CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC.

NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT KPSB/FM/GN01
GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH
SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK EFF. DATE NOV 2017
PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM REV : 00 PAGE : 1 OF 1

RFWI. NO.
REQUEST FOR WORK INSPECTION (RFWI)
RFWI/___
C&S ARCH M&E LANDCSCAPE OTHERS

Contractor
(Company Name)

To

Issued Date Issued Time Reference Drawing :

Received Date Received Time

Block / Level Reference Document :

Area / Location
Grid Line Relevent Approved Drawing / Layout / Sketches

Element Previous RFWI

Work Description : Pre-Concreting Check M & E Services Testing & Commisioning

Post-Concreting Check Testing Material Receiving Check

Others :

Attached Checklist : PKNS/CL/

Attached Test Report : PKNS/TR/

Participants Sub Contractor's Representative Consultant's Representative

Name

Designation

Signature

Inspection Date

Inspection Results :

Inspection passed. The contractor is allowed to proceed with the works

Remedial works listed below to be completed and inspection is required after remedial works

Remedial works listed below to be completed but no further inspection required

Rejected

Remarks / Comments :

Prepared by Checked by Verified by

Participants
Contractor's Representative Consultant's Representative Client's Representative

Name

Designation

Signature

Date
 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT),1 TINGKAT LOT KPSB/FM/GN02
GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH
SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK EFF. DATE NOV 2017
PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM
REV : 00 PAGE : 1 OF 1

REQUEST FOR INFORMATION (RFI)

CLIENT
ARCHITECT C &S ENGINEER M&E ENGINEER
TO : (Company
(Companay Name) (Company Name) (Company Name)
OTHERS ; ______________
Name)

ATTENTION TO :

ISSUED DATE : RFI NO :

URGENCY : CRITICAL CRITICAL (Within 14 Days) SUFFICIENT TIME

CRITICAL (Within 7 Days) 1 MONTH BY : _____________

INFO ESSENTIAL : IMMEDIATE WORK / PROCUMENT / SHOP DRAWING / COORDINATION / OTHERS

QUERY CATEGORY C&S ARCH M&E ID OTHER :1MDB RE

DRWG NO. : - DRWG ISSUED DATE : -

DRWG TITLE : - DRWG REV. : - DRWG SCALE :-

BUILDING /LOCATION : LEVEL / GRID LINE -

SUBJECT :

ISSUED BY : NAME : DESIGNATION : DATE :

(SIGNATURE)

REPLY:

RESPONDED BY : NAME : DESIGNATION : DATE :

(SIGNATURE)

C/C TO : CLIENT (PERBADANAN KEMAJUAN NEGERI SELANGOR) ARCHITECT (AJ SURIA RAHIM) C&S ENGINEER (SIGMA JELAS ENGINEERS) M&E NGINEER (SIGMA JELAS ENGINEERS)

CONSULTANT'S REP (R.E / C.O.W) OTHERS ; ______________

 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT KPSB/FM/GN03
GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH
SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK EFF. DATE NOV 2017
PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM REV : 00 PAGE : 1 OF 1

CONFIRMATION OF VERBAL INSTRUCTION ( CVI )

ISSUED BY
: NCR NO. :

ATTENTION TO : DATE :

KPSB/

We acknowledge receipt of instruction given to our site representatives on

Date

Verbally; OR

In Correspondence ref. : ; OR

During Meeting dated :

Regarding the following Details ;

Please be advised that the above instruction :

Have resulted in : Surplus Material Abortive Material Abortive Work, Record was endorsed by RE/COW
Required additional time of completion.
Involve direct loss and expense due to disturbance of regular progress of work.
Have resulted in additional costs.
The effect of cost and time will be advised and submitted in due coarse.

