
2/30

Project Name / ID NH No. Length Stretch State PIUScheduled Start

Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

Date of recording/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion ofrepair /

rectification


29 30 31 32 33 34 35 36 37

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


38 39 40 41 42 43 44 45 46

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


Rutting exceeding 10 mm in more than 2% of road surface in a stretch of 1 km Damages

17.2, Schedule-K (a)(v) Damages to be paid by Concessionaire Remarks (if any)

Damages

Remarks (if any)

Cracking in more than 5% of road surface in a stretch of 1 km Damages

Pot Holes

17.2, Schedule-K (a)(iii) Damages to be paid by Concessionaire

17.2, Schedule-K (a)(iv) Damages to be paid by Concessionaire Remarks (if any)


3/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

47 48 49 50 51 52 53 54 55


4/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields


Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of


rectification


56 57 58 59 60 61 62 63 64

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


65 66 67 68 69 70 71 72 73

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


17.2, Schedule-K (a)(vii) Damages to be paid by Concessionaire Remarks (if any)

Damage to pavement edges exceeding 10 cm Damages

17.2, Schedule-K (a)(viii) Damages to be paid by Concessionaire Remarks (if any)

Bleeding / Skidding Damages

17.2, Schedule-K (a)(vi) Damages to be paid by Concessionaire Remarks (if any)

Ravelling / Stripping of bitumen surface exceeding 10 sq.m Damages


5/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

74 75 76 77 78 79 80 81 82

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


83 84 85 86 87 88 89 90 91

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


91 92 93 94 95 96 97 98 99

17.2, Schedule-K (b)(i) Damages to be paid by Concessionaire Remarks (if any)

Hard / Earth shoulders, side slopes, drains and culverts

Removal of Debris / Dust Damages

17.2, Schedule-K (a)(ix) Damages to be paid by Concessionaire Remarks (if any)

Variation by more than 2% in the prescribed slope of camber / cross fall Damages


6/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields


Exact Location

(LHS/RHS) withChainage

Time Allowed

forrectification

Date & Time of


rectification


100 101 102 103 104 105 106 107 108

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


100 101 102 103 104 105 106 107 108

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


Variation by more than 15% in the prescribed side (embankment) slopes Damages

17.2, Schedule-K (b)(iii) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (b)(ii) Damages to be paid by Concessionaire Remarks (if any)

Edge drop at shoulders exceeding 40 mm Damages17.2, Schedule-K (b)(ii) Damages to be paid by Concessionaire Remarks (if any)

Edge drop at shoulders exceeding 40 mm Damages


7/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

109 110 111 112 113 114 115 116 117

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


118 119 120 121 122 123 124 125 126

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time ofcompletion of

repair /

rectification


127 128 129 130 131 132 133 134 135

17.2, Schedule-K (b)(iv) Damages to be paid by Concessionaire Remarks (if any)

Damage to or silting of culverts and side drains during and immediately preceding the rainy

seasonDamages

17.2, Schedule-K (b)(v) Damages to be paid by Concessionaire Remarks (if any)

Rain cuts/gullies in slope Damages


8/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields


Exact Location

(LHS/RHS) withChainage

Time Allowed

forrectification

Date & Time of


rectification


136 137 138 139 140 141 142 143 144

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


145 146 147 148 149 150 151 152 153

17.2, Schedule-K (d)(i) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (c)(i) Damages to be paid by Concessionaire Remarks (if any)

Road side furniture including road signs and pavement marking

Street Lighting and telecom (ATMS)

Any Major failure of the system Damages

De silting of drains in urban/semi-urban areas Damages

17.2, Schedule-K (b)(vi) Damages to be paid by Concessionaire Remarks (if any)

Damage to shape or position; poor visibility or loss of retro-reflectivity Damages


9/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


154 155 156 157 158 159 160 161 162

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


163 164 165 166 167 168 169 170 171

17.2, Schedule-K (e)(i) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (d)(ii) Damages to be paid by Concessionaire Remarks (if any)

Trees and plantation

Obstruction in a minimum head-room of 5 m above carriageway or obstruction in visibility of

road signsDamages

Street Lighting and telecom (ATMS)

Faults and minor failures Damages


10/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


172 173 174 175 176 177 178 179 180

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


181 182 183 184 185 186 187 188 189

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


17.2, Schedule-K (e)(iii) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (e)(ii) Damages to be paid by Concessionaire Remarks (if any)


Replacement of trees and bushes Damages


Deterioration in health of trees and bushes Damages


11/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

190 191 192 193 194 195 196 197 198

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


199 200 201 202 203 204 205 206 207

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


208 209 210 211 212 213 214 215 216

17.2, Schedule-K (f)(i) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (e)(iv) Damages to be paid by Concessionaire Remarks (if any)

Rest areas

Cleaning of toilets Damages


Removal of vegetation affecting sight line and road structures Damages


12/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


217 218 219 220 221 222 223 224 225

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


226 227 228 229 230 231 232 233 234

17.2, Schedule-K (g)(ii) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (g)(i) Damages to be paid by Concessionaire Remarks (if any)

Toll plazas

Damage to toll plaza Damages

17.2, Schedule-K (f)(ii) Damages to be paid by Concessionaire Remarks (if any)

Toll plazas

Failure of Toll collection equipment or lighting Damages

Rest areas

Defects in electrical, water and sanitary installations Damages


13/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


235 236 237 238 239 240 241 242 243

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


244 245 246 247 248 249 250 251 252

17.2, Schedule-K, Bridges (a)(i) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K (h)(i) Damages to be paid by Concessionaire Remarks (if any)

Superstructure of bridges

Cracks - Temporary measures Damages

Other Project Facilities and Approach roads

Damage or deterioration in Approach Roads, pedestrian facilities, truck lay-bys, bus-bays,

bus- shelters, cattle crossings, Traffic Aid Posts, Medical Aid Posts and other works Damages


14/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


253 254 255 256 257 258 259 260 261

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


262 263 264 265 266 267 268 269 270

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


17.2, Schedule-K, Bridges (a)(ii) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K, Bridges (a)(i) Damages to be paid by Concessionaire Remarks (if any)


Spalling/scaling Damages


Cracks - Permanent measures Damages


15/30


Date

Scheduled End

date

Name of

Concessionaire

1 2 3 4 5 6 7 8 9


Fixed Fields

271 272 273 274 275 276 277 278 279

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


280 281 282 283 284 285 286 287 288

Date of recording

/ reporting

Exact Location

(LHS/RHS) with

Chainage

Time Allowed

for

rectification

Date & Time of

completion of

repair /

rectification


289 290 291 292 293 294 295 296 297

17.2, Schedule-K, Bridges (c)(i) Damages to be paid by Concessionaire Remarks (if any)

17.2, Schedule-K, Bridges (b)(i) Damages to be paid by Concessionaire Remarks (if any)

Piers, abutments, return walls and wing walls of bridges

Cracks and damages including settlement and tilting Damages

Foundation of bridges

Scouring and / or cavitation Damages


16/30

Date of

Agreement10


17/30

Date of

Agreement10


18/30

Date of

Agreement10


19/30

Date of

Agreement10


20/30

Date of

Agreement10


21/30

Date of

Agreement10


22/30

Date of

Agreement10


23/30

Date of

Agreement

10


24/30

Date of

Agreement

10


25/30

Date of

Agreement

10


26/30

Date of

Agreement

10


27/30

Date of

Agreement

10


28/30

Date of

Agreement

10


29/30

Date of

Agreement

10


30/30

Date of

Agreement

10

Documents

Work Flow Tag