE)
Performed By Approved By Reviewed By
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page 1 of 2
STD REFERENCE : TESTING DATE :
MATERIAL : SAMPLING DATE :
SOURCE : PIC :
SUPPLIER : TESTING DATE :
Visual Test (Color)
Form Code : SNO-Q-FM-0013-1 Rev.0
Total
Sand Equivalent
ResultSieve No. mm
Weight
Retain Parameter
Absorption
PassingTotal
Weight% Retain
ASTM C33
min max
Washing Loss
Silt Content
Spec.
Additional Test
Specific Gravity
Sedimentation
Clay Lumps & Friable
Organic Impurities
FINE AGGREGATE (subconlogo)
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FINE AGGREGATE (subconlogo)
Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page 2 of 2
STD REFERENCE : TESTING DATE :
MATERIAL : SAMPLING DATE :
SOURCE : PIC :
SUPPLIER : TESTING DATE :
Silt Content
Washing Loss
Sedimentation
Clay Lumps & Friable
Organic Impurities
Visual Test (Color)
NameSign Date
Job TitleForm Code : SNO-Q-FM-0013-2 Rev.0
Involvement Party
Signature
TPI(If applicable)Sub-Contractor TSC JOB PMTS
Total
minSieve No. mm
Weight
Retain max Parameter Spec. Result
ASTM C33 Additional TestTotal
Weight
%.
RetainPassing
Specific Gravity
Absorption
max 12%
max 3%
max 3%
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
DESIGN MIX :
Slump : mm
W/C Ratio :
Cement : Kg/m3
Fly Ash : Kg/m3
Silica Fume : Kg/m3
Fine Aggregates : %
COMPOSITION FOR 1 CuM (SSD CONDITION)
Water : L
CementType : Kg
Fly Ash : Kg
Silica Fume : Kg
Admixture : L
Retarder : L
Superplasticise : L
Other : L
AGGREGATES VOLUME
Aggregates : Kg
Sand 1 : Kg
Sand 2 : Kg
Gravel - 01 : KgGravel - 02 : Kg
Gravel - 03 : Kg
Total : Ton
Density : T/CuM
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0014 Rev.0
Sub-Contractor TSC JOB PMTSTPI
(If applicable)
Signature
Involvement Party
MIX DESIGN CONCRETE
Performed By Approved By Reviewed By
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Equipment / Location :
Drawing no :
Revision :
Sheet :
Surveying Location
Elevation
Plumbness
Rebar Diameter Bending Footing/Pedestal
Lap LengthSurface Cleaning of Rebar
Rigidity
Form Work Dimension Alignment Footing/Pedestal
Form Oil Coating
Stability
Top Elevation
Chamfer Spacer
Concrete Cleaning Pouring Place Footing/Pedestal
Slump Test
Using Vibrator
Removal Laitance
Curing
Appearance of Surface
Anchor Bolt or Box Emb- Size Type Number
bedded Steel, Water Location Orientation Level
Stop Stability
Protection of Anchor Bolt Screw
Misc, Opening, Sleeve, Dimension, Location, Orientation, Material
etc
COMMENT
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0015 Rev.0
RESULT
Accepted Rejected
Signature
Involvement PartySub-Contractor TSC JOB PMTS
FOUNDATION CHECK LIST
Performed By Approved By Reviewed by
6
1
2
3
4
5
REMARKDESCRIPTION
TPI(If applicable)
NO
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
Design Mix : A(fc' = 35 Mpa) B (fc' = 28 Mpa)
: C(fc' = 20.7 Mpa) D (fc' = 10.3 Mpa)
Slump : Cm
Quantity : m3
APPROVED BY :
Civil
Piping
Mechanical
Electrical / Instrument
Survey
Engineering
WEATHER Sunny Cloudy Rainy
Placement Start Date : Time :
Placement Completed Dat : Time :
Number of Cube : QTY : (Nos)
Concrete Tested by :
REMARKS:
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0016 Rev.0
Signature
CONCRETE POUR PERMIT
Performed By Approved By Reviewed By
(Print name)
JOB SignaturesDiscipline
(Print name) DateDate
TSC Signatures
Involvement PartyTPI
(If applicable)Sub-Contractor
REVIEWED BY
TSC JOB PMTS
(subcon
logo)
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Project Title Senoro Gas Development ProjectJob No 9608/SU2573
Client JOB Pertamina Medco E & P Tomori Sulawesi
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM
Testing Laboratory :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0017 Rev.0
Involvement PartySub-Contractor TSC JOB PMTS
Signature
CONCRETE COMPRESSIVE STRENGTH TEST REPORT
Performed By Approved By Reviewed B
ITEM
NOPOURING LOCATION
TESTCAST
Actual
Slump
(cm)
INSPECTION DATE AND REPORT OF TESTPOURING DATA AND DELIVERY
SAMPLE NO.
