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Concrete Pouring Request Form

The document outlines a concrete pouring request for a project under the KALAHI-CIDSS program in the Philippines, detailing project specifics such as location, contractor, and estimated volume. It includes a checklist of required materials and equipment, as well as sections for approvals and remarks from project inspectors. The document serves as a formal request for the pouring of concrete for the improvement of barangay access roads.

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Chris Briones
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194 views4 pages

Concrete Pouring Request Form

The document outlines a concrete pouring request for a project under the KALAHI-CIDSS program in the Philippines, detailing project specifics such as location, contractor, and estimated volume. It includes a checklist of required materials and equipment, as well as sections for approvals and remarks from project inspectors. The document serves as a formal request for the pouring of concrete for the improvement of barangay access roads.

Uploaded by

Chris Briones
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

Republic of the Philippines

Department of Social Welfare and Development


KALAHI-CIDSS: KKB Project
Barangay: ________________
Municipality of Jimalalud
Province of Negros Oriental

Name of Project :
Location :
Contractor :
Part of structure to be poured:
Estimated Volume :
Designed Mix:
[Link]/Section :
Date of Pouring :
Time of Pouring:

Requested By:
Contractor: ________________________________________
(Name and Signature)

CHECKLIST
Concrete Vibrator Field Density Test
Protective Covering Materials Beam/Cylinder Molds
Warning Signs/Barricades/Flagmen Curing Materials
Concrete Saw Slump Cone
Concrete Block Spacer Plumbness
Quality of Materials Used (Result of Design/Trial Mix,
Finishing Tools/Equipment(screeder, broom, etc.)
Test Reports, etc.)

Line and Grade alignment (from setting, elevations, etc.) Lighting System

Required construction equipment Electrical Lay-out (Roughing-ins/embedments)


Rebars installation requirements Falsework/formworks adequacy
Checked by:

Project Inspector (MCT-TF or M.E) ENGR. JOSEPH JEROME M. JAYME


(Name and Signature)

Request: Approved Disapproved

Project Inspector (ACT-TF) GERLIE C. NAWANAO


(Name and Signature)

Remarks/Recommendations

Request: Approved Disapproved

Project Inspector ( Barangay Captain ) ________________________________________


(Name and Signature)
Remarks/Recommendations
Department of Social Welfare and Development
Region VI
KALAHI-CIDSS:NCDDP
Cycle/Phase: AF

Sub-Project : Improvement of Barangay Access Road at Barangay Amontay Date: ____________________

Barangay: Amontay
Municipality: Binalbagan
Province: Negros Occidental

CONCRETE POURING REQUEST


Structure to be Poured : ___________________
Estimated Total Volume : ___________________
Designed Mix : ___________________
Slump Test: _______________________
Date and Time Start: ________________________

Item No. Work Item Particulars Remarks

Inspector General Notes:

Requested by:

Project Supervisor

Inspected and Approved by:

ENGR. GABRIEL O. VILLANUEVA ______________________


ACT/MCT Technical Facilitator Date

VERGIE C. SARONA ______________________


BDC-TWG Chairperson Date
Department of Social Welfare and Development
Region VI
KALAHI-CIDSS:NCDDP
Cycle/Phase: AF

Sub-Project : Improvement of Barangay Access Road at Barangay Amontay Date: ____________________

Barangay: Amontay
Municipality: Binalbagan
Province: Negros Occidental

CONCRETE POURING REQUEST


Structure to be Poured : ___________________
Estimated Total Volume : ___________________
Designed Mix : ___________________
Slump Test: _______________________
Date and Time Start: ________________________

Item No. Work Item Particulars Remarks

Inspector General Notes:

Requested by:

Project Supervisor (Foreman) / Contractor

Inspected and Approved by:

ENGR. GABRIEL O. VILLANUEVA ______________________


Technical Facilitator / Municipal Engineer Date

VERGIE C. SARONA ______________________


BDC-TWG Chairperson Date

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