INSTRUCTION GIVEN BY NAME : SIGNATURE : DATE :

DESIGNATION : COMPANY NAME :

COMMENTS / REMARKS :

RECEIVED BY NAME : SIGNATURE : DATE :

DESIGNATION : COMPANY NAME :

C/C TO : CLIENT (PERBADANAN KEMAJUAN NEGERI SELANGOR) C&S ENGINEER (SIGMA JELAS ENGINEERS) ARCHITECT (AJ SURIA RAHIM) QUANTITY SURVEYOR (MCM ASSOCIATES)

CONSULTANT'S REP (R.E / C.O.W) PROJECT DIRECTOR - KPSB' HQ CPD - KPSB' HQ OTHERS ; ______________
 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT GERAI KPSB/FM/GN04
MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH SAMPAH, 1 UNIT
SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK PENGAWAL DI JALAN EFF. DATE NOV 2017
PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM REV : 00 PAGE : 1 OF 1

TRANSMITTAL NOTE

TO : REF. NO :
(COMPANY NAME)

ATTENTION TO : DATE :

TYPE OF DOCUMENT :

DRAWINGS PHOTOGRAPHS WORK SCHEDULE / PROGRAM

TECHNICAL SUBMISSION REPORTS SPECIFICATION / CONTRACT DOCUMENT

OTHERS ;

WE ARE PLEASED TO FORWARD HEREWITH THE FOLLOWING DOCUMENT / DRAWING ;

FOR REVIEW FOR COMMENT FOR APPROVAL / ENDORSEMENT

FOR RECORD FOR CONSTRUCTION AS REQUESTED

FOR ACTION FOR INFORMATION OTHERS

ITEM DESCRIPTION QTY UNIT STATUS / REMARKS

:
REMARKS : :

REQUESTED BY APPROVED BY

SIGNATURE : SIGNATURE :

NAME : NAME :

DATE : DATE :

** CHARGEABLE AT RM PER COPY (if any)

 KORIDOR PADU SDN BHD
CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT GERAI
MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH SAMPAH, 1 UNIT
SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK PENGAWAL DI JALAN P.K.K CLASS A CIDB G7
PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM ISO 9001:2008
401936-M

Date of Submission : NOVEMBER 2017 DOC. NO :

KPSB/FM/GN05
TRANSMITTAL FORMS

CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG MENGANDUNGI: 2 TINGKAT LOT GERAI
(440 UNIT), 1 TINGKAT LOT GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH SAMPAH, 1 UNIT
PROJECT : SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24,
40300 SHAH ALAM

Trade :

c/c to : PKNS AJSR SJE MCMA

Elements : Work Statement Material Shop Drawing General Doc

RFI

Attachment : Drawing Catalogue Sample Others

DESCRIPTION OF :
ITEM

REFERENCE NO. :

NOTES :

Prepared by : ……………………… Checked By : ………………….

(for KPSB) Project QAQC Senior Project Manager

CLIENT'S COMMENTS :
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….

STATUS
A REVIEWED & ACCEPTED
B REVIEWED & RESUBMIT
C REJECTED

NAME : DESIGNATION :

SIGNATURE : DATE :
 DOC. NO.
CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT
GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH
SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK KPSB/FM/GN06
PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM

EFF. DATE NOV 2017

SITE DAILY REPORT REV : 00 PG : 1 OF 2

DATE : DAY :

TRADE : C&S ARCH M&E OTHERS : ____________

ACTIVITIES
ITEM LOCATION
DESCRIPTION
( PHASE / BLOCK/ GRID LINE)
 EFF. DATE NOV 2017
SITE DAILY REPORT REV : 00 PG : 2 OF 2

Total Manpower Plant & Equipment

Trade Total Type Number Type Number
Project Manager Air Breaker Power Float Machine
Const. Manager Air Compressor Roller Compactor ( 1 Ton )
Senior Supervisor Bar Bending Machine Roller Compactor ( 10 Ton )
Site Supervisor Bar Cutting Machine Roller Compactor ( 20 Ton )
Surveyors Bosch Makita Cutter Backpusher
Operators Bulldozer Mobile Crane
General Worker Backhoe Fogging Machine
Barbender Concrete Pump Water Pump
Carpenter Concrete Mixer Hacker
Concreter Crawler Crane
Welder Dump Truck
Qa/Qc Dumper
Safety supervisor Forklift
Piler Generator Ser
Security Guard Excavator
Project Scheduler Lorry
Plumber Tower Crane
Brick Layer Mini Concrete Mixer
Plasterer Passenger
Formen Piling Machine
FDT Tester Plate Compactor

Material Delivery

Remarks :

23 0 1
22
2
21 3
20 4
Fair
19 5

18 6 Drizzle
7
17 Rain
16 8

15 9
14 10
13 12 11

Contractor's Representative Consultant's Representative S.O's Representative

Signature : Signature : Signature :

Name : Name : Name :
Designation : Designation : Designation :
Date : Date : Date :
 DOC. NO.

