CKD SHELTER WORKS

SITE ID
SUM-WSM-0030-X-B
SITE NAME DATE OF ACCEPTANCE :
Koto Tuo Lima Puluh Kota

ACCEPTANCE TEST BY (name, sign, company)

1. ,
2. ,
3. ,

No. Items Accepted Not Accepted N/A References Remarks

I. INSPECTION REPORT DOCUMENTATIONS

Inspection Report for Shelter Work. (pass
1. c c c
& completed)

II. CKD SHELTER

Shelter properly anchored (fixed)
1. c c c Standard

2. Shelter Base Frame / Foundation c c c Drawing

Walls, floor (anti static vynil material) &

a. roof are properly installed and sealed (no c c c Standard
leakage)

Shelter is new, without any damage or

b. c c c Standard
defect

3. Shelter Door & accessories(lock, hingers and stoppers):

Properly installed & completed
a. c c c Standard

Able to be opened & closed smoothly

b. c c c Standard

4. Cable Inlet (FEP):

a. No leakage c c c Standard

b. Installed correctly & sealed c c c Standard

5. No gap on CKD's Panel c c c Standard

III. SITE KEYS

Cabin Door key is working properly
1. c c c Standard

2. Key label are correctly attached c c c Standard

a bcdegf
IV. CLEANNESS AND TIDINESS ( to ensure that there is not any garbage or trash left as result of civil works process)

NO trash and garbage arround and

1. c c c
inside of site

2. NO excess materials left c c c

PENDING ITEMS
Please list down all the pending items and timeline to complete it
PERSON IN
No. ITEMS DATE OF COMPLETION CONTACT NO.
CHARGE

ADDITIONAL NOTES
Suggested to give photo's documentation before and after for pending item to be approved

REVIEWED & APPROVED BY, ACCEPTANCE TEST BY : ACCEPTANCE TEST BY :

PT. PROTELINDO PT. PT. ROTUA ABADI JAYA

NAME&SIGN, ______________________________________ NAME&SIGN, ______________________________________ NAME&SIGN, ______________________________________

DATE: DATE: DATE: