Format No : ARTL/ BKRP / F / 001 / Rev.

00

BADAKUMARI KARKI ROAD PRIVATE LIMITED (OD-3)

REQUEST FOR INSPECTION (RFI)

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500 under Raipur-
Name of Project :
Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)

Client : National Highways Authority of India

Independent Engineer : SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects Pvt.Ltd.
Concessionaire : Badakumari Karki Road Private Limited (OD-3)
EPC Contractor : Adani Road Transport Ltd.

RFI NO. Date :

Health, Safety & Environment Compliance : Yes No Work Can be started : Yes No
Note 1: Please Mark if found 'In compliance', If found 'Non compliant' and NA if not applicable
Work Permit Issued HIRA Fire Extinguiser Tool Box Conducted
Safe Access for Workplace First Aid Box Dust Control Plan Traffic Control Plan Implemented
Aspect Impact Analysis PPE Provided Fall Protection Edge Barricading Provided
Hazardous Chemical use Safety Supervision Waterbody Contamination Prevention Actions Implemented
Request for Inspection of works of :
Note 2 : Attachment of Checklist of each activity and Concrete Pour is Mandatory with this RFI for Acceptance
Clearing & Grubbing Aggregate Layer Toll Plaza Works Landscaping
Survey Kerb Rest Area Works DLC / PQC
Excavation Prime Coat /Tack Coat Layout Marking Hume Pipe Laying
NGL/OGL DBM PCC Drainage & Protection
Embankment BC/SDBC Formwork Dismantling Work
Subgrade RE Wall Pile Boring Structure Miscellaneous Works
GSB Retaining Wall Reinforcement Traffic Sign Board
WMM Road Marking Concreting Material Testing
CTB Soil Nailing Prestressing Others
CTSB Highway Miscellaneous Works Girder Erection

Location / Chainage : Side :

Work Particulars :
MCW SR AOP MJB VUP LVUP VOP MNB FOB BOX C HPC Others

Description of Works
:
Layer /Grade of Concrete: Time of Inspection:

Requested By (EPC Contractor) Received By Concessionaire: Received By NHAI / IE:

Name : Name : Name :

Signature : Signature : Signature :

Date : Date : Date :

Time : Time : Time :

Remarks / Comments / Observations / Remedial Action given by EPC / Concessionaire
Pre-Construction:

Construction:

Post -Construction:

Remarks / Comments / Observations / Remedial Action given by NHAI / IE

Status
APPROVED Name Name Name
NOT APPROVED Sign Sign Sign
HOLD Date Date Date
EPC Contractor's Representative Concessionaire's Representative IE/NHAI Representative
RFI Audited By Signature & Date Remarks if any
 Format No : ARTL/ BKRP / F / 001 / Rev.00

BADAKUMARI KARKI ROAD PRIVATE LIMITED (OD-3)

REQUEST FOR INSPECTION (RFI)

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500 under Raipur-
Name of Project :
Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)

Client : National Highways Authority of India

Independent Engineer : SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects Pvt.Ltd.
Concessionaire : Badakumari Karki Road Private Limited (OD-3)
EPC Contractor : Adani Road Transport Ltd.

RFI NO. Date :

Health, Safety & Environment Compliance : Yes No Work Can be started : Yes No
Note 1: Please Mark if found 'In compliance', If found 'Non compliant' and NA if not applicable
Work Permit Issued HIRA Fire Extinguiser Tool Box Conducted
Safe Access for Workplace First Aid Box Dust Control Plan Traffic Control Plan Implemented
Aspect Impact Analysis PPE Provided Fall Protection Edge Barricading Provided
Hazardous Chemical use Safety Supervision Waterbody Contamination Prevention Actions Implemented
Request for Inspection of works of :
Note 2 : Attachment of Checklist of each activity and Concrete Pour is Mandatory with this RFI for Acceptance
Clearing & Grubbing Aggregate Layer Toll Plaza Works Landscaping
Survey Kerb Rest Area Works DLC / PQC
Excavation Prime Coat /Tack Coat Layout Marking Hume Pipe Laying
NGL/OGL DBM PCC Drainage & Protection
Embankment BC/SDBC Formwork Dismantling Work
Subgrade RE Wall Pile Boring Structure Miscellaneous Works
GSB Retaining Wall Reinforcement Traffic Sign Board
WMM Road Marking Concreting Material Testing
CTB Soil Nailing Prestressing Others
CTSB Highway Miscellaneous Works Girder Erection

Location / Chainage : Side :

Work Particulars
:
MCW SR AOP MJB VUP LVUP VOP MNB FOB BOX C HPC Others

Description of Works
:
Layer /Grade of Concrete: Time of Inspection:

Requested By (EPC Contractor) Received By Concessionaire: Received By NHAI / IE:

Name : Name : Name :

Signature : Signature : Signature :

Date : Date : Date :

Time : Time : Time :

Remarks / Comments / Observations / Remedial Action given by EPC / Concessionaire

Remarks / Comments / Observations / Remedial Action given by NHAI / IE

Status
APPROVED Name Name Name
NOT APPROVED Sign Sign Sign
HOLD Date Date Date
EPC Contractor's Representative Concessionaire's Representative IE/NHAI Representative
RFI Audited By Signature & Date Remarks if any