KPSB/FM/GN06

NOV 2017
PG : 1 OF 2

OTHERS : ____________

ACTIVITIES

DESCRIPTION
 NOV 2017

PG : 2 OF 2

Plant & Equipment

Number

S.O's Representative

Signature :
Name :
Designation :
Date :
 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT
LOT GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT
KPSB/FM/GN07
RUMAH SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT EFF. DATE NOV 2017
PONDOK PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300
SHAH ALAM REV : 00 PAGE : 1 OF 1

SITE OFFICE : SITE TEL NO. :

SITE FAX NO. :

SITE MEMO
TO Koridor Padu Sdn Bhd FROM Sigma Jelas Engineers Sdn Bhd
ATTENTION Project Director REF. NO. Memo/KPSB/0022

TEL NO. DATE 1/28/2019

FAX NO. PAGE (s)

SUBJECT : Kegagalan Mengikut Prosedur dan Spesifikasi Kerja

Merujuk kepada NCP/KPSB/010 dan NCP/KPSB/011:

Pihak Kontraktor Utama, Koridor Padu Sdn. Bhd. telah gagal mengikuti prosedur bagi kerja
yang telah dilaksanakan. Pihak kontraktor utama didapati telah menggunakan besi tetulang
untuk kerja konkrit dan pilecap tanpa diuji terlebih dahulu di makmal yang telah disahkan.
Pihak kontraktor utama juga tidak mendapatkan pengesahan kelulusan besi tetulang dari
pihak perunding untuk digunapakai sebelum memulakan kerja konkrit. Selain itu, pihak
kontraktor utama telah menjalankan kerja tanggalan kotak acuan (striking formwork) untuk
pile cap tersebut tanpa mengikut JKR Spesifikiasi Piawaian JKR Untuk Kerja Bangunan 2014
(Standard Specifications for Building Works 2014).

Dengan adaanya Senior Project Manager sebagai wakil pihak kontraktor utama di tapak,
segala kerja di tapak seharusnya dapat dijalan dengan teratur dan teliti mengikut prosedur
dan spesifikasi seperti yang telah termaktub dalam kontrak.

Sekali lagi, pihak Koridor Padu Sdn. Bhd. dinasihatkan untuk mengikut prosedur bagi
sebarang kerja yang akan dilaksanakan termasuklah dari aspek kelulusan dokumen seperti
borang Request For Work Inspection (RFWI), method of statement, bahan binaan dan
sebagainya.

Tindakan selanjutnya oleh pengawai penguasa (PP) / wakil pengawai penguasa (WPP) boleh
diambil sekiranya kegagalan pihak tuan terhadap perkara ini. Segala kelewatan dan kos
yang terlibat disebabkan kegagalan pihak tuan terhadap perkara ini dibawah tanggungan
pihak tuan.

ISSUED BY : RECEIVED BY :

SIGNATURE SIGNATURE

NAME Muhammad Shazreel Amir Azmee NAME

DESIGNATION Sigma JELAS Engineers Sdn Bhd DESIGNATION

DATE 1/28/2019 DATE

ACKNOWLEDGE BY ; REMARKS :

PROJECT MANAGER

NOTE : THIS SITE MEMO IS SERVED AS FORMAL RECORD OF VERBAL INSTRUCTION HAS BEEN GIVEN TO THE SUB-CONTRACTORS TO CARRY OUT THE WORKS AS INSTRUCTED. IT
DOES NOT CONSTITUTE AS VO.
CLIENT
ARCHITECT (AJ SURIA C&S ENGINEER M&E NGINEER
C/C TO : (PERBADANAN KEMAJUAN NEGERI
RAHIM) (SIGMA JELAS ENGINEERS) (SIGMA JELAS ENGINEERS)
SELANGOR)
CONSULTANT'S REP (R.E / C.O.W) PROJECT DIRECTOR - KPSB' HQ CPD - KPSB' HQ OTHERS ; ______________
 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG
DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT
GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH KPSB/FM/GN08
SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK
PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300 SHAH EFF. DATE NOV 2017
ALAM
REV : 00 PAGE : 1 OF 1