DATEWeight
( kg )
Cube Size
( p x l x t )
Cylinder
Size
( d x h )
AGE
(days)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No :
Revision :
Sheet :
COMMENT :
Name
Sign Date
Job Title
Form Code : SNO-Q-FM-0018 Rev.0
Involvement PartyTPI
(If applicable)
Signature
Sub-Contractor TSC JOB PMTS
RELEASE OF FOUNDATION
Performed By Approved By Reviewed By
Attachment Document Hand Over
Acc Rej
No Document DescriptionStatus Attachment
Remark
3 Punch List report
1 Related Inspection Reports
2 Final Survey after pouring concrete
Equipment / Location Reference Document
THE ABOVE FOUNDATION HAS BEEN COMPLETED, AND COMPLIES WITH THE DRAWING REQUIREMENT,
ALL SURVEY'S HAVE BEEN COMPLETED WITHNESSED AND APPROVED
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
SKETCH Drawing No :
Revision :
Sheet :
WPS/PQR Check : Visual Check :
Process : Dimension Check :
Electrode : NDT :
Parameter :
Welder ID :
Painting System :
Painting Brand :
Surface Preparation :
Primer / DFT :
Intermediate / DFT :
To / DFT :
TOTAL DFT :
Signature
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0019 Rev.0
Involvement PartyTPI
(If applicable)Sub-Contractor TSC JOB PMTS
DIMENSIONAL, WELDING, NDT & PAINTING
INSPECTION RECORD
Performed By Approved By Reviewed By
#DIV/0!average
8
9
7
5
6
3
4
2
(Sub-Con) TSC
COATING / PAINTING INSPECTION RECORD
JOB PMTSRejected
1
DFT (micron) Actual
(micron)
RESULT
SAMPLE Std Tol Accepted
Approved By Reviewed By
Approved By Reviewed By
JOB PMTS(Sub-Con) TSC
TSC JOB PMTS
D
(Sub-Con)
WELDING & NDT INSPECTION RECORDS
E E
D
B
A
C
A
C
B
Tol
DIMENSION (mm)
Actual Rejected
RESULT
RejectedAcceptedMark Design
DIMENSION (mm) RESULT
Mark Design Tol Accepted
DIMENSIONAL INSPECTION RECORD
Actual
Approved By Reviewed By
(subcon
logo)
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Project Title Senoro Gas Development Project
Job No 9608/SU2573
Client JOB Pertamina Medco E & P Tomori Sulawesi
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM
Discipline : RT : A
Request No. : UT :
Request Date : MT :
Area / Unit : PT :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0020 Rev.0
Involvement Party
Signature
Sub-Contractor TSC JOB PMTS
NON DESTRUCTIVE EXAMINATION REQUEST
Performed By Approved By Reviewed By
NO. Drawing Number Sheet Member Section No. Profile MaterialWelding
Process
Welder
StampShoot DRevision
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
N :
E :
N :
E :
N :E :
N :
E :
N :
E :
N :
E :
N :
E :
N :
E :
N :
E :N :
E :
N :
E :
N :
E :
N :
E :
N :
E :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0021 Rev.0
Involvement Party
Signature
Sub-Contractor TSC JOB PMTS
TPI
(If applicable)
PLUMBNESS INSPECTION REPORT
Performed By Approved By Reviewed By
REMARKTOLERANCE
ACTUALTOP
ELEVATION BASE PLATE
BOT
STRUCTURE
NAMEPOSITION
PLAN
PLUMBNESS
DIFFERENCE
LOCATION
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No : Equipment / Location :
Revision :
Sheet :
NOTE :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0022 Rev.0
APPROVED REVIEWED
Signature
GROUTING INSPECTION REPORT
Performed By Approved By Reviewed ByInvolvement Party
TPI(If applicable)Sub-Contractor TSC JOB PMTS
CURING
BASE PLATE
LOCATION
SURFACE FINISHING
Accepted Rejected JOB PMTS
MIXING PROPORTION
SURFACE ROUGHNESS
(Sub-Con)NO CHECKING ITEM
RESULT
TSC
CLEANING
REMARKS
