F-OPR.

pond-001/00
PROYEK : THE TOWER JAKARTA CONTRACTOR MAIN CONTRACTOR
SUB PROJECT : PT. ACSET INDONUSA PT. TOTAL BANGUN PERSADA
FORM REQUEST PACKAGE : FOUNDATION & DIAPHRAGM WALL
JOB : Bored Pile and Diaphragm Wall

No. Page : Day : Jumat

Qty. Page : 1of 1 Date : 26 Juli 2013

NO. LOCATION DESCRIPTION WORK COMMENTS

: Dwg. Attachment Pengeboran Sumur Pengamatan 1

: Dwg. Attachment
: Dwg. Attachment
: Dwg. Attachment

Disetujui Oleh : Diketahui Oleh : Diajukan Oleh :

PT. TOTAL BANGUN PERSADA PT. ALFA GOLDLAND REALTY PT. ACSET INDONUSA
 CHECK LIST DIAPHRAGM WALL
PROYEK GEDUNG MENARA BRI MEDAN

Date :
Grid :
No. Referensi
1. Shop Drawing :
2. Technical Spesification :
Inspection Result
NO Inspection Item I II III NOTE
OK NO OK NO OK NO
I EXCAVATION TRENCH
1. No. D-Wall :
2. Type :
3. Size ( theoritis)
- Thick : mm
- Width : mm
- Length From Top of Concrette Wall : mm
4. Top of Guide Wall Level :
5. Top of Concrette Wall Level :
6. Bottom of D-Wall Level :
7. Depth From Top of Guide Wall (Actual)
- Section I : mm
- Section II : mm
- Section III : mm
8. Grab Equipment :
9. Slurry Bentonite :

II REINFORCEMENT
1. Vertikal Rebar
2. Horizontal Rebar
3. Lifting Bar
4. Stiffner Bar
5. Hanger Bar
6. Starter Bar
Basement 2 :
Basement 3 :
Basement 4 :
Basement 5 :
7. Top of Reinforcement Level :
8. CWS+Rubber Waterstop : m'

III CONCRETING
1. Length of Tremie Pipe : m'
2. Crushing Test Sample : pcs
3. Concrete Grade : MPa
4. Slump : cm
5. Concrete Volume : m3
6. Length Top of Concrette Level (Actual) : mm

DISETUJUI OLEH, DIBUAT OLEH,

PT. ARTEFAK ARKINDO PT. ADHI KARYA (Persero) Tbk PT. ACSET PONDASI INDONUSA

(…..................................) (…..................................) (…..................................) (…..................................)

MK SPV QC ENG
 PROYEK GEDUNG MENARA BRI MEDAN
DIAPHRAGM WALL (CWS SYSTEM)

CONCRETE RECORD DIAPHRAGM WALL Width : m Date :

Ref. No. : Bottom Level : Volume Concrete Teoritis : M3
No. Panel : Operator : Volume Concrete Actual : M3
Type Panel : Ground Level : Trimmed Level :
Thick : mm Equipment : Waste :
Top of Guide Wall Level : Weather : Top Concrete : m'
Concrete Level (C.O.L) : Sampel : Pcs Concrete Grade : MPa
Excavation Concreting
JOB TIME No. Mixer/ VOL TIME DEPTH ( m ) LENGTH OF TREMIE
TRUCK
NO SLUMP REMARK
DESCRIPTION No. Doket ON SITE (M3)
START FINISH START FINISH SEC I SEC II SEC III SEC I SEC II SEC III
SETTING
1
EQUIPMENT
START
2 Trimmed level
EXCAVATION
3

9 concrete monitoring

10
top guide wall
11 c.o.l

12

13
FINISH
14
EXCAVATION
CLEANING 15
ELEVATION
16
CHECK
INSTALL OF
17
REBAR
INSTALL OF
18 reinforcement cage position
TREMIE
ELEVATION
19
CHECK
Note :

DISETUJUI OLEH, DIBUAT OLEH,

PT. ARTEFAK ARKINDO PT. ADHI KARYA (Persero) Tbk PT. ACSET PONDASI INDONUSA

(…..................................) (…..................................) (…..................................) (…..................................)

MK SPV QC ENG
 MAIN CONTRACTOR FOUNDATION CONTRACTOR
PELAYANAN KESEHATAN PENERBANGAN - KEMAYORAN
BORED PILE & SOLDIER PILE

BORING AND CONCRETING RECORD SOLDIER PILE

PELAYANAN KESEHATAN PENERBANGAN - KEMAYORAN

AREA TOWER : .....................

