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Form JI

This document is a checklist for building/structure components at a PLTU Gorontalo 2 x 25 MW power plant project. It lists items that need to be checked such as surveying, rebar installation, formwork, concrete pouring, anchor bolts, and miscellaneous items. For each item, it includes descriptions of what needs to be checked such as location, dimensions, cleanliness, and stability. Representatives from the contractor and PLN are required to review each item and sign off to confirm it meets specifications.

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Bryan Rimbing
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71 views4 pages

Form JI

This document is a checklist for building/structure components at a PLTU Gorontalo 2 x 25 MW power plant project. It lists items that need to be checked such as surveying, rebar installation, formwork, concrete pouring, anchor bolts, and miscellaneous items. For each item, it includes descriptions of what needs to be checked such as location, dimensions, cleanliness, and stability. Representatives from the contractor and PLN are required to review each item and sign off to confirm it meets specifications.

Uploaded by

Bryan Rimbing
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
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CHECK LIST FOR BUILDING/STRUCTURE

COMPANY : PT. PLN (Persero) Contractor : PT. Rekadaya Elektrika


PROJECT : PLTU Gorontalo 2 x 25 MW
ANGGREK, GORONTALO UTARA

ITEM NAME :…………………………………………………. FORM No. : /CVL/CL-F/2016


DWG No. :…………………………………………………. SHEET : OF
REV :………………………………………………….
REVIEWED/WITNESSED
ITEM DESCRIPTION PT. RE PT. PLN
DATE SIGN DATE SIGN

1. SURVEYING - LOCATION
- ELEVATION
- PLUMBNESS

2. RE-BAR - DIAMETER BENDING


- LAP LENGTH COLUMN
- LOCATION NUMBER WALL
- SURFACE CLEANING OF REBAR BEAM
- RIGIDITY SLAB

3. FORM WORK - DIMENSION ALIGNMENT


- FORM OIL COATING COLUMN
- STABILITY WALL
- TOP ELEVATION BEAM
- CHAMPER, SPACER SLAB

4. CONCRETE - CLEANING POURING PLACE


- SLUMP TEST COLUMN
- USING VIBRATOR WALL
- REMOVAL OF LEITANCE BEAM
- CURING SLAB
- APPEARANCE OF SURFACE
5. ANCHOR BOLT/BOX - SIZE, TYPE, NUMBER
EMBEDDED STEEL, WATER - LOCATION, ORIENTATION, LEVEL
STOP, PIPE CHASING - STABILITY
- PROTECTION OF ANCHOR BOLT SCREW
6. MISC : OPENING SLEEVE, etc - DIMENSION, LOCATION, ORIENTATION, MATERIAL
REMARK :

Prepared by Prepared by Witnessed by Approved by


PT. SARTONIA AGUNG PT. REKADAYA ELEKTRIKA PT. PLN-PUSMANKON PT. PLN (Persero) upp
(………………………………………) (…………………………………….) (…………………...………………) (……………..……………………….)
PERMIT CONCRETE POURING
COMPANY : PT. PLN (Persero) FORM No. : __________
PROJECT : PLTU GORONTALO 2 x 25 MW SHEET : __________
ANGGREK, GORONTALO UTARA __________
POUR No. : PLTU / PCP / / / 17 DATE : ____________________
LOCATION : ___________________ QUANTITY : ____________________
STRUCTURE NAME : ___________________ ELEVATION : ____________________
___________________ PLACING TEMP. : ____________________
___________________ REQUIRED CURING : ____________________

DESAIN MIX : C-15 C-25 C-30


CEMENT TYPE : TYPE-I TYPE II TYPE V
SLUMP : _______ CM
REQUIRED FINISH : SMOOTH / ROUGHNESS*)

PT.RE PT.SA
CIVIL : ______________ DATE : ____________________
PIPING : ______________ DATE : ____________________
MECHANICAL : ______________ DATE : ____________________
ELECTRICAL : ______________ DATE : ____________________
SURVEY : ______________ DATE : ____________________

ENGINEERING / QC PRE POUR APPROVALS

PT.RE
ENGINEERING : ______________ DATE : ____________________
QUALITY CONTROL : ______________ DATE : ____________________

WEATHER : SUNNY / CLAUDY / RAIN / DRIZZLE


PLACEMENT STARTED DATE : _______ TIME : ____________________
PLACEMENT COMPLETED DATE : _______ TIME : ____________________
NUMBER OF CYLINDER : _______ NOS, ACTUAL SLUMP: ____________
CYLINDER CODE : ______________________
CONCRETE TESTED BY : ______________________

REMARK :
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Prepared by, Reviewed by, Witnessed by, Approved by,
PT.Sartonia Agung PT.Rekadaya Elektrika PT.PLN - PMK PT.PLN-UPP KITRING Gorontalo
(…………………………..) (………………………………..) (………………………..) (………………………………………..)

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