8/18/2019 Inspection Form Shimizu

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PROJECT NAME : B. BRAUN MEDICAL INDUSTRIES SDN. BHD. (B1A Package 1

Work : Structure Works

To :

Attn :

The following works / tests are ready for inspection / will be conducted 

at (time) on (date)

DESCRIPTION OF WORKS

Location :

 Nature of Work :

Drawing / Sketches No. : Refer attachment

 (Note: Where required, include details of products, labour and equipment to be used)

Submitted by Sub-Contractor Received by Shimizu Corporation

Signature : Signature :

 Name : Name :

Time / Date : Time / Date :

INSPECTION / TEST RESPONSE

Inspection acceptable / test passed*, with / without* comment. Works are allowed to proceed

Inspection unacceptable / test failed*. Contractor to carry out remedial works

Re-inspection is required / Re-Testing is required

Signature : (Synertec/QP) Date:

* delete whichever not applicable

REQUEST FOR INSPECTION FORM

RIN No.:

12-3, 12th Floor, Faber Imperial Court, Jalan Sultan Ismail, 50250 Kuala Lumpur. Tel :03-2070 000. Fax: 03-2072 0222.

DOC.NO.: STR-01 REV.2: ISSUED DATE : 3-12-2010