1. NO PILE ( BP ) : 8. TOP OF REBAR : mm

2. DIAMETER PILE : : mm 9. REBAR LENGTH : mm

3. CUT OF LEVEL : : mm 10. PILE LENGTH : mm

4. GROUND LEVEL : : mm 11. CONCRETE GRADE : K-300 Mpa

5. TOP CASING : : mm 12. SLUMP : 16 ±2 cm

6. EMPTY BOR :: mm 13. EQUIPMENT :

7. DEPTH OF BOR : : mm 14. WEATHER :

A. BORING DATE : / /

TIME JOB DEPTH SOIL

SKETSA
START FINISH DESCRIPTION (M) DESCRIPTION

SETTING EQUIPMENT

START BOR

Top of Casing

T op of R ebar
Ground Level

C ut O f Level
Toe Level

FINISH BOR

CLEANING

ELEVATION CHECK

INSTALL OF REBAR

INSTALL OF TREMIE

ELEVATION CHECK

B. CONCRETING DATE : / /
CONCRETE GRADE CONCRETING LENGTH OF
DEPTH
TRUCK CONCRETE TIME TREMIE REMARK
TRUCK NO. TRUCK/ VOLUME (M) (M)
SLUMP START FINISH
ON SITE DOCKET ( M3 )

TOTAL VOLUME

TOTAL PLAIN VOLUME

DEVIATION

JAKARTA,
APPROVED BY, SUBMITTED BY,
PT. NINDYA KARYA PERSERO PT. ACSET INDONUSA, Tbk

( …………………………) ( …………………………)
 OWNER CONTRACTOR
TAMAN ANGGREK RESIDENCES PROJECT
PACKAGES : BORED PILE,CAPPING BEAM AND DIAPHRAGM WALL

BORING AND CONCRETING RECORD

TAMAN ANGGREK RESIDENCES PROJECT

AREA TOWER : .....................

1. NO PILE ( BP ) : 8. TOP OF REBAR : mm

2. DIAMETER PILE : : mm 9. REBAR LENGTH : mm

3. CUT OF LEVEL : : mm 10. PILE LENGTH : mm

4. GROUND LEVEL : : mm 11. CONCRETE GRADE : FC 25' Mpa

5. TOP CASING :: mm 12. SLUMP : 18 ±2 cm

6. EMPTY BOR :: mm 13. EQUIPMENT : SANY SR

7. DEPTH OF BOR : : mm 14. WEATHER :

A. BORING DATE : / /

TIME JOB DEPTH SOIL

SKETSA
START FINISH DESCRIPTION (M) DESCRIPTION

SETTING EQUIPMENT 0-3 Silty Clay, reddish Brown, Stiff to Very Stiff Consistency BH.3
START BOR 3-7 Clayey Silt, Reddish Brown, Soft Consistency

7-8 Silty Clay, Brownish Brown, Stiff Consistency

8-10 Clayey Silt, Brownish Grey, Medium Consistency

10-12 Clayey Silt, Light Brownish Grey, Stiff Consistency

Top of Casing

12-14 Clayey silt, light brown, very stiff consistency

T op of R ebar
Ground Level

14-18 Clayey Silt, Light Brownish Grey, Very Stiff Consistency

C ut O f Level
18-22 Clayey Silt, Light Brown, Hard Consistency

22-23 Clayey silt, dark grey, stiff consistency

23-28 Clayey silt, brownish grey, very stiff consistency

28-30 Clayey Silt, Light Brownish Grey,Very Stiff Consistency

30-34 Sand, Fine to Medium Grained, Very Stiff Consistency

34-39 Clayey Silt, Light Brownish Grey, Hard Consistency

39-41 Clayey Silt, Dark Grey, Hard Consistency

41-42 Silty Sand, Coarse Grained Sand

Toe Level

42-45 Clayey Silt, Dark Grey, Hard Consistency

45-48 Clayey Silt, Light Brownish Grey, Hard Consistency

FINISH BOR

CLEANING

ELEVATION CHECK

INSTALL OF REBAR

INSTALL OF TREMIE

ELEVATION CHECK

B. CONCRETING DATE : / /
CONCRETE GRADE CONCRETING LENGTH OF
DEPTH
TRUCK CONCRETE TIME TREMIE REMARK
TRUCK NO. TRUCK/ VOLUME (M) (M)
SLUMP START FINISH
ON SITE DOCKET ( M3 )

TOTAL VOLUME

TOTAL PLAIN VOLUME

DEVIATION

JAKARTA,
APPROVED BY SUBMITTED BY
PT. ARYAKENCANA SEMESTA PT. ACSET INDONUSA

( …………………………) ( …………………………)
 OWNER CONTRACTOR
TAMAN ANGGREK RESIDENCES PROJECT
PACKAGES : BORED PILE,CAPPING BEAM AND DIAPHRAGM WALL

BORING AND CONCRETING RECORD

TAMAN ANGGREK RESIDENCES PROJECT

AREA TOWER : .....................

