PROJECT :

FORM NO. :

F-CMGSI-QC-10-023
HAND-OVER FORM REQUEST
CONTRACTOR : _____________________________________________________________________________________________________________

NAME/POSITION : ________________________________________________________________
REQUEST NO. :_________________________

DATE PREPARED : ________________________________________________________________

SIGNATURE : __________________________

DEFINABLE FEATURE OF WORK : ___________________________________________________________________________________________

ROOM NO.: ROOM DESIGNATION: LEVEL: GRIDLINE / LOCATION:

AREA (Pls. enclose key plan) : INSPECTION TYPE: INSPECTION DATE/TIME: INSPECTION CLOSE OUT DATE:
Preliminary
Final

NOTE : ALL SIGNATORIES SHOULD PRINT THEIR NAME AND SIGN TO IDENTIFY EACH SPECIMEN

The A&E Representatives certify to the CMG Representative that inspections were conducted by the subcontractor and verified by te CONTRACTOR'S-Project Engineers, and that the
(Pass/Fail) recommendations reflect the findings from those inspections.

Prepared By Checked By Inspected By REMARKS

TRADE
CONTRACTOR'S OPERATION CONTRACTOR'S QC ENGINEER YLFCCS REPRESENTATIVE (YLFCCS TO FILL UP)

AREA CLEANLINESS

SURFACE DEFECTS
COMPLETENESS

ARCHITECTURAL

CIVIL/STRUCTURAL

ELECTRICAL

WATER PROOFING

FDAS

MECHANICAL

SANITARY/PLUMBING

FIRE PROTECTION

SAFETY

OTHERS

ATTACHMENTS: Keyplan Inspection Checklist Test Reports (IF APPLICABLE) Material/s Inspection (IF APPLICABLE)

REMARKS / COMMENTS: ACTION

For Follow-up

Proceed to Succeeding Work

Do Not Proceed

Others _________________

CHECKED BY : APPROVED BY:

CONTRACTOR'S PROJECT/SITE ENGINEER YLFCCS REPRESENTATIVE

RECOMMENDING APPROVAL: NOTED BY:

CONTRACTOR'S QC ENGINEER YLFCCS - Project Manager

NOTED : THIS FORM MUST BE SUBMITTED TO THE CMGSI TEAM, DULY ACCOMPLISHED AND SIGNED BY THE CORRESPONDING CONTRACTOR'S PERSONNEL-IN-
CHARGE AT LEAST 24 HOURS BEFORE THE ACTUAL INSPECTION AND/OR INSTALLATION.
 MANILA NEW OFFICE
Contract No.:ANNEX

MAKATI DEVELOPMENT CORPORATION SAQMMAA-07-C-0044

MANILA NEW OFFICE ANNEX PROJECT Form No.:
US EMBASSY, Manila City, Philippines F-MNOX-CQC-07-009
DEFINABLE FEATURE OF WORK INSPECTION TYPE

REQUEST FOR INSPECTION Preliminary (INSTALLATION)

Final (INSPECTION)

/INSTALLATION SITE LOCATION STRUCTURE GRIDLINE REQUEST NO.

REQUESTED BY : Name/ Designation :

Subcontractor : ____________________________________ Signature :

NOTE : ALL SIGNATORIES SHOULD PRINT THEIR NAME AND SIGN TO IDENTIFY EACH SPECIMEN
AREA (Pls. enclose key plan) LEVEL INSPECTION DATE/TIME INSPECTION CLOSE OUT DATE

The A&E Representatives certify to the CQC Representative that inspections were conducted by the subcontractor and verified by te MDC-Project Engineers, and that the
(Pass/Fail) recommendations reflect the findings from those inspections.

Prepared By Checked By Inspected By

TRADE
SUBCONTRACTOR MDC FIELD OPERATIONS MDC CQC OBO REPRESENTATIVE

ARCHITECTURAL

CIVIL/STRUCTURAL

ELECTRICAL

TELECOM

FDAS

BMS

FE/BR

MECHANICAL

SANITARY/PLUMBING

FIRE PROTECTION

RED LINING

OTHERS

ATTACHMENTS: Keyplan Inspection Checklist Test Reports (IF APPLICABLE) Material/s Inspection (IF APPLICABLE)

REMARKS / COMMENTS: ACTION

For Follow-up

Proceed to Succeeding Work

Do Not Proceed

Others _________________

CHECKED BY : APPROVED BY:

JOEL C. DOMINGO
Site Superintendent MDC - CQC Manager

RECOMMENDING APPROVAL: NOTED BY:

RODELITO J. OCAMPO
MDC - CQC Representative MDC - Project Manager

NOTED : THIS FORM MUST BE SUBMITTED TO THE CQC TEAM, DULY ACCOMPLISHED AND SIGNED BY THE CORRESPONDING CONTRACTOR'S PERSONNEL-
IN-CHARGE AT LEAST 24 HOURS BEFORE THE ACTUAL INSPECTION AND/OR INSTALLATION.