TOP ELEVATION OF FORM
WORK
CHAMFER
DIMENSION, ALIGNMENT &
STABILITY OF FORM WORK
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No : Equipment / Location :
Revision :
Sheet :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0023 Rev.0
BOLT TIGHTENING CHECK
Performed By Approved by Reviewed byInvolvement Party
TPI(If applicable)Sub-Contractor TSC JOB PMTS
Signature
STRUCTURE NAME BOLT SPEC./SIZETENSION STD.
(NM)
RESULTBOLT CHECK LOCATION
ACCEPTED REJECTED
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No :
Revision :
Sheet :
COMMENT :
Name
Sign Date
Job Title
Form Code : SNO-Q-FM-0024 Rev.0
Signature
Involvement PartyTPI
(If applicable)TSCSub-Contractor JOB PMTS
RELEASE OF STEEL STRUCTURE INSTALLATION
Performed By Approved By Reviewed By
2 Final Survey (Plumbness)
3 Punch List report
1 Related Inspection Reports
Attachment Document Hand Over
RemarkNo Document Description
Status Attachment
Acc Rej
Equipment / Location Reference Document
THE ABOVE STEEL STRUCTURE INSTALLATION HAS BEEN COMPLETED, AND COMPLIES WITH THE DRAWING
REQUIREMENT, ALL SURVEY'S HAVE BEEN COMPLETED WITHNESSED AND APPROVED
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Sample No. :
Source of Aggregate:
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0025 Rev.0
Signature
Involvement PartyTPI
(If applicable)TSCSub-Contrcator JOB PMTS
AGGREGATE GRADATION REPORT
( SIEVE TEST )
Performed By Approved By Reviewed By
NOTE :
TOTAL
Inch mm Wt.Ret ( gr ) ( gr )
REMARKIndividual Wt.Ret
Pass
SAMPLE ISieve Size
% Ret % Pass Spec %
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
REFERENCES :
Drawing No. : Location :
Revision :
Sheet :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0026 Rev.0
COMMENT
Check Thickness and Width of Gravelling
Signature
JOB PMTSTSCSub-ContractorTPI
(If applicable)Involvement Party
GRAVEL INSPECTION REPORT
Performed By Approved By Reviewed By
Result
Rejected
Quality of Cleaning before Spreading
Quality of Cleaning after Spreading
Remarks
Condition of Compaction
JOB PMTSItem of Inspection
Accepted
ReviewedApproved
Sub-Con TSC
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page 1 of 2
Location :
Test Date :
Ap=
Load= Reading x CF
CBR 0.1"
Corrected load x 100%
Ap x 1000 Psi
CBR 0.2"
Corrected load x 100%
Ap x 1500 Psi
Cf = Calibration Factor
Ap = Area of Plunger
Note :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0027-1 Rev.0
CALIFORNIA BEARING RATIO (CBR) INSITU
Performed By Approved By Reviewed By
Remarks
900
1000
1100
Involvement Party
1200
1300
1400
Signature
Sub-Contractor TSC JOB PMTS
TPI(If applicable)
150
Penetration Inc
x 10-2
450
500
600
400
Time second
200
250
300
700
800
Remarks
Cf=
50
0
1500
350
Reading x 10-2 Load (lbs)
100
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page 2 of 2
Location :
Test Date :
CBR 0.1" = Remarks :
CBR 0.2" =
Name
Sign Date
Job Title
Form Code : SNO-Q-FM-0027-2 Rev.0
Signature
Involvement
Party
TPI
(If applicable)Sub-Contractor TSC JOB PMTS
Performed By Approved By Reviewed by
Penetration of Plunger ( inch )
CALIFORNIA BEARING RATIO ( CBR )REPORT
Load
(lbs)
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
COMMENT
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0028 Rev.0
TPI
(If applicable)Sub-Contractor TSC JOB PMTS
Signature
Reviewed ByApproved ByPerformed ByInvolvement