1. NO PILE ( BP ) : 8. TOP OF REBAR : mm

2. DIAMETER PILE :: mm 9. REBAR LENGTH : mm

3. CUT OF LEVEL :: mm 10. PILE LENGTH : mm

4. GROUND LEVEL :: mm 11. CONCRETE GRADE : FC 25' Mpa

5. TOP CASING :: mm 12. SLUMP : 18 ±2 cm

6. EMPTY BOR : mm 13. EQUIPMENT : SANY SR

7. DEPTH OF BOR :: mm 14. WEATHER :

A. BORING DATE : / /

TIME JOB DEPTH SOIL

SKETSA
START FINISH DESCRIPTION (M) DESCRIPTION

SETTING EQUIPMENT 0-2 Concrete Material & Silty Clay, Reddish Brown BH.2
START BOR 2-8 Clayey Silt, Reddish Brown, Medium Consistency

8-10 Clayey Silt, Light Brown, Medium Consistency

10-13 Silty Clay, Light Brownish Grey, Stiff Consistency

13-14 Silty Clay, Light Brownish Grey, Very Stiff Consistency

Top of Casing

14-16 Clayey Silt, Light Brown, Hard Consistency

T op of R ebar
Ground Level

16-17 Silty Sand, Dark Grey, Slightly Cemencted, Very Dence

C ut O f Level
17-20 Clayey Silt, Light Brown, Very Stiff to Hard Consistency

20-21 Silty Clay, Stiff Consistency

21-23 Silty Clay, Medium Consistency

23-26 Clayey Silt, Dark Grey, Hard Consistency

26-32 Silty Sand, Dark Brown, Dense to Very Dense

32-34 Clayey Silt, Light Brownish Grey, Hard Consistency

34-35 Silty Clay, Light Brownish, Hard Consistency

35-38 Sandy Silt, Dark Grey, Dense

Toe Level

38-40 Silty Sand, Dark Grey, Very Dense

41-42 Silty Sand, Dark Grey, Slightly Cemented, Very Dense

42-47 Clayey Silt, Grey to Dark Grey, Hard Consistency

FINISH BOR

CLEANING

ELEVATION CHECK

INSTALL OF REBAR

INSTALL OF TREMIE

ELEVATION CHECK

B. CONCRETING DATE : / /
CONCRETE GRADE CONCRETING LENGTH OF
DEPTH
TRUCK CONCRETE TIME TREMIE REMARK
TRUCK NO. TRUCK/ VOLUME (M) (M)
SLUMP START FINISH
ON SITE DOCKET ( M3 )

TOTAL VOLUME

TOTAL PLAIN VOLUME

DEVIATION

JAKARTA,
APPROVED BY SUBMITTED BY
PT. ARYAKENCANA SEMESTA PT. ACSET INDONUSA

( …………………………) ( …………………………)
 FORM CHECK LIST PRA PENGECORAN
THE TOWER JAKARTA PROJECT

1. NO PILE : ……………….. 9. PILE LENGTH : ………………..

2. DIAMETER PILE : ……………….. 10. CONCRETE GRADE : ………………..
3. CUT OF LEVEL : ……………….. 11. SLUMP : ………………..
4. GROUND LEVEL : ……………….. 12. EQUIPMENT : ………………..
5. TOP CASING : ……………….. 13. WEATHER : ………………..
6. EMPTY BOR : ………………..
7. DEPTH OF BOR : ………………..
8. DEPTH OF BOR ACTUAL : ………………..

1 Type : Tanggal :
2 Pembesian
3 - Ujung Atas : D….. L=……… sk: D13_

4 -Tengah D….. L=……… sk: D13_

5 -Tengah D….. L=……… sk: D13_

6 -Tengah : D….. L=……… sk: D13_

7 -Ujung Bawah : D….. L=……… sk: D13_

8 Elevasi muka tanah :……………………………………………m

9 Elv. Renc toe level :……………………………………………m Kedalaman bor dari T.O.C :……………….m (Actual)
10 Elv. Cut Off Level :……………………………………………m Ukuran kedalaman setelah cor :……………….m (Actual)
11 Elv min Pengecoran :……………………………………………m Panjang efektif min. pengecoran :……………….m (Actual)
12 Cleaning : Perkiraan volume beton :………………m3
13 Start Pengecoran : pk selesai pk :
14 Catatan :

Diajukan, Diketahui Disetujui

PT. Acset Indonusa PT. Total Bangun Persada PT. Geo Optima

( …………………………) ( …………………………) ( …………………………)

 OWNER CONTRACTOR
TAMAN ANGGREK RESIDENCES PROJECT
PACKAGES : BORED PILE,CAPPING BEAM AND DIAPHRAGM WALL

BORING AND CONCRETING RECORD

TAMAN ANGGREK RESIDENCES PROJECT

AREA TOWER : .....................