NON - CONFORMANCE REPORT (NCR)

C&S ARCH M&E ID LANDSCAPE OTHERS

ISSUED BY
: Mohd Luckman Alwadi NCR NO. : NCR/ KPSB /0001
ATTENTION TO : Koridor Padu Sdn Bhd ISSUED DATE :2/5/2018

1. DESCRIPTION OF NON-CONFORMANCE (State location, specific equipment name / number tag and brief description on deficiencies as
observed and where possible attach supporting evidence)
failed to provide proper diesel storage REFERENCE DRWG / DOC.
Please take action
Photo Attached

ISSUER / AUDITOR NAME : Mohd Luckman Alwadi SIGNATURE : DATE : ###

RECIPIENT / AUDITEE NAME : SIGNATURE : DATE :

2. PROPOSED CORRECTIVE ACTION (Recipients is to respond (reply) on this section within 7 days from the date of receipt).

3. PREVENTIVE STEP & ACTION TO BE TAKEN (Recipients / Auditee to proposed and upon acceptance to emplement accordingly).

ITEM 1 & 2 PROPOSED BY NAME : SIGNATURE : DATE :

TARGETED COMPLETION DATE :

ISSUER / AUDITOR NAME : SIGNATURE : DATE :

ISSUER EVALUATION ACCEPTED REJECTED REMARKS :

4. CLOSE-OUT COMMENT / REPORT

ISSUER / AUDITOR NAME : SIGNATURE : DATE :

ISSUER EVALUATION ACCEPTED REJECTED REMARKS :

PHOTOGRAPHIC RECORD

RFWI RECORD

REVIEWED & CLOSED OUT BY NAME : SIGNATURE : DATE :

ARCHITECT C&S ENGINEER QUANTITY SURVEYOR
C/C TO : CLIENT (PKNS) (SIGMA [MCM OTHERS ; ______________
(AJ SURIA RAHIM) JELAS ENGINEERS) ASSOCIATES]
 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT GERAI KPSB/FM/GN09
MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH SAMPAH, 1 UNIT
SURAU LELAKI DAN PEREMPUAN, 2 UNIT PONDOK PENGAWAL DI JALAN EFF. DATE NOV 2017
PUDINA 24/41, SEKSYEN 24, 40300 SHAH ALAM REV : 00 PAGE : 1 OF 1

TRANSMITTAL FORM
(for Machineries, Equipment, Etc.)
TO : REF. NO :
(COMPANY NAME)

ATTENTION TO : DATE :

WE ARE PLEASED TO FORWARD HEREWITH THE FOLLOWING ITEMS ;

FOR RECORD FOR COMMENT FOR APPROVAL / ENDORSEMENT

FOR REVIEW FOR CONSTRUCTION AS REQUESTED

FOR ACTION FOR INFORMATION OTHERS

ITEM DESCRIPTION QTY UNIT CONDITION / REMARKS

:
REMARKS : :

CHECKED BY APPROVED BY

SIGNATURE : SIGNATURE :

NAME : NAME :

DATE : DATE :

** CHARGEABLE AT RM PER COPY (if any)

 DOC. NO.

KORIDOR PADU SDN BHD

KPSB/FM/GN10

SITE MATERIAL REQUISITION FORM EFF. DATE NOV 2017

( INTERNAL USE ONLY ) REV : 00 PG : 1 OF 1

NAME : DATE REQUESTED :

DESIGNATION : DATE REQUIRED :

DEPARTMENT :

SIGNATURE :

PLEASE PURCHASE THE FOLLOWING ITEMS;

ITEM DESCRIPTION CODE UNIT QTY LOCATION / PURPOSE

NOTE :

MATERIAL / EQUIPMENT TO SUB-CONTRACTOR : BORROWING

SUPPLYING HOUR / DAY
BACK CHARGE

SUB-CONTRACTOR :
(COMPANY'S NAME)

ACTION : PLEASE GET CERTIFY AND APPROVAL BY PSPK's PROJECT MANAGER AND SEND TO CPD / STOREKEEPER (ASAP) FOR ACTION.

