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Inspection Report
Checklist for Backfilling
Project
Client Inspection Report No
PMC Date
Vendor
Package Civil structure (Earth work)
Description of Work Backfilling Quantity
Inspection Request
Location Level Inspected by By Time
Grid
Sl. No Description YES NO NA Remarks
Method of work agreed and all parties involved/informed
1
about specified tolerance.
2 Check safety adequecy
Is the concrete surface/structure attain the strength to retain
3
the backfill load?
4 Surface defects,if any, repaired/rectified and accepted
5 Backfill material checked and approved for filling
6 Initial depth measured and recorded in joint measurement sheet
7 Maximum thickness of layer(s) marked on the structure clearly
8 Was the previous layer placed at acceptable depth ?
9 Density of previous layer checked and accepted
10 No Loose,Segregation of material observed
11 Is the area uniform and compacted properly including edges?
Present layer In-Situ density checked and results entered in
12
the lab form No:
Observations if any :
Above Observations attended to and completed YES NO NA
Note: The quantity mentioned above is approximate measure and can not be considered for any billing purpose. Only JMS to be considered for
billing else GFC drawings are to be referred for quantity
The above works have been completed and accepted
PMC Client
Contractor Civil Contractor Quality Contractor Safety Representative CBRE Safety CBRE Safety
Representative
Signature
Name
Date
Time
Distribution Original : cc : Vendor
Format No. F019-QC-Ch-013/Rev01/Oct2013
Project Management, India 1 of 1