1. NO PILE ( BP ) : 8. TOP OF REBAR : mm

2. DIAMETER PILE :: mm 9. REBAR LENGTH : mm

3. CUT OF LEVEL :: mm 10. PILE LENGTH : mm

4. GROUND LEVEL :: mm 11. CONCRETE GRADE : FC 25' Mpa

5. TOP CASING :: mm 12. SLUMP : 18 ±2 cm

6. EMPTY BOR : mm 13. EQUIPMENT : SANY SR

7. DEPTH OF BOR :: mm 14. WEATHER :

A. BORING DATE : / /

TIME JOB DEPTH SOIL

SKETSA
START FINISH DESCRIPTION (M) DESCRIPTION

SETTING EQUIPMENT 0-4 Clayey silt, reddish brown, medium consistency BH.1
START BOR 5-10 Silty clay, light brownish grey, stiff consistency

11-15 Silty clay, light brownish grey, stiff consistency

15-21 Clayey silt, light brown, hard consistency

22-23 Sand, dark grey, medium dense

Top of Casing

23-28 Clayey silt, light grey, very stiff consistency

T op of R ebar
Ground Level

29-32 Sand, fine grained, light grey, medium dense

C ut O f Level
32-34 Silty sand, light grey, coarse grained, slight cemented

34-36 Clayey silt, brownish grey, very stiff consistency

36-40 Clayey silt, brownish grey, hard consistency

41-42 Silty sand, dark grey, coarse grained, very dense

42-47 Clayey silt, light brownish grey, hard consistency

Toe Level

FINISH BOR

CLEANING

ELEVATION CHECK

INSTALL OF REBAR

INSTALL OF TREMIE

ELEVATION CHECK

B. CONCRETING DATE : / /
CONCRETE GRADE CONCRETING LENGTH OF
DEPTH
TRUCK CONCRETE TIME TREMIE REMARK
TRUCK NO. TRUCK/ VOLUME (M) (M)
SLUMP START FINISH
ON SITE DOCKET ( M3 )

TOTAL VOLUME

TOTAL PLAIN VOLUME

DEVIATION

JAKARTA,
APPROVED BY SUBMITTED BY
PT. ARYAKENCANA SEMESTA PT. ACSET INDONUSA

( …………………………) ( …………………………)
 F-OPR.pond-006/00

HASIL PEMBACAAN LOADING TEST

PROYEK PASAR TANAH ABANG BLOK B
No. Pile : P.490
Diameter : 1200
Tgl :
lembar :
BEBAN DIAL GAUGES (mm) SCALE RULE (mm) DIAL GAUGES
TGL WAKTU AVERAGE
KETERANGAN
% TON A B C D RA RB RC RD
X Y

PT. ACSET INDONUSA

Dicatat oleh : Diperiksa Oleh : Mengetahui :
( ) ( ) ( )
 F-OPR-007/00

SURVEY KEPUASAN PELANGGAN

Terima kasih atas waktu yang telah anda sediakan untuk memberikan
penilaian terhadap PT. Acset Indonusa

A. Silahkan memberikan persentase bobot terhadap pernyataan di bawah ini.

B. Pernyataan ini adalah harapan anda terhadap perusahaan yang bergerak dibidang konstruksi,
dan silahkan anda mengisi nilai disebelah kanan point dan jika dijumlah
point tersebut tidak boleh melebihi 100.

Nilai
No. Pernyataan
0 - 100
1. Ketersediaan alat-alat berat dan alat penunjang keselamatan yang
berfungsi dengan baik, serta memiliki gudang yang memadai dan
kebersihan lokasi proyek.

2. Kualitas pekerjaan yang baik dan sesuai dengan spesifikasi teknis dan
pelaksanaan project yang tepat waktu, karyawan yang berkualifikasi dan
memiliki keahlian.
3. Penanganan keluhan pelanggan yang cepat dan tanggap.

4. Harga proyek yang relative competitive dan memberikan laporan

pelaksanaan yang tepat waktu.

5. Karyawan yang memberikan penjelasan mengenai pekerjaan secara jelas

kepada pelanggan.

100%
Berilah tanda Ö pada pilihan anda.
Angka Penilaian :
1 : Sangat Tidak Setuju
2 : Tidak Setuju
3 : Netral
2 : Setuju
5 : Sangat Setuju

Catatan : Kolom harapan adalah harapan anda terhadap perusahaan konstruksi dan kolom persepsi adalah penilaian
anda terhadap PT. Acset Indonusa.

Persepsi
Harapan PT. Acset
No. Pernyataan
Indonusa
1 2 3 4 5 1 2 3 5
1. Ketersediaan alat-alat berat yang berfungsi
dengan baik.
2. Alat-alat penunjang keselamatan tersedia
dan dipakai dalam bekerja.
3. Kebersihan lokasi proyek dalam pelaksanaan
pekerjaan.
4. Memiliki warehouse / gudang untuk
menampung alat-alat berat yang memadai.
5. Kualitas pekerjaan yang baik sesuai dengan
spesifikasi teknis
6. Pelaksanaan project yang tepat waktu

7. Karyawan yang berkualifikasi dan memiliki

keahlian dalam melakukan pekerjaan
8. Penanganan keluhan pelanggan yang cepat
dan tanggap
9. Harga proyek yang relative competitive.

