National Rural Infrastructure Development Agency Ministry of Rural Development, Government of In Id 303023 Template Version : V1.0 _m Format QB Version 2021.0- Part 1 Format for information to QM for Inspection of Ongoing/Completed Bridge Work , PART Work Information (Lo be filled-up by PIU) Ig -of-a026 ‘ (Crow fe v. MRL.15-TO1 His Alias Pottvaha to habar vi Hotar vL fiti7rspAL-owroR vu 10.640 m m VIII, Reasons for deviation (if any) Ix, Rs.19797 Lakh X. Technical sanetion cost: * Rs. 25328 Takh XL Rs. 21091 Lakh XII, Expenditure: (if work is ongoing) Rs.0.00 Lakh - b. Bills pending: — [ Rs. 00 Lakh Total expenditure = (a'b)" [Rs 000 Lakh Xill, Completion cost: (ifwork is completed) Rs axXVIL Actual date of ‘completion: (date! month year)(in [L case of completed work) 2. PHYSICAL PROGRES : (Ongoing/Completed) * Construction programme and Physical progress (Strike off whichever not applicable): NcmaFwork [Units [Quantiy [Quan] Come] Fin ip gar and eampienonanes [DA bs pexDPR| exceuted | percentage otitem | Prosress | Stn — Completion status} Date Date o @,o | o@ 5 @ o, ® o i) Layout nos |s00 3000 roo FX Sonsranes | sninnas |g ‘wal | aonan3y | awsrao3s ii) Foundation nes fso00 fro. fos.or = tenonons | oanianes | ‘Actual | 061072023 it) Subsivewre — fos fs000— fooco oa Dus Sevier teint ‘Actual es eC Ce ¥) Protection Works fm = |40.000 fo.oon o.00 vie zipsnma | sane Due owes | oomaao3s i) Approaches Im fe 00 ) Approach coo foom foo horn vil) Mandatory boards! Due eaosmos | osnnas | 5 Signage cie. os oo {3000 (sooo ‘tua Signage et 00 0 tual) opaons 3. PARTICULARS OF THE BRIDGE: 3.1 Type ofthe bridge (according to HFL) 7 | Submersible (on-submersble (according to Material) v RCC I Steel [1 Composite Pre-Strss |] 3.2. Type of foundation [ Oren | [ Raft v Pile Ww 33 Length of bridge [an a 3.4 Number of spans and spans length [2000 200003 312 3.13 315 3.16 3.17 318 Width of the bridge is m Footpaths provided | vy]__% f provided, width of footpath m Formation Level (F.L.) faosis m Highest Flood Level (HFLOrdinary Flood Level (OFL)_ fas 7i6 m] bem Bed level (Lowest) fasta m Catchment area T3000 kin Linear waterway at HEL 2000 m Design discharge fae ‘cumee Design velocity as inis Foundation levels (2) Piers v piaasia_nj [p2 | [Ps a] Pa ml [Ps nm} [P65 ml Pr PR nm] [Po ml ()Abutments [7 Alsi ml [A220560 m (©) Retums RI nl [Re a Foundation Strata Rook Safe Bearing Capacity (SBC) 00000 _tonsimn River protection works provided or not (Lv. [ No itprovided PAC cb eer ‘Type of Subsinicture @ Piers — ¥ | Solid circutar | [7 [Hottow cireular L_Livan ype vi [Any other type Oy _Abetmonts- [1 Gawvity type] ET spit ttroush [4] boxtype | [7 Tcoumertor ope Any other type:© Retums~ 3.19. Type of bearings 3.20. Test report of bes ings available or not 3.21. Type of superstructure ‘Type of expansion joints 32: ‘Type of wearing coat 3.24 Type of drainage spouts tao L Counter fort Cots tilever type me (sma Rocker & Roller} Any other type Yes RCC Solid slaty VY [_tBeam stab Voided slab Box sinter “Any other type: Steel Plate girder Truss frame ‘Arch bridges [Tecate waned Bailey bridges Any other type Buried Copper plate Bituminous ¥ [_ Swip seat Modular La type ‘Any other type: VT ce [ Bituminow v Aspe IRC SP ‘As per Designcane Single lane IRC Class “AA” loading or| of | doubte lane IRC class “A” loading which ver produces severe stesss faaliicua [ Single lane IRC class “7OR” loading or loading, double lane IRC class “A” loading which ever produces severe stresses. Any other type: 326 Wheherapproachesarein cating orin iting: [—] caving] [7] _ Filing Partly cutting and filing 327 Type of pitching in approaches J [Boulder pitching] [Concrete block 3.28 Whether bench marks and alignment are established [7 Yes [ No near the bridge site (give locations and RLs) [focation: 0.000 RL23068 a Location RL E Location RL a] RL: 3.29 Type of Railings v REC spot Pie alias