Party
SEWER PIPING AND DRAINAGE INSPECTION
REPORT
Result
JOB PMTSRemarks
Check Dimensional ( Location, Elevation &
Slope )
Accepted Rejected Sub-Con
Check Installation of Pipes
TSCItem of Inspection
Approved Reviewed
Concrete
Surface Finishing
Water Flow / Service test
Check Connection of pipe and manhole
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
COMMENT
NameSign Date
Job TitleForm Code : SNO-Q-FM-0029 Rev.0
Involvement Party
Signature
TPI(If applicable)Sub-Contractor TSC JOB PMTS
BRICK INSPECTION REPORT
Performed By Approved by Reviewed By
Approved Reviewed
Location, wall centre, vertical board
Result
Finish of surface
Reinforcement and installation of accessories
(Horizontal Dowels, Veltical Dowels, etc)
Proportioning and Mixing Mortar
Location of door and windows
BRICK WORK
Sub-Con TSCRemarks
Installation of Column Practice
Rejected JOB PMTSAcceptedItem of Inspection
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0030 Rev.0
Overlap Joint
TPI
(If applicable)
Signature
Involvement PartySub-Contractor TSC JOB PMTS
WATER PROOFING INSPECTION REPORT
Performed by Approved by Reviewed by
RemarksResult
JOB PMTSSub-ConItem of Inspection
TSC
Condition & Application of Material
COMMENT
Approved Reviewed
Leakage Test
Accepted
Surface Preparation
Rejected
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0031 Rev.0
COMMENT
Functional Test
Signature
Involvement
Party Sub-Contractor TSC JOB PMTS
DOORS & WINDOWS INSPECTION REPORT
Performed By Approved By Reviewed By
Item of Inspection
Installation of Frames and doors & windows
Result
Accepted
TPI(If applicable)
RemarksJOB PMTSSub-Con TSCRejected
Approved Reviewed
Installation of Hardware
Fixed condition of glass
Condition of Cleaning
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
Name
Sign DateJob TitleForm Code : SNO-Q-FM-0032 Rev.0
Signature
Involvement PartySub-Contractor TSC JOB PMTS
TPI(If applicable)
Performed By Approved by Reviewed By
WALL , CEILING AND FLOOR INSPECTION REPORT
Surface
Flatness
Surface
Cleaning and Waxing
Condition of Joint
Condition of Cleaning
Layout and Pattern
Pattern and Layout of Installation
Condition of Joint
COMMENT
Painting
Condition Cleaning and Protection
III. FLOOR WORK
Treatment of Joint
RemarksItem of InspectionResult
Accepted JOB PMTSTSCSub-ConRejected
I. WALL FINISHING (Brick, Concrete, Gypsum or Partition)
Approved Reviewed
II. CEILING (Acoustic Board or Gypsum Board)
Setting Frame
Flatness
Painting or Wall Paper
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location :
Revision :
Sheet :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0033 Rev.0
Approved Reviewed
TPI(If applicable)
Signature
Involvement PartySub-Contractor TSC JOB PMTS
Performed By Approved By Reviewed By
PLUMBING & SANITARY FIXTURE INSPECTION
REPORT
TSC JOB PMTSRejectedItem of Inspection
Result
Check Location, Elevation & Slope
RemarksSub-ConAccepted
COMMENT
Function Test
Installation of Pipes
II. SANITARY FIXTURE
Equipment Location
I. PLUMBING WORK
Tightness of screw and / or bolts & nuts
Cleaning Condition
Connection of Sanitary Hardware to Pipe
Accepted
Alignment and Level of Installation
Water Flow & Service Test
(subcon
logo)
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Project Title Senoro Gas Development Project Sub-Contractor
Job No 9608/SU2573 Report No.