10. Memberikan laporan pelaksanaan pekerjaan

yang tepat waktu dan jelas
11. Karyawan yang memberikan penjelasan
mengenai pekerjaan secara jelas kepada
pelanggan.

Saran dan Keterangan :

Tanggal :
 F-OPR-008/00

LAPORAN KELUHAN PELANGGAN

Diterima Oleh : Tgl/Bln/Thn :

Nama : Dept. / Posisi :

Perusahaan : Telp. :

Fax :

Keluhan :

Diselesaikan sendiri

Diserahkan ke Departemen Terkait

Penyebab :

Tindakan Koreksi dan Pencegahan :

Tanggal Rencana : Dilakukan Oleh :

Tanggal Selesai : Tanda Tangan :

Status Verifikasi : OK / NG
Keterangan :

Diverifikasi Oleh :

Tanda Tangan Oleh :

Diperiksa Oleh : Disetujui Oleh :

 F-OPR-009/00

TINDAKAN KOREKSI DAN PENCEGAHAN

( NCR )

Diminta Oleh : Tgl/Bln/Thn :

Departemen : Posisi :

Masalah / Keluhan yang dihadapi :

Status Penyelesaian : Diselesaikan Sendiri Tanda Tangan :

Serahkan ke Departemen Terkait

Penyebab / Analisa Masalah :

Tindakan Koreksi dan Pencegahan :

Tanggal Rencana : Dilakukan Oleh :

Tanggal Selesai : Tanda Tangan :

Status Verifikasi : OK / NG
Keterangan :

Diverifikasi Oleh :
Tanda Tangan Oleh :

Diperiksa Oleh : Disetujui Oleh :

PT……………………….. F-OPR.str-014/00
……………………………

Column Reinforcement/Formwork Inspection Form

Ref. No. : Dwg. Ref. No. :

Date :
Time : Location (Flr. & G/L) :
Attn. :

CHECKLIST ME RE/COW COMMENTS

1 Formwork
a. Dimension
b. Verticality
c. Mould Oil / release agent
d. Cleanliness
2 Column reinforcement
a. Main rebar
b. Stirrups
c. Secondary stirrups
d. Lap length
3 Concrete cover
4 Base roughening

STATUS

APPROVED

APPROVED WITH COMMENTS

REJECTED

Requested by, Checked by, Approved by,

MC Project Manager Clerk of Works (C&S) Resident Engineer (C&S)

Name : Name : Name :

Date : Date : Date :
PT……………………….. F-OPR.str-013/00
……………………………

Pilecap Reinforcement/Formwork Inspection Form

Ref. No. : Dwg. Ref. No. :

Date :
Time : Location (G/L) :
Attn. :

CHECKLIST ME RE/COW COMMENTS

1 Formwork
a. Dimension, elevation
b. Depth of pilecap
c. Rigidity / verticality
d. Cleanliness
2 Pilecap reinforcement
a. Top rebar
b. Bottom rebar
c. Side rebar
d. Lap length
3 Concrete cover

4 Column / Wall starter rebars

a. No.& diameter of main rebars
b. No., spacing & dia. Of stirrups
c. Alignment & verticality
5 Embedment into pilecap
6 Cleanliness
7 As-built of piles

STATUS

APPROVED

APPROVED WITH COMMENTS

REJECTED

Requested by, Checked by, Approved by,

Engineer Clerk of Works (C&S) Resident Engineer (C&S)

Name : Name : Name :

Date : Date : Date :
 F-OPR.str-015/00

Readymix Concrete Delivery Records

Project : The Tower Jakarta Delivery for : Bored Pile

Diaphragm Wall
Date : Guide Wall
Platform

VOLUME : f'c : Mpa

COMMENTS
SUPPLIER :

Arrival Pouring Leaving

S/N Truck No. Slump Volume
Time Time Time

Requested by, Checked by, Acknowledged by,

Supervisor Quality Control Site Engineer

Name : Name : Name :

Date : Date : Date :
PT……………………….. F-OPR.str-020/00
……………………………

Material Testing Report Form

Ref. No. : Subject :

Date :
Attn. :
Copy to : Place of testing :

PM Architect C & S Eng.

M&E Eng. ID Date of testing :

DESCRIPTION COMMENTS

STATUS

APPROVED

APPROVED WITH COMMENTS

REJECTED

Submitted by, Replied by, Acknowledge by,

RE (C&S) / RE (M&E) / RA Project Manager

Name : Name : Name :

Date : Date : Date :
PT……………………….. F-OPR.str-021/00
……………………………

Shop Drawing Submission Form

Ref. No. : Attn :

Date : Copy to :

PM Architect C & S Eng.