Stoel Collapsible pitching ‘Any other type 4. QUALITY CONTROL: |, Location of Field Laboratory * ATSIDE Il Geo-tagged photograph of laboratory uploaded on: (date/ month’year):” [aan 2023 IIL Reason for delay in establishment of Field laboratory (iso): [WA 1V. Details of contractor, exceuting the work:* Name of contactor PAN number | Mobile number Exmail ID. [from exrenerases AIFPSsast Frmo1333 neler 286ging quality control resister part-T V. Details of contractor's engineer avaiable at sit: (Responsible for mana Sl. ] Name of contractor's ber Duration of posting ote 10, ; Identity number | Mobile number |} Fons i engineer at site y = [enor era anon rcrTonos Iaanoes 2 ol VI. Details of head of PIU supervising the work: * Duration of posting at site SI. Head of PIU ployee num ie number 5 70. | (Executive Engineer) | Employee number Mobile na From T Wasa eax loo lemon fovea |sowia02s oO Ol ter Part-II: * VIL. Details of assistant engineer supervising the work and maintaining quality control regist Duration of posting at site Name of assistant . s. ian Employee number | Mobile number } Fs a 1 paasiramean coo aonzi98es6 jamaanoas —_[so012028 oP ob Vill, Details ofthe junior engincer supervising the work: * 5 no.| Nameativnior | gnploycenumber | Mobile umber | Dution of postings ste ba From To. [Z__[saniay rane oooo season STS jo7menans [30012025 Oj o IX. List of equipment available in field lab: ° Lt. ‘Available equipment that are in working condition | Available equipment that are not in working a ‘condition (2) * [ALL Ina X. List of equipment not available in field lnb:* |NAXI Reasons put forth by PIU for non-availability of equipment in field lab NA, XI. Details of calibrations of equipment done: [aus XIII, Equipment, documents and drawings ready to be made available to QM before or during the inspection: DPR. AGGREMENT, QCR PART 1 PART2, MIX DESIGN S._ DETAILS OF MIX DESIGN Si No. Mix Design Average Mix Design Strength, Details of Institute? Iaboratory where mix design was done Details of Mix Design approving PMGSY Authority ‘Cement Concrete M20 ‘Cement Conerete M25 ‘Cement Concrete M30 38.20 GLOBAL TESTING AND RI INABL LAB: ‘Cement Concrete M35 ‘Cement Conerete M40 Wet Mix Macadam (WMM) Dense Bituminous Macadam ‘Semi Dense Bituminous Conerete Bituminous Concretea 6 EARLIER INSPECTIONS BY NOM, SQM or SENIOR DEPART OFFICE (Details about dpartienta fiers who inset the work should be ot ater & CEs) AND ACTION TAKEN STATEMENT: (sl ho Ihe NOMISOM de Date | Nameand [Road distance] Stage of work at | Major observations of | Designation of (RD) | thetime with date sit | inspecting officer of inspection (NOM/SOMICE! | From] To ; o SEQ) ai 6 we | Hane) Kumar | sarisracrory — |NA lama FE Retod 000.000 |ramtain iage-of ‘Aetion taken by PIU sett hate work Signature of the Head of PIU Name and Designation of the Head of PI = 9877110434 Mobile Number of the Head of PIU. conrdpalamu@gmail.com E-mail of the Head of PIU. KUTCHERY COMPLEX DALTONGANJ Address of the PIU.. ovo2025 « VISHAL XALXO EXECUTIVE ENGINEERNational Rural Infrastructure Development Agency Ministry of Rural Development, Government of India Format QB Version 2021.0- Part IT Monitor (NQMY/State Quality Monitor (SQM) NOM/SOM f in Bridge We (To be filled-up by QM) 1. GENERAL DETAILS: |. Date of inspection: tefer| 2525 TL, Name of Quality Monitor (QM) [Exe \aanoRO WreSm mee (check retevant box and fill code) Fsom ][ cour TH. state: roxerona— | District: Block: VOSA PraeeRany eho coaudhon Sp AL Ree Bee a Cho SHBAF ovEY Vandella Aker River V. Package number: SAP SPAL 84 EDL VI. Physical status of work: 4 (check anyone box) IV. Name of Bridge & Location: Ongoing Completed VII. Present status of work: (checkv boxes as applicable) XL bayout Foundation Substructure Seana Protection work Approaches Finishine stave VILL. Photographic or video-graphic records (optional) of all hidden