EPM-ITP-CC-

SAFCO/IBB MOBILE COATING Doc No 002

UNIT POJECT Rev. No. 00
ITP FOR EXCAVATION AND
Date 25th Jun, 2020
BACKFILLING
Page 1 of 10

IBB MCUP & MODIFICATION OF K-12 BUILDING

PROJECT NO. : SP-173100119

INSPECTION AND TEST PLAN

FOR
BACKFILLING & EXCAVATON

A 25 Jun, 2020 Issue for Approval MSH NCC

Rev
Date Description Original By Checked By Approved By Checked By Approved By
.

No Part of this document or the information it contains may be reproduced or transmitted in any
form or by any means electronic or mechanical, including photocopying, recording, or by any
information storage and retrieval system, without permission in writing from SABIC or NCC
 EPM-ITP-CC-
SAFCO/IBB MOBILE COATING Doc No 002
UNIT POJECT Rev. No. 00
ITP FOR EXCAVATION AND
Date 25th Jun, 2020
BACKFILLING
Page 2 of 10

TABLE OF CONTENTS

1.0 ITP for Excavation and Backfilling .............................................................................................3

2.0 Checklist-Material Receiving Inspection.....................................................................................5

3.0 Checklist-Survey for Excavation Record.....................................................................................6

4.0 Checklist-Soil Inspection...............................................................................................................7

5.0 Checklist-Backfill/Compaction.....................................................................................................8
 Doc No EPM-ITP-CC-002

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR EXCAVATION AND BACKFILLING Date 25th Jun, 2020
Page 3 of 10

1.0 ITP for Excavation and Backfilling of Underground Utilities

Print Name Signature Name of Doc No: EPM-ITP-CC-002
INSPECTION AND TEST PLAN FOR COMPANY
Prepared By: (1) Georgy Mathew MSH Revision: 00
EXCAVATION AND BACKFILLING Approved By: (2) Date: 25 Jun, 2020
COMPANY App: Page:
Discipline: CIVIL PROJECT: IBB MCU PROJECT & MODIFICATION OF K-12 BUILDING
Inspection Level :
Location: (3) IBB/SAFCO
Table No:
Criticality Level : Item Name (3): Tag No (3):

Inspection Responsibility
Sr. Acceptance Verifying Sub-
B Inspection Activity Characteristic Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

1 Material Verify or approval

1.1 Backfill Material Approved Document SES-C02-S01 SES-C02-S01 Approved Document I W A

Type of material conformance SES-C02-S01 SES-C02-S01

1.2 Material Receiving Inspection CV-MRI-1 I W W
to Specification and Drawing Drawing Drawing

2 Excavation/Trenching

As per inspection items in the

2.1 Surveying and Record SES-C02-S01 SES-C02-S01 CV-001-1 I W W
Checklist of QVD

As per inspection items in the

2.2 Dewatering Inspection (if applicable) SES-C02-S01 SES-C02-S01 CV-001-2 I W SW
Checklist of QVD

Soil Inspection for Excavation Surface As per inspection items in the

2.3 SES-C02-S01 SES-C02-S01 CV-001-2 I W SW
Preparation Checklist of QVD

2.4 Check benching and sloping As per inspection items in the SES-C02-S01 SES-C02-S01 CV-001-2 I W SW
 Doc No EPM-ITP-CC-002

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR EXCAVATION AND BACKFILLING Date 25th Jun, 2020
Page 4 of 10

Inspection Responsibility
Sr. Acceptance Verifying Sub-
Inspection Activity Characteristic Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

Checklist of QVD

CV-001-2
2.5 Sample Collection Approved Document SES-C02-S01 SES-C02-S01 I W SW
Lab Test Report

Type of material conformance

2.6 Check bed adequacy SES-C02-S01 SES-C02-S01 CV-001-2 I W SW
to Specification

3 Compaction

As per inspection items in the

3.1 Check bed is firmed and compacted SES-C02-S01 SES-C02-S01 CV-001-2 I W SW
Checklist of QVD

Install concrete tiles/warning Tape (if As per inspection items in the

3.2 SES-C02-S01 SES-C02-S01 CV-001-2 I W SW
applicable) Checklist of QVD

As per inspection items in the

3.3 Inspection of Backfilling Layers SES-C02-S01 SES-C02-S01 CV-001-3 I W W
Checklist of QVD
B
As per inspection items in the CV-001-3
3.4 Filed Density Test / Layer SES-C02-S01 SES-C02-S01 I H W
Checklist of QVD Lab Test Report

Legend

(1) ‘Prepared by’ should be the name, signature and COMPANY’s name for the Vendor’s/Sub contractor’s representative.
(2) ‘Approved by’ should be the name, signature and COMPANY’s name for the CONTRACTOR’s representative.
(3) ‘Location’, ‘Item Name’ and ‘Tag Number’ shall be used if applicable.
(4) ‘Characteristics Verified’ are the parameters checked during the inspection activity.
(5) ‘Reference Document’ is the Project Specification / Code / Standard / Drawing, Procedure etc. on the basis of which inspection shall be conducted.
(6) ‘Acceptance Criteria’ is the tolerance, reading, value or an outcome derived from reference documents.
(7) ‘Verifying Document’ is the record generated during inspection & Testing using approved forms / checklists.
 Doc No EPM-ITP-CC-002