M&E Eng. ID

A B C Shop Dwg No. Shop Dwg No. Drawing Title

STATUS REMARKS

[A] APPROVED

[B] APPROVED WITH COMMENTS

[C] REJECTED

Submitted by, Replied by, Acknowledge by,

Arch / C&S / M&E / ID Project Manager

Name : Name : Name :

Date : Date : Date :
PT……………………….. F-OPR.str-022/00
……………………………

As-Built Drawing Submission Form

Ref. No. : Attn :

Date : Copy to :

PM Architect C & S Eng.

M&E Eng. ID

A B C Shop Dwg No. Shop Dwg No. Drawing Title

STATUS REMARKS

[A] APPROVED

[B] APPROVED WITH COMMENTS

[C] REJECTED

Submitted by, Replied by, Acknowledge by,

Arch / C&S / M&E / ID Project Manager

Name : Name : Name :

Date : Date : Date :
PT……………………….. F-OPR.str-023/00
……………………………

Daily Report (C&S)

Ref. No. : Date :

Manpower Qty Equipment Qty Activites

Project Manager

CM (Arch)

CM (C&S)

Site Engineer (Arch)

Site Engineer (C&S)

M&E Co-ordinator

NSC Co-ordinator

Arch Supervisor

C&S Supervisor

M&E Supervisor

Engineering Manager

Surveyor

Chainman

Operator

Mechanic

Excavator

Carpenter

Mason

Steel Bender

Steel Fixer

Concretor

Soil Treatment Worker

Dewatering Worker

General Worker

Submitted by, Acknowledge by,

RE C&S

Name : Name :
Date : Date :

To be submitted in 2 copies on the following day before 8.30 am.

 F-OPR.str-023/00

Activites

in 2 copies on the following day before 8.30 am.

PT……………………….. F-OPR-025/00
……………………………

Request for Rectification Work Inspection Form

Ref. No. : Subject :
Date :
Attn. :

Allow to Proceed Rectification Work

Item Proposed Rectification Work Location/Area (Yes / No) Satisfactorily completed
Cont. Rep Consult. Rep Cont. Rep Consult. Rep

Date for initial Inspection / Completion

Requested by, Acknowledge by,

MC Project manager RE (C&S) / RE(M&E) / RA

Name : Name :
Date : Date :

To be submitted in 2 copies on the following day before 8.30 am.

 Rectification Work
Satisfactorily completed
Consult. Rep

d in 2 copies on the following day before 8.30 am.

PT. ACSET INDONUSA F-OPR.str-026/00

PROYEK : ………………. CONTRACTOR SUPERVISOR CONSULTANT

SUB PROJECT : ………………. PT. ACSET INDONUSA PT. …………………………………….
WORK PERMIT FORM
PART : _______________
WORK ITEM : _______________
REF. NO :
Attn : Day :
No. of Page : 1of 1 Date :
NO. LOCATION DESCRIPTION REMARKS

: Dwg. Attachment
: Dwg. Attachment
: Dwg. Attachment

NOTE : ACKNOWLEDGE BY : APPROVED BY : PROPOSED BY :

PT. …………………………….. CONTRACTOR
PT. ACSET INDONUSA
 F-OPR.str-027/00

OVER TIME REQUEST

………………. PROJECT
Ref. No. :

Herewith we propose over time to do the works :

The Work to Over Time

No. Description Date Location Volume Remark / Comment
Over Time Start Finish

APPROVED

APPROVED WITH COMMENT

NOT AGREED Surabaya,

Propose by
PT. ………………………………….. PT. ACSET INDONUSA

( …………………………………………… ) ( ……………………………….. )
 No Dokumen : F-OPR.str-029/00
PT. ACSET INDONUSA Revisi : 00
Tanggal Berlaku : 6 Maret 2006
PROYEK :

FORM INSPEKSI No :
PENGELASAN

Hal :
REFERENSI : Edisi :
Revisi :

FORM : Berikan tanda Ö yang sesuai

Tidak
NO ITEM PEMERIKSAAN Ya Tidak
Disyaratkan

1 Gambar detail ( Type & Ukuran ) sesuai dengan spesifikasi

2 Jenis Pengelasan Penuh atau setempat sesuai dengan yang telah disetujui

3 Kelurusan arah Horisontal & Vertical bidang yang di las sudah lurus

4 Kerapihan hasil Pekerjaan setelah Pengelasan sudah rapih.

Telah dilakukan inspeksi :

Penanggung Jawab : Denah Lokasi :

Nama Jelas : As
Lantai
Tanda Tangan :

Tgl / Bln / Thn :

Pemeriksaan ke :

Hasil Inspeksi adalah :

Semua Instruksi Kerja di atas telah

dilaksanakan sesuai persyaratan.

Instruksi Kerja belum semua dilaksanakan dan

akan diinspeksi ulang

Tgl.