items like reinforcements of foundations! sub structures/ super structures etc. are kept by PIU, till Defect liability period is over for bridge for any future reference or notz (Check V any one box) es NoI cee of nag wrk ob SI IONS (in case of onge oc lable equipment’ to be uptoag, » eacizlatnncbptatciberty sowing thar a N (Geo-tagged photograph of ‘one box) F¥es Partly oS fees No isheds(check ¥ a 1. Whether field laboratory established: ( is same as HL Whether location of field laboratory is ane bos indicated by PIU in format part-I. (check ¥ any J tu 8 Partly No ] ML. Whether necessary equipment as indicated in part-1 are actually {7% available: (cheek V any one box) 1) _ Part TV. Whether equipment’s have bocn used: (check V any onebox) — [FX zi No| 'V. Ifall necessary equipment is not available, whether you Lo Yes No | Nf verified them with thelist of deficient equipment’s provided by PIU in format Par (check any one bas) Fes No ‘Wl. Calibration of equipment done or not: ehieck’ any one box) VIL. Whether contractor's engineer a per Parl of this format, is Tres No available at site (checkV any one box) VIIL If contractor's engineer as per Parl of this report is not availble, Tres | L Partly O No | NR Whether you are satisfied with altemative arrangement made ty ‘maintain QCR-I: (check any one box) TX. Whether lab technician and other sais available for testing in the laboratory (check any one box) ves no ] Guiding note: IF the field laboratory is not established, overall item grading shall be U- Ifanyone or more | Traian ate graded partly or no, overall item grading shel he sgn Item Grading-2: [ (Check any one box) S Jeet i graded SRUU, write clear reasons and suggestions for improvemen deficient equipments: M, indicating important ' ATTENTION TO QUALITY cin case of ongoing nora onpy 1. Maintenance of Quality Control Test Registers: (@) Based on executed quantities, whether all mandatory pe tests conducted: (Check any one box vs | [ | TJ] Te] (©) Whether QC register part I! maintained and test results p< ‘monitored as per provisions: (check V any one box) Yes [ Partly | [ No Panty | [J xe (6) Whether Quality control tst register maintained as er provisions: (check ¥ anyone box) 0Zoom ease Item of Work (@): Adequae i “auacy of quality control tess, as per quality control test register: Quantity] “Quantity | Name ofthe | Number of asper | executed test DPR Number of | Testing tests required tests adequate (as perexecuted | actually | (Yes/No) a 5 quantity) conducted Foundation 2 ey @ ce) 6) i work Substructure work Superstructure work ‘Approach Stab and fixed items (Railing, kerb, Crash barrier etc.) ‘Approach work ©) Ttesting foun adequate, the reason for less testing: (Check V one or more box) . Negligence : Lack of equipment in lab + [Lack of knowledge . Any other, please specifi’ (o) Verification of test results: (C: conforming, N: non-conforming) ‘Quality control tests to be conducted by QM and the results to be matched with test results previously recorded in Quality control test register, at the same component of the structure, [temof | Name of | Results ofthe | Testresulis as per [Results of the test] Whether the test Work Test test Quality Control test | conducted _ | results recorded in conducted by | register at the same previously by QM| Quality control QMatihe location. atdefined | test register and component of |(Mention the Page no.