Annex 15 Form No.

REPUBLIC OF THE PHILIPPINES

PHILIPPINE RURAL DEVELOPMENT PROJECT (PRDP) PLGU LOGO

Province of___, Region___

QC Inspection Report (QCIR)

Name of Project
Project Location:
Contractor: Date Prepared:
Inspection Report No.
Contract No.
Construction Activity Inspected
Ref. Pay Description Location Date Time Remarks
Item No.

Findings/Observations

Prepared by: Test Conducted?

Yes No
Signature
Type of Test Needed
Name
Title PPMIU Resident Engineer
Date NCR To be issued Reference NCR No.
Yes
Test/Inspection witnessed by No

Signature
Noted by:
Name
Signature
Title RPCO/PSO/NPCO
Date Name
Title PPMIU Engineer
Note: See form filling-in instructions Date
Form Filling-in Instructions:

1 Fill out the form by diligently supplying all the required information asked for in this "QC Inspection Report form".

2 The space provided for "Project" shall indicate the specific Project to be inspected.
3 The IRF/Work Request reference number shall be Proj ID No IRF A XXX
Project ID no: = Indicated in the IMA
IRF = Acronym for the Inspection Request Form
A= = Area of Discipline
A= Architectural Works C= Civil Works
E= Electrical Works M= Mechanical Works
P= Plumbing and Sanitary Works S= Structural Works
XXX = is the sequential numbering system of the IRF
4 Under the "Construction Activity Inspected" box, the PPMIU Engineer doing the inspection MUST diligently fill in
all the information required to clearly determine the details of the:
a The "Reference Pay Item No." as per Contract BOQ.
b The detailed "Description" of the 'Reference Pay Item No." which includes the specific activities under
inspection as well as its "Location, "Date", "Time" and "Remarks" in the corresponding spaces provided
herein.
5 The detailed findings made or concluded after the conduct of the inspection shall be indicated in the space
provided for "Findings/Observations".
6 The PPMIU Engineer should indicate the name of any inspectorate team present during the inspection who
witness the activity, after which shall fill out the space provided for the "Test/Inspection Witnessed by".
7 The Inspector shall also indicate in the form whether the "Pay Items" inspected needs to be tested further or not
and if there is indeed a test needed, he/she must specify the particulars of the test needed.
8 If a sort of violation/out of track processes are being carried out by the people inspected, meaning, a "Non-
Conformity Report" should be issued, MUST be also indicated in the space provided so as to inform the PPMIU
Head and come up with the necessary course of action before he/she affix his/her signature.