SAFCO/IBB MOBILE COATING UNIT POJECT Rev. No. 00

ITP FOR EXCAVATION AND BACKFILLING Date 25th Jun, 2020
Page 5 of 10

(8) ‘Inspection Responsibility’ is the role of Vendor / Sub contractor, CONTRACTOR and COMPANY for each inspection step. Inspection responsibility shall be ‘I’ for Inspection, ‘R’ for review, ‘A’ for approval, ‘S’ for
Surveillance, “W’ for 100% Witness, ‘SW’ for random witness and ‘H’ for hold.
 EPM-ITP-CC-
SAFCO/IBB MOBILE COATING Doc No 002
UNIT POJECT Rev. No. 00
ITP FOR EXCAVATION AND
Date 25th Jun, 2020
BACKFILLING
Page 5 of 10
2.0 Checklist-Material Receiving Inspection
CV-MRI-1
MATERIAL RECEIVING INSPECTION Record No
Date
Disciplin
Project No. SP-173100119 Civil Area No
e
1 Material Type

2 Supplier

3 Purpose & Service

For further details, as per attached (Mention associated report no.)

□ Quality certificate/3rd Party Report

Inspection
Contents □ Test certificate/3rd Party Report
4
□ Catalogue
□ Specification
□ Sample

□ Satisfied
5 Visual Inspection
□ Unsatisfied

6 Remarks

Submitted by:
Review and approval Status:
□ (A) Approved without comments.
□ (B) Approved with comments.
□ (C) Disapproved.
Comments:

Subcontractor NCC PMT

Name

Signature

Date
 EPM-ITP-CC-
SAFCO/IBB MOBILE COATING Doc No 002
UNIT POJECT Rev. No. 00
ITP FOR EXCAVATION AND
Date 25th Jun, 2020
BACKFILLING
Page 6 of 10
3.0 Checklist-Survey for Excavation Record

CV-001-1
SURVEY FOR EXCAVATION RECORD Record
No
Date
Project No: SP-173100119 Area No.

Survey Basis Drawing No.

Location
IBB/SAFCO
Description

Point Coordinate
Remark
No. N E

Survey and setting out

Excavation Depth m Check the stability of slope Satisfied Unsatisfied

Excavation EL m Excavation Bottom Satisfied Unsatisfied
Condition
Calibration Record
Surveying Equipment Series No. Manufacturer Calibrated Date Expired Date

Sub Contractor NCC PMT

Name

Signature

Date
 EPM-ITP-CC-
SAFCO/IBB MOBILE COATING Doc No 002
UNIT POJECT Rev. No. 00
ITP FOR EXCAVATION AND
Date 25th Jun, 2020
BACKFILLING
Page 7 of 10
4.0 Checklist-Soil Inspection

CV-001-2
SOIL INSPECTION CHECKLIST FOR EXCAVATION AND Record
SURFACE PREPARATION IN CONSTRUCTION PHASE No

Date

Project No SP-173100119 Area No.

Drawing
Location Description IBB/SAFCO
No.
Sub cont. NCC
Item Description of Check
Accept Reject Accept Reject
01 Excavation cleared of foreign and loose material.
02 Slopes shored or correctly stepped.
03 Dewatering system is adequate
Sample collected and tested for proctor value and optimum
04
moisture content and results recorded
Fill Material shall conform to requirements (if required over
05
excavation fill )
Final elevation in accordance to drawings.( Bottom of
06
Foundation/Structure)
07 Field Density Test acceptable
08 Moisture control acceptable.
09 Install concrete tiles/warning Tape (if applicable)

NOTES :

Sub contractor NCC PMT

Name

Signature

Date
 EPM-ITP-CC-
SAFCO/IBB MOBILE COATING Doc No 002
UNIT POJECT Rev. No. 00
ITP FOR EXCAVATION AND
Date 25th Jun, 2020
BACKFILLING
Page 8 of 10
5.0 Checklist-Backfill/Compaction
CV-001-3
Record
BACKFILL/COMPACTION CHECKLIST No
Date
Project No SP-173100119 Area No.
Material Type Drawing No.
Compaction Optimum
Equipment Moisture
Field Test
Proctor Density
Equipment
Location IBB/SAFCO
Description
Examination Items Result Examination Items Result
Keep cleaning without water,  Satisfied
 Satisfied
roots, trash, other foreign Fill material test Reports filed  Unsatisfied
 Unsatisfied
materials  N/A
 Satisfied  Satisfied
Coating protection filler
 Unsatisfied Properly moistened before placing  Unsatisfied
board installed properly
 N/A  N/A
 Satisfied
Material comply with ≧90%
 Unsatisfied Compacted Density
specification ≧95%
 N/A
Bottom Bed/Backfill Depth mm Total Layer of Compaction
Layer Density Test (Points)
Layer Thick Repor
1st 2nd 3rd 4th 5th 6th 7th 8th 9th Result
No. (mm) t No.
Density Density Density Density Density Density Density Density Density
1  Sat.  Unsat.
2  Sat.  Unsat.
3  Sat.  Unsat.
4  Sat.  Unsat.
5  Sat.  Unsat.
6  Sat.  Unsat.
7  Sat.  Unsat.
8  Sat.  Unsat.
9  Sat.  Unsat.
10  Sat.  Unsat.

Subcontractor NCC PMT

Name

Signature

Date