PROFORMA NO.
01 – PSC/PCCP PIPE :- PROFORMA FOR PIPE INVENTORY
Name Of Project :- Name Of Pipe Supplier :-
Name Of Work :- Checked by- Name & Designation of WRD Engineer:-
Name of Circle office :- Name & Designation of Inspecting Officer :-
Name of Division Office :- Date of Checking/ Inspection:-
1 2 3 4 5 6 7 8 9 10 11
Sr. No. Diameter Pressure rating Total pipe Date No of Pipe Cumulative No of pipe No of Pipes Cumulative no Remark
received received now no of pipe used rejected of balance pipe
received
PROFORMA NO. 02 – PSC/PCCP PIPE :- PROFORMA FOR EXCAVATION ACTIVITY
Name Of Project: Name Of Pipe Supplier:
Name Of Work: Checked by- Name & Designation of WRD Engineer:-
Name of Circle office: Name & Designation of Inspecting Officer :-
Name of Division Office: Date of Checking/ Inspection:
1 2 3 4 5 6 7 8 9 10 11 12
Sr. Component Chainage Type of Strata Pipe Width of Design Actual Design Actual Depth of Remarks
No. Dia. Trench Ground Ground Excavation Excavation Trench
R.L. R.L. R.L. R.L.
(Satisfactory / (Satisfactory /
- (Main Line / Minor etc.) (meter) (mm) (meter) (meter) (meter) (meter)
Not Satisfactory) Not Satisfactory)
Reference For Permissible Limits Clause As per
(Clause No. of IS 783) - - - - - - --
15.2/Tender spe. Tender/design
PROFORMA NO. 03 – PSC/PCCP PIPE :- PROFORMA FOR BEDDING ACTIVITY
Name Of Project: Name Of Pipe Supplier:
Name Of Work: Checked by- Name & Designation of WRD Engineer:-
Name of Circle office: Name & Designation of Inspecting Officer :-
Name of Division Office: Date of Checking/ Inspection:
1 2 3 4 5 6 7 8 9 10 11 12 13
Sr. Component Chainage Type of Strata Any Non compressible Type of Design Actual Design Actual Bed Actual Remarks
No. sharp Fine sand/soft Bedding Ground Ground Bed R.L. R.L. Depth of
Objects Murum R.L. R.L. Bed
around bedding under
pipe &around pipe/as per
tender
- (Murum /
(Main Line / Minor etc.) (M) Yes / No Yes / No (meter) (meter) (meter) (meter) (mm)
Sand)
PROFORMA NO. 04 – PSC/PCCP PIPE :- PROFORMA FOR LAYING ACTIVITY
Name Of Project: Name Of Pipe Supplier:
Name Of Work: Checked by- Name & Designation of WRD Engineer:-
Name of Circle office: Name & Designation of Inspecting Officer :-
Name of Division Office: Date of Checking/ Inspection:
1 2 3 4 5 6 7 8 9 10 11
Sr. Component Chainage Diameter Pressure Type of Strata Bedding Design Pipe Actual Pipe Actual Depth from Remarks
No. of Rating Prepared Invert Bottom Invert Bottom GL to Top of Pipe
Received R.L. R.L.
Pipes
(Main Line / (Satisfactory / Not
- (meter) (meter) (meter) (mm) (Satisfactory / Not Satisfactory)
Minor etc.) Satisfactory)
- - - - - -
Reference For Permissible
Limits
(Clause No. of IS 783)
PROFORMA NO. 05 – PSC/PCCP PIPE :- PROFORMA FOR JOINTING ACTIVITY
Name Of Project :- Name Of Pipe Supplier :-
Name Of Work :- Checked by (WRD Engineer/Third Party):-
Name of Circle office :- Name of Inspecting Officer :-
Name of Division Office :- Date of Checking/ Inspection:
Sr. Component Chainage Number of Number of Pipe Joint Overlapp Welding Welding Whether Joints Steep Expansion Remarks
No. pipes Joints Faces ing of Electrodes as per IS Suitable covered gradient Joints
Cleaned, Socket as per IS 816 spacers properly Transverse
Centralized over 814 used ? with cement Anchoring
& well Spigot mortar
located
before
Welding
(Satisfactory / (Satisfactory / (Satisfactory / Not
(Main Line / Minor (Satisfactory / Not (Satisfactory / Not (Satisfactory /
- From - TO - (mm) Not Not ( Yes / No) Satisfactory/ Not -
etc.) Satisfactory) Satisfactory) Not Satisfactory) Required)
Satisfactory) Satisfactory)
IS : 783 - IS : 783 - 1985, IS : 783 - 1985, IS : 783 - 1985,
Reference For Permissible Limits - IS : 783 - 1985, 15.4.2 - - -
1985, 15.4.3 15.4.2 15.4.3 15.4.1
Note :- IS-783-1985-Clause No. 15.4.1- Expansion joints for buried pipeline at max. 100m interval& for exposed -45m
IS-783-1985-Clause No. 15.4.3- When gradient is steeper than 1:6, necessary anchor blocks (spacing ranging from 5 to 15 m) to be provided.