Catatan : ……………………………..
Dibuat Oleh, Menngetahui,
( ) ( )
 F-OPR-032/00

PEMBERITAHUAN BARANG RUSAK / HILANG KE PELANGGAN

Tanggal Kerusakan / Hilang :

Nama Barang :

Kode / Identifikasi :

Type :

Jumlah :

Masalah

Penyebab :

Tindakan Koreksi dan Pencegahan :

Verifikasi
Hasil : OK NG
Keterangan :

Mengetahui Penanggung Jawab

(Persetujuan Pelanggan)

Pelangggan Factory/Plant Mgr. MR

 Purchase Order (F-OPR-046) PT. ACSET INDONUSA
Project Office :

Date : Tel :
Fax:

PO No. :

To : Please deliver to :
Supplier Name Project Name
Address Address

Phone No. Phone No.

Fax.No. Fax.No
Attention Attention
OUR NPWP

Your quotation : Receiver

UNIT PRICE TOTAL AMOUNT

ITEM DESCRIPTION UNIT QTY
( Rp.) (Rp.)

SUB TOTAL -
Disc........%
Total after Discount
PPN -
TOTAL
Transport

GRAND TOTAL
-

Say :

Delivery time / Required date of delivery

Payment terms

Note

Authorized signature : Received and approved by

Deputy Project Manager Supplier

Date Date

Head Office : Lisaco Building 1th Floor # 109 Jl.Jatibaru Raya No. 28, Jakarta
Tel : (62-21)3519991 Fax: (62-21)3519992
 PT.PT.
ACSET
ACSET F-OPR-047/00
INDONUSA
INDONUSA
RISALAH PEMBAYARAN
NO :

SUBCON :
SUB. PEKERJAAN :
PRIODE :
DATE :
PEMBAYARAN KE :
PROGRESS LALU :
PROGRESS INI :
S/D PROGRESS INI :
PROYEK :

JUMLAH PPN 10% TOTAL

NO URAIAN
( Rp ) ( Rp ) ( Rp )

1 Kontrak
2 Addendum 1

PORSENTASE JUMLAH PPN 10% TOTAL

NO URAIAN
% ( Rp ) ( Rp ) ( Rp )
1 Uang Muka Rp - Rp - Rp -
2 Retensi 5% Rp - Rp - Rp -

NO PEMBAYARAN PROGRESS 0.00%

1 DP ( Uang Muka ) Rp -
1. SPK/ Kontrak
Terbayar 2. Additional 1
Ke- Pot. Material (Rp)
(Rp)
2 1 Jumlah (a) Rp -
3 2
4 3 2. Uang Muka ( -/- ) Rp -
5 4 3. Retensi (- / - ) Rp -
6 5 Jumlah (b) Rp -
7 6
8 7
9 8 4.Tagihan yang telah di bayar ( -/- ) ( c1 ) Rp -
10 9 5. Potongan Material ( c2 )
11 10 Jumlah nilai Tagihan sekarang ( d ) = a+b+c Rp -
12 11
16 15 6. PPN 10 % Rp -
Jumlah Pembayaran ( nilai dalam kwitansi ) (e) Rp -

7. Potongan PPh ( - /- ) ( 2% x d ) Rp -
JML ### - - 8. Potongan Lain-Lain (*)
Terbayar (f) Rp -
SISA Rp -

CATATAN :

Jakarta,
Diketahui/ Disetujui Oleh : Diperiksa Oleh : Di buat Oleh :

Dept. Project Manager Const. Manager Dept. Const. Manager Site Manager Quantity Surveyor
 PT. ACSET F-OPR-048/00
INDONUSA
RISALAH PEMBAYARAN
NO :

SUBCON :
SUB. PEKERJAAN :
PRIODE :
DATE :
PEMBAYARAN KE :
PROGRESS LALU :
PROGRESS INI :
S/D PROGRESS INI :

PROYEK :

JUMLAH PPN 10% TOTAL

NO URAIAN
( Rp ) ( Rp ) ( Rp )
1 Kontrak
2 Addendum 1

Rp - Rp - Rp -

PORSENTASE JUMLAH PPN 10% TOTAL

NO URAIAN
% ( Rp ) ( Rp ) ( Rp )
1 Uang Muka 0% Rp - Rp - Rp -
2 Retensi 5% Rp - Rp - Rp -

NO PEMBAYARAN PROGRESS 0.00%

1 DP ( Uang Muka ) Rp - 1. SPK/ Kontrak Rp -

2. Add Rp -
2 Pembayaran ke 1 Jumlah (a) Rp -
3 Pembayaran ke 2
4 Pembayaran ke 3 3. Uang Muka ( -/- ) Rp -
5 Pembayaran ke 4 4. Retensi (- / - ) Rp -
6 Pembayaran ke 5 Jumlah (b) Rp -
7 Pembayaran ke 6
8 Pembayaran ke 7 5.Tagihan yang telah di bayar ( -/- ) (c) Rp -
9 Pembayaran ke 8 Jumlah nilai Tagihan sekarang ( d ) = a+b+c Rp -
10 Pembayaran ke 9
11 Pembayaran ke 10 6. PPN 10 % Rp -
12 Pembayaran ke 11
Jumlah Pembayaran ( nilai dalam kwitansi ) (e) Rp -