| location. as conducted by the structure. of Register) (cm) QM are in (cm) conformity? (Yes /No) a Q) GB) (4) 6) 6)(© Whether non-conformities recorded in QCR-M by AE (©) In order to assess the quality of concrete in case of doubt, if any Non Destructive have been rectified and recorded in Quality control est register again as conformilies, after conducting necessary tests? (Cheek Yany one box) Test (NDT) such as Rebound Hammer test, Ultra Sonic Pulse Velocity (UPY) ete. shas been conducted: (Check/any oneb00) [~Tyes ] [ [Neo [oa Dots: Tie QC ete tea manana or vrai oF est ress re nat conforming ‘overall item grading shall be U. Ifanyone or more sub-items are graded partly or no, overall item grading stall be SRL * ® Item Grading-3: (Check? any one box) Vs SRI U {this item is graded SRI/U, write clear reasons and suggestions for improvement, are to be recorded: eS)4, FOUNDATION: A) Ongoing (Work in progress) 1. Foundation Piers, Abutments and Returns progress as on date of inspection-in % Abutments: AI Se % AISO% Piers: Tso %] [a ~] [_%)] 2%) PS_% P% PT %)] (Pe) Returns: RI %) [RZ % Location! | Grade of ‘Quality of material is adequate as per quality Testing | Grade Ttem of concrete control register _ of (s/U) work Cement Coarse Fine Steel | concrete aggregate | aggregate cubes by NQM (ifany) © @ ® @ © © @ (8) At m3s | Yes cS ves | yes | — Ss pie | wes] yes Yes yes | Yes | = Ss fad m5 | yes Yes yes | yes | — s Tocation | Grade | Form work | Reinforcement | Workability | Compaction | Curing | Grade iemof | of | qualityand | checked by Of | arrangement | arrangements | ($7Uy work | concrete | arrangements | competent ‘Concrete, authority oO @) @) (4) (5) (6) @ (8) Ar [mas ow [Rs Ter BU] abshreal pereReSEt ae Ss, Bier [Mas ow (ss Wr MY] qhtsWeal pecs] oe, g Aa fuwss] of ks fer BW] oMieWed[Acerb ee [TS I. Whether Cement and Stecl tests (other than those provided by supplier), got conducted by independent laboratories: (CheckVany one box) Yes Ne IIL. Whether flushing of bore before and after placement of reinforcement done in case of bored uncased cast-insitu piles. (CheckVany one box) Wes Ne Bof pile casted beyond cut off| Ievel, to be dismantled for ra length of p IV. Whether at least 600MM extt laitance effect (Check/any one bos) Fee] LT ether bottom plugging in case of well foundation cart jed out by using tremie method only Wheth 7 , - (Chet any one ba) Yes No B) Completed work ais Location’ | Grade] Compressive | Testingof | Surface ‘Size and a (su) Item of | of | strength of | concrete | acceptability | shape as | BSS work | conerete | Concrete ‘cubes by and per Paes cubes as per | NQM Gif | workmanship | design | judgment Quality any) Control Test Register Oo @ @B) oy ey © oO (8) : =|: ZO 1. Whether Cement and Steel tests other than provided by supplier, got conducted by independent laboratories: (CheckYany one box) Yes No IL, In order to assess the quality of concrete in case of doubt, if any, Non Destructive Test (NDT) such as Rebound hammer test, Ultra Sonic Pulse Velocity (UPV) etc. has been conducted: (CheckYany one box) Yes No [Guiding note: IF quality of ether material or workmanship i U, dhe overall em shall be graded as * Item Grading-4: (fs U (check J any one box) (this item is graded as U, clear reasons and suggestions for improvement are to be recorded).ey 7 nL. mm. 5. SUBSTRUCTURE A) Ongoing (Work in progress) | Eosainr Grade of | Quality of material is adequate as per quality | Testing | Grade temot | conrete control register are | fru _ ‘Cement ‘Coarse Fine ‘Steel | concrete aggregate | agerogate cubes by NQM (itany) o @ @ @ ©) © @ (3) Tacatoa | Gems | Farm work Reatoregpent | Wovtabiiy | Compaction | Curie’ ] Grade | cation] Grade | Ferivand | checkedby. | OF [arrangement | arrangements | sip) tee | ccaeete | arangements | compltent | Concrete ‘suifcty a) 2 @B) @ (5) (6) @ (8)_| (Check/any one Bos) Yes No Whether marking with faintis done on bridge components with date of easting for concrete: (Check/any one box) Yes No Whether Cement and Steel tests other than provided by supplier, got conducted by independent laboratories: (Cheek’any one box) Yes No 1sB) Completed work Locatio | Grade ] Compressiv Testing | Surface ] Size Quality | Weep | Riding aye | of | eaten | of fost] [assesment] hols || reums oFwork Jerr ofan cone | iyant | tape Jy peso Ada © | ctesas | eabesty | woskmn | sper | jndomet | (For per Quality | NOM (if ship. design 7 Control | any) an Test relum) Register a © | @ Te » | © [ol o @ | @ | ao I. Whether Cement and Steet tefts other than independent laboratories: IL, Im order to assess the quality of co such as Rebound hammer Provi / / (Checkvany ncrete in case of dou! st, Ultra Sonic Pulse Velocity (UPV) ete. (Check¥any one box) ided by supplier, got conducted by ‘one box) Yes No bt, if any Non Destructive Test (NDT) has been conducted: Yes No Item Grading-5: (check J any one bof) ‘Guiding note: If quality Af either material or workimanshy s] Ce] U, the overall item shall be graded as "0" Cyt tem i graded as U, clear reasons and suggestion for improvement are tobe recone),6 SUPERSTRUCTURE @ RCC Superstructure A) Ongoing (Work in progress) Quality of man “ : terial Workmanship _ 2 é\4 aiz |eoee.|eeh]i 3 i\ee) | Ele) ie eee age laa ilAls = | Be) E Bloch egehed acu seta ae\% Bs qseGlcecard ected 2) 28) 8 | gz PLS) elale Hes pega dd| "| ale 2 \2 B/E) ges |PEaNF) gad 4s i (| @) 5) @. a 8) @_Lag [an | a2 103) Whether Cement and Steet sts other/than provided by supplier, got eonducted by Independent labora (Check/any/one tox) ve] [_ [re Item Grading-6 Az (check ¢ any one box) Ss u Guiding nove: Ifquality of either material or workmanship is U, the overall item shall be graded as (this tem is graded as U, clear redsons and suggestions for improvement are to be recorded).B) Completed work Tllveilaal als 2 i slg gs| 2/2 gles g 3 2 iii el alelalelel dl zl e/alél 2] ele ORR V a Aa E/E] a] ala] ala bala Bes obese] fal als él ble é a| ae jeelala OTe @ @ fafota tele foo lan fas tax [a9 fas) [ao fap [os I. Whether Cement and Steel tests othe than provided by supplier, got conducted by independent laboratories: (CheckVany one box) ve] No u. 1n order to assess the quality of concréte in case of doubt, Non Destructive Test (NDT) such as Rebound hammer test, Uitra Soni¢ Pulse Velocity (UPV) ete. has been conducted if any: (Check any one box) Yes No Item Grading-6 Br (check V any one bax) (his item is graded as U, flear reasons and suggestions for improvement are to be recorded)(ii) Stee! Superstructure A) Ongoing (Work in progress) Quality of Material Workmanship El s| ef2 |al2 |s 2 22 s\a\ Flee (4 las. la, | tg. [elgg 2)4)2\¢2 2 Be 22 |B es gage é S| Bl] ge 25 |#8) »2 | 38s 23 gees Caran SPILCE Ee Ear eee B/S) 2) 2)e2| <2) 24 26/582) sce | 32°* 3 2/2/2°) 3 |ey se] 2 26 He a 2\/2/2 |e |63 5 3 Zo Ee fele|e |é |= 12 |é 2 be OTe Te Te | @ (6) @) (8) ) (10) ay L. Presence of water spray or moisture in the vicinity of bridge such as waterfall or marshy wet land? (Check/ any one box) Yes IL. Presence of industrial units nearby, hich emit corrosive fumes or discharge chemical effluents? (Cheek/any one box) Yes No IIL, Presence of salinity in the atmésphere? _(CheckVany one box) Yes No aiding noe: quality of iter matoal or workeanship 8 U, the overall Wem sail be waded as Item Grading-6A: s] Cle (check V any one bos) (Ufihis tem ts graded as U, clear reasons and suzestons for improvement are to be recorded).8) Completed Work [- Welding Material 5 Fresenos of Conosion 3 : 2 (Ye No) s|zl/é jz Wes, ype of Any change in e/ 2/85/35 sorrion and specif | pesenee of sence of joad =| | 22 | 22] mae wie” |e | nie 3 SB/eR) Fracture ‘es! No) B}°) SE] Ss") Es | as] 8] cvevnoy | evn Ss 18 | Fela 68 2 |2 | £6|/68/7é8 [Ole Te Tole Tela ® oO (10) le u. Presence of water spray or moisture in theAicinity of bridge such as waterfall or marshy wet land? Presence of industrial units nearby, which emit corrosive fumes or discharge chemical efflucais? (Check/any one box) LP] Fv (CheckVany one box) Yes Me TIL. Presence of salinity inthe atmospfere? __(Checkany one box) ‘Yes No Item Grading-6B: CIs] ni (check J any one box) (Wf this tem is graded as U, clear reasons and suggestions for improvement are to be recorded)(can (iti) A) Ongoing (Work in progress) Bailey Bridge Superstructure s Quality of Material = | Workmanship] = | g2 ae fe = Bag BES le 22 t E38 e B2e2/5e eu 3 | 832] 88 | 8 & |Sba les 23 os 5 &3| 22 | 2s |gzs Bet lbs Baas S is as Be ez2z\|Z8 ag ZEzS 3 | 282] g& | 285 /ee3/Eoe/222 [2242 3 gas] FS | Fee | Beeler] Sse Pn 3 Bag | £2 | 28° |2°"| Es f\ 2s ae § | eg4] s 2 |£e3|22 ae é <8 s 22 5/8 Es & z a) 2) GB) 4) (3) 6) @ 8) 1. Any oll ana or akers ad tie plates are missing or lose?(CheckVany one box)[ [Yes Ne TI. Any sway braces and or transom clamps are missing of loose? ‘Yes No (Check/any one box) II, Presence of any cracking inthe Bailey bridge? (Cheskany one box) [_ | Yes Ne IV. Presence of any bends in bridge members? (Cheekvany one boxy [ ]¥es No Item Grading-6A: (check Z any one box) Ss U Guiding note: If any of panel PIN is missing or Toose, the overall item shall be graded as “U™ (fthis tem is graded as U, clear reasons and suggestions for improvement are to be recorded).B) Completed Work 7 Welding Material a fap 3 =~ | oF 2 2 Presence of Corrosion S29 g £/283/¢ | 2 (Yes! No) gee | G Ss |eso|é é Yes, ype ofcorrosionand | 3 & B Be & | S82| 35 aS specific location gee 35 2 | 248] 2%] 22 zee | 22 2) 832/52/ 52] gel as|s| FFE] 2 8/588} e-] §° | 28 23/22! 284 2 aye ge z fe | SE |SE| 22 2 2 @ |g 2 20 | oS S| S83 2 a Q) G) (4) () (6) a) (8) (0) 1+ Anyblt ror rakes an i plates are ming or fose(Checkany one bos [ [ve No TL. Any sway braces and/or transom clamps are missing or loose? Yes No (Cheekany one box) MIL. Presence of any cracking in the Bailey bridge? (CheckVany one box) Yes No IV. Presence of any bends in bridge members? (Check any one box) Yes No Guiding not: any of panel FIN missing o oon, e overall Rem aa bs Gad S =O Item Grading-6B: Ss U (check any one bax) (Pistons eraded a clear reson and sugestion for improvement re tobe eeorded nLOAD TEST 1+ Results of Load Test attached or not (checkv“any one box) Yes Ityes, ¢ yes, comments required and copy of test results shall be enclosed. Guiding note: Toad Item Grading-7: (Check ¥ any one box) S 2 ‘est is not done or not satisfactory, overall item grading shall be U. Pithis item is graded U, write clear reasons and suggestions for improvement: BEARINGS A) Types of Bearing (Tick appropriate) Roller and Rocker Bearing Elastomerie Bearing, [ Pot cum PTFE Bearing he ‘Spherical Bearing Cylindrical Bearing ‘Any other type B) Condition of Bearings (@) Metallic Bearings i, General Condition- any rusting / ceasing of plates/ cleanliness or not ji, Functioning ~any excessive mbvement tilting/ jumping off guides ’ i Greasing/ oil bath required td be redone or not iv, Cracks in supporting member- Abutment cap, Pier cap, Pedestal, if any ¥. Effectiveness of anchor bolts, whether in position and tight or not vi. Report any other defect or observation found) i. Report condition of pads ~ Oxi creep, Flatten Displacement if any pling clean and free or not iil. Report any other defect ar observation found (©) Any type other than ‘a’ and *b? above Report - Any other defect or observation found ‘Whether test results of bearings are Available or not: (CheckVany one box) [ ves | [ ne] ‘Guiding note: IF anyone of the sub-itemspare gra Item Grading-§ [s] (check J any one box) (U this item is graded as U, ded as U, overall tom grading shall be U. ] lear redsons and suggestions for improvement are to be recorded).. EXPANSION JOINTS A) Types of Expansion joint (tiek V appropriate) Buried Expansion joint Filler Joint with Copper Plate Asphaltie Plag Joint ‘Compression Seal J Single Strip / Box Seal Joint Reinforced Blastomerie Joint Modular Strip / Box Seat joi Finger Joint Reinforced Coupled Elastomeric Joint B) Condition of Expansion joints any resporpe of questions in sub Hem B is "Yee the overall em shall beaded as Item Grading-9: (check Y any one: Ss u (fthis item is graded as U, clear reasons and suggestions for improvement are to be recorded).10. APPROACHES 10.1 Embankment Location | Suitability of soil | Compaction | Sideslopes | Shoulders Grade (s/SRVU) 5) © oO ® @ @ 112 50 ba (5.0) / Tocaion] Conforms] Matoial | Diy Pe Gimp] Whether | Thiskass] Messed] Prscibed (RD) |__| Suitable | density | selon [compaction fxper DPR| Thickness | Theknece Grading | from N/m / jis adequate (in (inmm) provided (YIN) | plasticity. / (YIN) mm) (yIN) angle a) Q) (Y/N) (3) @) s) (6) Mm (8), oo) 10.3 Base Course (Non Bituminous (WMM) and Bituminous Macadam (BM)) [ Location Grading of | Volume of | Compaction | Design | Thickness Thickness (RD) Aggregates| filler based on | thickness | of each adequate (s/u) ‘material material volumetric jas per DPR] layer of | (S/U) (SU) | percent of -fanalyss/ sand WBM/ coarse | replacement | (mm) | WMM / Aggregate | method (am / (SU) 1) ® c ® ® o © |@ | 2%10.4 Wearing Course [ecation [Grading oF] Taying | Bitumen [Bitumen] —Ofserved thickness | Surace ‘arse | Temper |content %, aslcontent %4 of layer un-evenness Aggregate | ature of (SIU) (s/U) (SMU) | the mix [Asmeasie S70 as per y qc NQM/SQM oO @ @) @ 6) © ” @) 10.5 Protection Work: 1 Whether sanctioned DPR has the provision of protection works: Yes No (checkVany one box) IL Type of protection work: (check boxes as applicable) Retaining wall Breast wall Parapet wall ‘Any other type of Protection work . TI, Quality of Materials: Tocation 7] Structure Type | Type of Protection [General quality of] Size and [Quality assessment RD |(Retaining Wall] | work (RCC/CC/ |material conforms} shape as |” by personal Breast Wall) | Masonry wire | to specifications |perdesign| judgement Parapets) crate) (YesiNo) | (Yes/No) o @ @) @) () ©IV. Workmanship of Re sining structures: Location 7] Workmanship of Whether ve weep holes Fdequoey of RD — | retainingstructures | honeycombingany | been provided ep hi other defects are (Yes/No) (if provided) observed (Y/N) (rex) a 2) ©) @ ©). V. Incase, Stone masonry is used in retaining structuyls a) ‘Workmanship of stone masonry igheceptable: (check Zany ohe box) Yes No b) Bond stone has been provideddn stone masonry: a we (checkY ghy one box) Guiding note: sub fem 10.2, 103, 0.4 are graded as U, the overall Nem sal bo U Item Grading-10: (check J any one box) (f this item is graded SRUU, Ss SRI u Jrite clear reasons and suggestions for iprovenen11. BRIDGE FURNITURE AND MARKINGS: 11.1 Observations: Q: (Main Information Board Fixed : (i) Citizen Information Board Fixed : ly of Bridge Furniture and Markings : (Ongoing / Completed works) SRI SRI U tem Grading-11. (Check J any one box) s | srt | U If this item is graded SRI/U, write clear reasons and suggestions for improvement: 11.2 Observatior Quality of Bridge Furniture and Markings: Gif) Guard stones fixed on 5 ai approaches : (iv) Mandatory and caution s SRI signage : Tem Grading-11.2: (Check any one box) s SRI U a If this item is graded SRIIU, write clear reasons and suggestions for improvement:12. General Observations of QM, (including the observations made during the interaction with PIU staff and Contractor/Consultant Engineers): A; Qinervations about deficieney in praject preparation: (Give detailed observations about : feneral and items which have been left but are required as per site conditions): deficiencies in (cheeky 1 or 1) |. No deficiency in project preparation noticed during the interaction with PIU Staff and Contractor/Consultant engineers: [a IL Deficiencies Observed: (check one or multiple box) Nomenclature of BOQ Items is not cle: Grade/Emutsion) has to be used and th: LE) Number oFspans are insufficient as pe [Ey No provision of protective workin D the site's hydrologi arly stated such as what type of binder (VG ¢ quantity of such items. condition, PR but as per site conditions it is required. EF) Hycrautic Design & cateutation fr bridge design not provisioned in Dre [Ey