( SIGNATURE )

PROJECT MANAGER
 KORIDOR PADU SDN BHD DOC. NO.
CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH
YANG MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT LOT GERAI
KPSB/FM/GN11
MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT RUMAH SAMPAH, 1 UNIT SURAU EFF. DATE NOV 2017
LELAKI DAN PEREMPUAN, 2 UNIT PONDOK PENGAWAL DI JALAN PUDINA 24/41,
SEKSYEN 24, 40300 SHAH ALAM REV : 00 PG : 1 OF 1

MATERIAL RECEIVING INSPECTION CHECKLIST

Material / Equipment Description :
Transport No. MRI No.

Inspection
D.O No.
Date

Acceptability Checking
Item Description Date Remarks
Yes No Method

1.0 Delivery Documents

1.1 Quantity received as per D.O

1.2 Material delivered as per specification

1.3 Mill Certificates ( If Applicable ) Refer to

Delivery
1.4 Factory Test Certicates ( If Applicable ) Document

2.0 Physical Check

2.1 Goods with no physical damages Visual

2.2 Goods in Packages with no physical damage Visual

Dimensional : Size/Colour/Thickness Visual /
2.3
( Where stipulated / specified ) Measured

Besides the methods of checking others shall be

Supporting
2.4 checked appropriately as required or otherwise as
Document
specified.

** N/A where Not Applicable and Add item(s) whereas Necessary

Inspection Comments : Accepted Rejected

Remarks :

Witnessed by QAQC
Prepared by Contractor's Rep : Checked by RE/COW Rep :
( Whereas Applicable )

Signature : Signature :

Name : Name :

Designation : Designation :

Company's Name : Department :

Date : Date :

For materials / equipments purchased on behalf or transfered to the subcontractor then the said subcontactor and their site representatives will be held responsible for adherence and
ensurance of the Quality practices of PSPK such as the handling, storage and preservation of such materials / equipments. The said materials / equipments must be checked, received and
aknowledged by them before taking possesion of the same. PSPK's Relevant Site Staff shall ensure the adherence of the same.
 CADANGAN MEMBINA DAN MENYIAPKAN PASAR MUHIBBAH YANG DOC. NO :
MENGANDUNGI: 2 TINGKAT LOT GERAI (440 UNIT), 1 TINGKAT
LOT GERAI MAKANAN (20 UNIT), 1 UNIT PE 2 RUANG, 1 UNIT
KPSB/FM/GN12
RUMAH SAMPAH, 1 UNIT SURAU LELAKI DAN PEREMPUAN, 2 UNIT EFF. DATE NOV 2017
PONDOK PENGAWAL DI JALAN PUDINA 24/41, SEKSYEN 24, 40300
SHAH ALAM REV : 00 PAGE : 1 OF 1

DAYWORK RECORD
A. INSTRUCTION REF. NO. : SHEET NO. : /

B. DATE OF INSTRUCTION ISSUED : / / DATE WORK DONE : / /

C. BACKCHARGE TO (COMPANY'S NAME) :

D. LOCATION / DETAILS :
ITEM LOCATION DESCRIPTION OF WORK

SUB -TOTAL =

E. LABOUR
DESCRIPTION WORKING HOURS
ITEM CATEGORY QTY UNIT RATE AMOUNT
NAME OF WORKERS FROM TO
S U/S

SUB -TOTAL =

F. MATERIAL
ITEM DESCRIPTION OF MATERIAL USED QTY UNIT RATE AMOUNT

SUB -TOTAL =

G. PLANT / EQUIPMENT
ITEM DESCRIPTION OF PLANT/EQUIPMENT USED QTY UNIT RATE AMOUNT

SUB -TOTAL =

H. TOTAL COST TO BE CARRIED FORWARD TO SUMMARY TOTAL =

WORK DONE RECORDED BY : WORK DONE VERIFIED BY : QUANTITIES/RATES VERIFIED BY :

SIGNATURE : SIGNATURE : SIGNATURE :

NAME : NAME : NAME :

DESIGNATION : DESIGNATION : DESIGNATION :

DATE : DATE : DATE :

ACKNOWLEDGE BY ; REMARKS :

PROJECT MANAGER

C/C TO : PROJECT DIRECTOR - PKNS' HQ CPD - KPSB' HQ OTHERS ; ___________________