Project Name	[Project name]	Inspection Checklist Earthworks
Project Number	[Project number]
Client	[Client name]	WBS ID	[WBS ID]	Date	[Date]
Client’s Repres.	[Client representative name]	Location	[Area]
Contractor	[Contractor name]	Reference Doc	[Drawing etc. against which is inspected]
ITR No.	[Checklist to be attached to ITR no. …]
Item	Work Executor	Contractor	Client	Remarks
Checked (initials & Date)	Hold Point	Inspected (initials & Date)	Hold Point	Inspected (initials & Date)
1.0 General
1.1 Protection of Existing Structures and Utilities	W H	W H
1.2 Adequate Disposal of Excavated Material	W H	W H
1.3 Dust and Dirt Control	W H	W H
1.4 Shoring and Bracing	W H	W H
2.0 Survey
2.1 Dimensions, Position, Level of Excavation	W H	W H
2.2 Underground Utilities Detected	W H	W H
3.0 Backfilling
3.1 Approved Material in use	W H	W H
3.2 Filling Placed in required Layers	W H	W H
3.3 Compacting Verified by Lab	W H	W H
4.0 Bedding
4.1 Approved Material in use for Pipe etc. Bedding	W H	W H
4.2 Thickness and Dimension of Bedding	W H	W H
4.3 Marking (Warning Tape etc.)	W H	W H
5.0 Grading/Shaping
5.1 Approved Material in use	W H	W H
5.2 Compacting Verified by Lab	W H	W H
5.3 Level/Dimensions	W H	W H
5.3 Slope away from Structure respect. as Planned	W H	W H
Work Executor	Contractor Acceptance	Client Acceptance
Name	Name	Name
Signature	Signature	Signature
Date	Date	Date