Guard stone Crash barter R ‘oad studs on approches are required to be provisioned in DPR. [Deviation trom proposed Alignment Any other comment: B. Whether the work has been completed/ occurred. If delay has occurred, whether the li recovered: (check W relevant box and fill details) Connie Whether thre war ay Progress as per work programme or the delay has iquidated damages have been withhold or In progress Work progress is Yes No Ifyes, fill below details Period of delay (in months) amounts [[wannoe] [| rement ‘Amount (in lakh) Reason for delay/any other comment: [Lasers oor extension of last date, fill below details Period ofexteson Gomis) [——] Witold amount rfid ve] | Amount (in lakh) | [~ Amount of penalty on contractor : C7 Reason for delay/any other comment date completion NoC, Whether the work has been completed wit Whether the work is completed within the sanctioned cost IPno, fill the below details Sanctioned cost (inlakt) [+] Completion cost ¢inlakif id : the sanctioned cost, if not, what is the action ‘taken by the PIU (in case of complete works): (check vrelevant bax and il details) Reason for extra cost Action taken by PIU D. Observations about the a Monitors). n taken by the PIU on the observations of inspecti cluding SQMs and NOMs. (clearly offer comments about the action taken on the “observations of Departmental Officers, State Quality Monitors and National Quality Previous Previous OMS observtion “ation vaken by PID Q's Designation 7NOM) SOM DO - "Your abservation about ” Luu sub13, OVERALL GRADING OF BRIDGE WORK ae tems Description Awardable | Awarded - Grade | Grade 1 | General De 2 | Quality Arrangements S/SRUU S 3 | Attention to Quality SISRUO Ss 4 | Foundation (Stage 1 0 a 5 | Sub-Structure (Stage) su l 6 | Super-structure (Stage II) 0 i 7 | Toad Test so Bearing = 7 1 8 | (Grading to be same as for condition of Bearing) e Type of Bearing- Roller and Rocker Bearing, Elastomeric Bearing, Pot cum PTFE Bearing, Spherical Bearing, Cylindrical Bearing Any other Bearing) B. Condition of bearing Siu 7] Expansion Joint a (Grading to be same as for condition of Expansion joints) “Type of Expansion Joint= Buried Expansion joint, Filler Joint with Copper Plate, Asphaltic Plug Joint, Compression Seal Joint, Single Strip / Box Seal Joint, Reinforced Elastomeric Joint, Modular Strip / Box Seal joint, Finger Joint, Reinforced Coupled Elastomeric Joint, &. Condition of Expuarion ein 0 T TO_| Approaches ATS cacavimenencrmsnin | S80 | | @) Embankment SERVO Gp Sub Base (GSB) SERVO Gi Base Course aan (Non Bituminous (WBM) and Bituminous(BM)) |~Gv) Wearing Course SERVO @ Protection Work SERVO11 | Bridge Fumiture and Markings (to be U, if any of the sub items are U) iy @ Main information Board oe Gil) Citizen Taformation Board ‘SISRIU Gil) Guard stone on approaches SISRIU (iv) Mandatory and Caution signage ‘SISRIU ~y SISRVU ¢ s s s Overall Grading siSRIU Guiding notes for overall grading: + Tall work items are “S”, the overall quality of work shall be “S" * Titems atst. nos. 4, 5, 6,7 and 8 are “S” and other items are either “SRI” or “U? the overall quality of work shall be “SRI” * [any item at sr. nos. 4 5, 6,7 and 8 are “U", the overall quality of work shall be “U”, irrespective of the quality grading of other items Signature of QM. Name of QM Date4. UALIT t QUALITY GRADING OF ITEMS OF BRIDGE WORK: Tem No. Tem for observation ‘Awardable | Awarded lem No.7 General Details Grate Grade Trem No.2 ‘Quality Control Arrangements S7SRI70 Ss Trem No. 3 ‘Attention to Quality S7SRI7U S rem No. 4 Foundation 370 = Tem No. 5 Sub structure s7U Ss Trem No. 6 | Super structure Siu _ Trem No.7 | Load Test 370 = Trem No. 8B | Condition of Bearing 370 = TtemNo,9 | Expansion Joint 370 _ TremNo. 10 | Approaches Stage Tand 11) s7sri7u | __ Tem No.1 | Bridge furniture & marking S7SRI7U Ss ‘Overall Grading S/SRI/U = Signature of QM Name of QM Date