7. Potongan PPh ( - /- ) ( 2% x d ) Rp -
JUMLAH Rp - 8. Potongan Lain lain (*)
Terbayar (f) Rp -
SISA Rp -

CATATAN :

Jakarta,
Diketahui/ Disetujui Oleh : Diperiksa Oleh : Di buat Oleh :

Dept. Project Manager Const. Manager Dept. Const. Manager Site Manager Quantity Surveyor
 PT. ACSET INDONUSA F-OPR-049/00

PROGRESS PEMBAYARAN PEKERJAAN ___________________________

PT. __________________________

Periode :

PROGRESS
NO. JENIS PEKERJAAN SATUAN VOLUME HARGA TOTAL KETERANGAN
S/D LALU SAAT INI KUMULATIF
VOLUME TOTAL (Rp) VOLUME TOTAL (Rp) VOLUME TOTAL (Rp)

TOTAL Rp - Rp - Rp - Rp -

Jakarta,
Diketahui/ Disetujui Oleh : Di buat Oleh :

Dept. Project Manager Quantity Surveyor

 P.T. ACSET F-OPR-050/00
I N D O N U S A
GD. LISACO LT. 1 #109. JL. JATIBARU RAYA NO. 28 Telp. (021) 3519991, FAX : (021) 3519992
JAKARTA PUSAT 10160, INDONESIA

PROYEK

SURAT PERINTAH KERJA

Nama SubCon / Mandor No. SPK

Pekerjaan
Lokasi
Tanggal
0
No. Uraian Pekerjaan Volume Satuan Harga Satuan Total Harga

Subtotal Rp -
Pemasangan Rp -
Total Rp -
Terbilang :
Catatan

Jakarta,

Pemberi tugas,
PT.ACSET INDONUSA Penerima tugas,
Deputy Project Manager Sub.Con/Mandor

( ) ( )
 OPR-051/00
OPNAME PEKERJAAN
PROYEK :
MANDOR / SUB. CONT. : SPK NO. :
PEKERJAAN : PEMBAYARAN :
TGL. PEMBAYARAN : PERIODE : s/d

HARGA. JUMLAH PEMBAYARAN

SATUAN HARGA MINGGU LALU MINGGU INI S/D MINGGU INI
NO. URAIAN PEKERJAAN SAT VOLUME
( Rp. ) ( Rp. ) % VOLUME Rp. % VOLUME Rp. % VOLUME Rp.

###
0% ###

###
###
###
###
###
###
###
###
###
###
###
###
###
###
###
Sub Total - - - -
Retensi 5% -
Sub Total - - -
Kasbon
Jumlah yang dibayar - - - -

Disetujui oleh, Di periksa Oleh , Dibuat oleh, Diterima,

Dept. Project Manager Construction Manager Dept. Const. Manager Site Manager Quantity Surveyor Mandor
 PT. ACSET F-OPR-052/00
INDONUSA

VARIATION ORDER

SCOPE OF WORK :
LOCATION :
REFER TO :

No Description Quantity Unit Rate Total

Rp Rp

Total

Jakarta,
Checked and Agreed by, Prepared by,
PT. ACSET INDONUSA

(Quantity Surveyor) (Quantity Surveyor) (Quantity Surveyor)

 PT. ACSET F-OPR-053/00
INDONUSA

VARIATION ORDER

SCOPE OF WORK :
LOCATION :
REFER TO :

No Description Quantity Unit Rate Rate Total Total

Rp US$ Rp US$

Total

Jakarta,
Checked and Agreed by, Prepared by,
PT. ACSET INDONUSA

(Quantity Surveyor) (Quantity Surveyor) (Quantity Surveyor)

 ACSET NON CONFORMING REPORT
INDONUSA EKSTERN / INTERN
F-OPR-054/00
PROYEK :

No. N C R :
Tanggal :

Nama Barang / Pekerjaan Originator :

Lokasi : Tanda Tangan :

Unit :

Temuan : Ketentuan / Spesifikasi :

DISPOSISI :

Pakai apa adanya : Rework / Repair :

Down Grade : Scrap :

Lain-lain :

Catatan :
Note

Analisis Penyebab NCR : Apakah harus dianalisis secara mendalam ? Ya / Tidak

Jika Ya, No. C A R :

Jika Tidak, jelaskan sebab-sebabnya ?

VERIVIKASI S Q C M PERSETUJUAN DISPOSISI

SQCM SM PM/CM

( …………….……………) ( ……………….…………) ( ……………….…………)

file:///conversion/tmp/activity_task_scratch/630079282.xlsx