Client JOB Pertamina Medco E & P Tomori Sulawesi Date DD/MM/YY
Main Contractor TRIPATRA-SAMSUNG CONSORTIUM Page of
Drawing No. : Equipment / Location Name :
Revision :
Sheet :
Name
Sign Date
Job TitleForm Code : SNO-Q-FM-0034 Rev.0
TPI(If applicable)
Involvement Party
Signature
Sub-Contractor TSC JOB PMTS
ROOFING AND SIDING INSPECTION REPORT
Performed By Approved by Reviewed by
COMMENT
Installation of Roof & Accessories
Condition of Fastening
Lapped Joint ( Length & Width )
RemarksRejected
Item of InspectionResult
Accepted Sub-Con TSC JOB PMTS
Approved Reviewed
Installation of Framing
(subcon
logo)
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SYSTEM / SUB SYSTEM NO. :SYSTEM DISCRIPTION :
TEST PACKAGE NUMBER :
REFERENCE DOC/DWG/SPEC. :
Category A - Item must be complete before Mechanical Completion The System at Approval of JOB Pertamina Medco E & P Tomori SulawesiCategory B - Item can be complete after Mechanical Completion The System at Approval of JOB Pertamina Medco E & P Tomori Sulawesi
Name
Sign Date
Job Title
Form Code : SNO-Q-FM-0035 Rev.0
DESCRIPTIONPLAN
Signature
Involvement PartySub-Contractor TSC
Performed by Approved by
GENERAL PUNCH LI
COMPLETION DATE
ACTUALORIITEM
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Subcontractor Name :
Form Code : SNO-Q-FM-0036 Rev.0
INSPECTION, MEASUREMENT & TEST E
NO.EQUIPMENT / INSTRUMENT
IDENTIFICATION NO.
DESCRIPTION
SIZE-RANGE
MANUFACTURER
MODEL No.
MANUFACTU
NUM
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Project Title : Senoro Gas Development Project
Job No : 9608/SU2573
Client : JOB Pertamina Medco E & P Tomori Sulawesi.
Main Contractor : Tripatra-Samsung Consortium
Sub-Contractor :
NO WELDER NAMEWELDER
STAMPWPS / PQR NO
STANDARD /
REFERENCES
TEST
BASE
METAL
JOINT
DISEGN
DIAMETER
(Inch)
TH
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Project Title : Senoro Gas Development Project
Job No : 9608/SU2573
Client : JOB Pertamina Medco E & P Tomori Sulawesi.
Main Contractor : Tripatra-Samsung Consortium
Sub-Contractor :
Name
Sign Date
Signature
Involvement PartySub-Contractor TSC
WPS / PQR MATRIX
Performed By Approved by
NO DESCRIPTION WPS/PQR NOSTANDARD /
REFERENCES
TEST COUPON
BASE
METAL
JOINT
DISEGN
DIAMETER
(Inch)
THICKNESS
(mm)
WELDING
PROCESSESPOSITION
WELDING
PROGRESS
BAS
MET