04/25/2024 F-MNOX-CQC-07-009 REV-3

 MANILA NEW OFFICE
Contract No.:ANNEX

MAKATI DEVELOPMENT CORPORATION SAQMMAA-07-C-0044

MANILA NEW OFFICE ANNEX PROJECT Form No.:
US EMBASSY, Manila City, Philippines F-MNOX-CQC-07-009
DEFINABLE FEATURE OF WORK INSPECTION TYPE
SECTION 09622; 09638; 09651 - STONE
REQUEST FOR INSPECTION PAVING AND FLOORING
Preliminary (INSTALLATION)
Final (INSPECTION)

/INSTALLATION SITE LOCATION STRUCTURE GRIDLINE REQUEST NO.

REQUESTED BY : Name/ Designation :

Subcontractor : ____________________________________ Signature :

NOTE : ALL SIGNATORIES SHOULD PRINT THEIR NAME AND SIGN TO IDENTIFY EACH SPECIMEN
AREA (Pls. enclose key plan) LEVEL INSPECTION DATE/TIME INSPECTION CLOSE OUT DATE

The A&E Representatives certify to the CQC Representative that inspections were conducted by the subcontractor and verified by te MDC-Project Engineers, and that the
(Pass/Fail) recommendations reflect the findings from those inspections.

Prepared By Checked By Inspected By

TRADE
SUBCONTRACTOR MDC FIELD OPERATIONS MDC CQC OBO REPRESENTATIVE

ARCHITECTURAL

CIVIL/STRUCTURAL

ELECTRICAL

TELECOM

FDAS

BMS

FE/BR

MECHANICAL

SANITARY/PLUMBING

FIRE PROTECTION

OTHERS

ATTACHMENTS: Keyplan Inspection Checklist Test Reports (IF APPLICABLE) Material/s Inspection (IF APPLICABLE)

REMARKS / COMMENTS: ACTION

For Follow-up

Proceed to Succeeding Work

Do Not Proceed

Others _________________

CHECKED BY : APPROVED BY:

JOEL C. DOMINGO
Site Superintendent MDC - CQC Manager

RECOMMENDING APPROVAL: NOTED BY:

RODELITO J. OCAMPO
MDC - CQC Representative MDC - Project Manager

NOTED : THIS FORM MUST BE SUBMITTED TO THE CQC TEAM, DULY ACCOMPLISHED AND SIGNED BY THE CORRESPONDING CONTRACTOR'S PERSONNEL-
IN-CHARGE AT LEAST 24 HOURS BEFORE THE ACTUAL INSPECTION AND/OR INSTALLATION.

04/25/2024 F-MNOX-CQC-07-009 REV-2

 MANILA NEW OFFICE ANNEX
Contract No.:
MAKATI DEVELOPMENT CORPORATION SAQMMAA-07-C-0044
MANILA NEW OFFICE ANNEX PROJECT Form No.:
US EMBASSY, Manila City, Philippines F-MNOX-CQC-07-009
Date Prepared Request No. Page No.

REQUEST FOR INSPECTION / 1 of 1

INSTALLATION Location
MNOX-1
REQUESTED BY : Name/ Designation :
Subcontractor : ____________________________________ Signature :

Note : All signatories should print their name and sign.

AREA (Pls. enclose key plan) GRIDLINE/AXES LEVEL STRUCTURE

DEFINABLE FEATURE OF WORK INSPECTION DATE/TIME INSPECTION CLOSE OUT INSPECTION TYPE

Preliminary
Final

The A&E Representatives certify to the CQC Representative that inspections were conducted by the subcontractor and verified by te MDC-Project Engineers, and that the (Pass/Fail)
recommendations reflect the findings from those inspections.

Prepared By Checked By Inspected By

TRADE
SUBCONTRACTOR MDC FIELD OPERATIONS MDC CQC OBO REPRESENTATIVE
ARCHITECTURAL
CIVIL/STRUCTURAL
MECHANICAL
ELECTRICAL
SANITARY/PLUMBING
FIRE PROTECTION

OTHERS

REMARKS : ACTION

For Follow-up
Proceed to Succeeding Work
Do Not
Proceed Others
_______________

CHECKED BY : APPROVED BY:

JOEL C. DOMINGO
SITE SUPERINTENDENT CQC MANAGER

RECOMMENDING APPROVAL: NOTED BY:

RODELITO J. OCAMPO
MDC CQC REPRESENTATIVE PROJECT MANAGER

NOTE : This form must be submitted to The CQC TEAM, duly accomplished and signed by the corresponding
Contractor's Personnel-in-charge at least 24 hours before actual installation.

F-MNOX-CQC-07-009 REV-0
REQUEST FOR INSPECTION/INSTALLATION