IS-783-1985-Clause No. 15.4.2- The weld joints to be covered with cement mortar (1:2 for non-pressure and 1:1.5 for pressure pipe) at joint with thickness not less than 100mm.
PROFORMA NO. 06 – PSC/PCCP PIPE :- PROFORMA FOR BACKFILLING ACTIVITY
Name Of Project: Name Of Pipe Supplier:
Name Of Work: Checked by- Name & Designation of WRD Engineer:-
Name of Circle office: Name & Designation of Inspecting Officer :-
Name of Division Office: Date of Checking/ Inspection:
1 2 3 4 5 6 7 8 9
Sr. No. Component Chainage Dewatering of Pipe Length Total % of test Pipe safe for Arrangement made to Remarks
water in the trench? that passed Overburden locate buried pipeline
Density test Pressure
Geo-tagging /Metallic
(Satisfactory / Not
- (Main Line / Minor etc.) (meter) Not required / Done (meter) % (Yes / No) Tape/Physical tagging/ Satisfactory)
any other please
specify
PROFORMA NO. 07 – PSC/PCCP PIPE :- PROFORMA FOR THRUST BLOCK
Name Of Project: Name Of Pipe Supplier:
Name Of Work: Checked by- Name & Designation of WRD Engineer:-
Name of Circle office: Name & Designation of Inspecting Officer :-
Name of Division Office: Date of Checking/ Inspection:
1 2 3 4 5 6 7 8 9 10 11
whether surface Signature with name
Thrust block Qty. of reinforcement
Grade of Date of &designation
Sr. No. Chainage Location no. as per concrete provided as per Remarks
concrete casting
drawing executed drawing/specification?
(Yes/No) Maintained by Checked by
PROFORMA NO.08 – PCCP PIPE :-Proforma for Hydraulic Test Inspection Report
Name of Project: Name of Pipe Supplier:
Name of Work: Name and Designation of Inspecting Officer:
Name of Circle office:
Name of Division Office: Date of Checking/ Inspection:
1 2 3
Sr.
Details Observations
No
1 Location
2 Length of pipeline under Hydraulic Testing
Test pressure (shall be 1.5 times the rated pressure
3 of pipes or of the proposed maximum design
pressure of the section.)
Whether air valves at high points are open to allow
4 Yes / No
air to escape while water is being filled.
Whether pipeline is filled with water slowly
5 Yes / No
allowing for splurging the entrapped air?
Whether after filling with water the pipeline is left
6 Yes / No
to stabilize for a period of 1 hr.?
Whether the test pressure is applied by
7 Yes / No
continuously pumping at a constant rate?
Whether the pipeline is pressure tested from the
8 Yes / No
lowest point?
During the test period, whether make-up water is,
9 Yes / No
continuously added to maintain the pressure?
Whether the pressure remains steady (within 5
10 Yes / No
percent of the target value) for 1½ h?
Whether there is any leakage in the section from
11 Yes / No
joints?
Whether Third Party inspection provision is there
12 Yes / No
for this activity in contract?
If Yes,
Whether Third Party has checked the Hydraulic
a) Yes / No
Testing activity?
Specify major observation of Third Party regarding
b)
this activity
7 Specific remarks of Inspecting Officer
Whether the Hydraulic Testing activity is as per
8 Yes / No
requirement?
Sign -
Name -
Designation -
