Project Name	[Project name]	Inspection Checklist Concrete Works
Project Number	[Project number]
Client	[Client name]	WBS ID	[WBS ID]	Date	[Date]
Client’s Repres.	[Client representative name]	Mix Design	[Mix design]
Contractor	[Contractor name]	Reference Doc	[Drawing etc. against which is inspected]
ITR No.	[Checklist to be attached to ITR no. …]
Location	[Area]
Item	Work Executor	Contractor	Client	Remarks
Checked (initials & Date)	Hold Point	Inspected (initials & Date)	Hold Point	Inspected (initials & Date)
1.0 Excavation (if applicable)
1.1 Compaction Test	W H	W H
1.2 Blinding Concrete	W H	W H
2.0 Forms
2.1 Location, Elevation, Dimension, Plumpness, Level	W H	W H
2.2 Cleanliness, Support	W H	W H
2.3 Chamfer Strips, Filler Strips, Vapor Barrier	W H	W H
3.0 Reinforcement
3.1 Rebar/Welded Wire Mesh (size, spacing, lap, ties)	W H	W H
3.2 Mill Certificates	W H	W H
4.0 Embedded Items
4.1 Sleeves (size, location)	W H	W H
4.2 Anchor Bolts (dimension, location)	W H	W H
4.3 Mill Certificates	W H	W H
5.0 Ground Wires
5.1 Wire Size	W H	W H
5.2 Attachments	W H	W H
6.0 Preparation
6.1 Access	W H	W H
6.2 Equipment	W H	W H
6.3 Pour Plan	W H	W H
Work Executor	Contractor Acceptance	Client Acceptance
Name	Name	Name
Signature	Signature	Signature
Date	Date	Date