Big Networks For Contracting ITP Ref.

: ROYAL COMMISSION IN JAZAN

INSPECTION & TEST PLAN Rev. KINGDOM OF SAUDI ARABIA
(ITP) CONTRACT NO. JCPDI R- Disp:
3016 Sec.:

ENVIRNTL DEPT.
RECEIVING

MARAFIQ
AL HARBI
CONTRACT

CHECK
ITEM FREQUENCY OF CODE/STANDARD/SPE TYPE OF

TEST

ITL
REMARKS

RC
ITEM DESCRIPTION REF.SPECS.SECTI ACCEPTABLE CRITERIA
NO. INSPECTION CS./PROCEDURE REPORT
ON

LEGENDS: RC= Royal Commission R= Review Pont ( To determine subject matter has achieved objectives
ITL= Independent Testing Laboratory M= Monitoring periodic and systematic check)
P= Perform W= Witness point ( Observation of an activity to ensure work is progressing activity as per requirements
T= Test, C= Check, RCVD= Received H= Hold Point A point beyond which an activity must not proceed without the approval of a designated
organization, RC inspecdtor
 Royal Commission for Jubail and Yanbu RCJY MANAGEMENT PROCEDURE

Request for Inspection Form

CONTRACT NO: JCPDI R- 3016

Project Title: Construction of Infrastructure and Road 10.

REQUEST FOR INSPECTION-JCPDI-R 3016 PROJECT

CONTRACTOR: BIG NETWORKS FOR CONTRACTING EST. & PARTNERS CO. LTD
DATE : REQUEST NO.: RFI-
TO : – RC Authorized Representatives

TYPE OF INSPECTION:
CIVIL (CE) MECHANICAL (ME) ELECTRICAL (EE) SURVEY (SU) STRUCTURAL (ST)

WOULD YOU PLEASE CONDUCT INSPECTION AND WITNESS THE PORTION OF THE WORK AS
FOLLOWS;

DESCRIPTION DATE TIME LOCATION

CERTIFICATION:

The Inspection has been done and found work according to

the approved Drawings, Specifications and ITP / Test Procedures.

REQUESTED BY:
VERIFIED BY:
Engr.
Engr.
QC Engineer
CM Manager
WITNESSED BY:

RCE

REMARKS:

ATTACHMENTS:
HOLD POINT CHECKLIST
INSPECTION CHECKLIST
INDEPENDENT TESTING LAB. RESULTS
 CONTRACT NO. JCPDI R-3016

Project Title: Construction of Infrastructure and Road 10

HOLD POINT RELEASE
Activity Title Architectural Work Type

Work Area/Location Architectural Civil

Building Mechanical Structural

HPR Number Electrical Others

Date References

Material Submittal Number Code Drawing Reference Number REV Number

IFC Take-Off Qty. Submittal Number Code I.T.P. Number

IFC Final Qty. Submittal Number Code The Final RFI Number

QUANTITY RECORDS SCHEDULE

Approved IFC
Pay item No. Description U.O.M BOQ Previous Qty. This Period To Date Run %
QTY

Note : All IFC Take-Off Quantity Must be Offically Submit it to R.C. and Approved Before 20% of B.O.Q.
The Royal Commission permission to proceed does not constitute (Final Acceptance) of Resolution of Quantities for unit Price work calculations. Analysis or oter Contractor furnished back up attached to this "Hold PointRelease Form"
serve as Contractors preliminary support documentation Subject to final reconciliation by the Royal Commission and the Contractor.

Inspected by Contractor QC Department The R.C Representative Engineers

Position Name Signature Hold Point Released by R.C Representative
QC Engineer Name
Remarks Signature Date:
QC Manager Remark
Remarks R.E. Signature if ( Run % = 90% or more )
QS : Name
Remarks Signature Date:
Safety Manager Remark
Attachments:

Checklist Survey Report IFC Drawing Shop Drawing Calculation

MIR ITP BOQ/Pay Item Test Result Others

 Document Type

Royal Commission for Jubail and Yanbu

Method Statement

METHOD STATEMENT TEMPLATE

METHOD STATEMENT
(Discipline / Works)

(Area/Building)

(Contractor)

Method Statement No: Issued

by:

Rev. # Date Description Prepared Checked Approved

Rev 27, MAYl 2024

 Document Type

Royal Commission for Jubail and Yanbu

Method Statement

1. DESCRIPTION OF WORKS
Describe the works covered by this Method Statement. Include or attach sketches, maps,
drawings if applicable.

2. LOCATION AND WORK LIMITS (AREA/SITE SPECIFIC LAYOUT)

State the work location and work limits this Method Statement includes. Include sketches,
maps, drawings if applicable.

3. ACCESS/EGRESS
Describe access and egress to the site and/or the work area. Include sketches, maps,
drawings if required.

4. PROTECTION AND ISOLATION ARRANGEMENTS (E.G 3RD

PARTIES)
Area Protection/Isolation Measures
 Document Type

Royal Commission for Jubail and Yanbu

Method Statement

5. TASK SPECIFIC EMERGENCY ARRANGEMENTS

Describe any task specific emergency arrangements in place for these work e.g. method of
rescuing a worker from a confined space.

6. WORK METHODOLOGY
(Provide a description and sequence of tasks and activities – alternate format may be
used)
Number Activity Description and sequencing
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
(Add or delete rows as required)
(Alternatively provide a flowchart of the Sequenced Activities)

7. RESOURCES

A. SITE KEY PERSONNEL AND WORKFORCE

Title No. Required Task Specific Training Required (if applicable)
 Document Type

Royal Commission for Jubail and Yanbu

Method Statement

(Add or delete rows as required)

B. PLANT AND EQUIPMENT

Item Reason for use

(Add or delete rows as required)

C. MATERIALS AND TOOLS

Item Reason for use

(Add or delete rows as required)

D. CHEMICALS REQUIRED
Item MSDS Number Reason for use
 Document Type

Royal Commission for Jubail and Yanbu

Method Statement

(Add or delete rows as required)

E. TASK SPECIFIC PPE REQUIRED (REFER

CONTROL MEASURES FROM RISK ASSESSMENT)
Item Reason for use

(Add or delete rows as required)

Note that all works require mandatory PPE as follows Hardhat, gloves, safety
glasses, safety boots, hi-vis vest.

8. INTERFACES – OTHER SITES, WORK ACTIVITIES,

GENERAL PUBLIC ETC.
Interfacing party or activity Description of Interface

(Add or delete rows as required)

9. PERMITS
Any Permits Required (from RC ESH Manual or 3rd Party)
Permit Type Issued By Additional Information (Reference No. etc.)

(Add or delete rows as required)

 Document Type

Royal Commission for Jubail and Yanbu

Method Statement

10. REFERENCES DRAWINGS / SPECIFICATIONS / OTHER

Document Number Title

(Add or delete rows as required)

11. RISK ASSESSMENT

Risk Assessment template can be found in the RC ES&H Manual.

The Risk Assessment must include all Environmental, Safety and Health Hazards and
controls/mitigation for the works.

A Risk Assessment shall be carried out in-line with the Method statement. The Method
Statement shall then be produced taking into account items identified in the Risk
Assessment. The Risk Assessment may be amended as necessary after the Method
Statement is produced.

A Risk Assessment is always necessary with a Method Statement.

 Royal Commission for Jubail and Yanbu JUBAIL MANAGEMENT PROCEDURE
ATTACHMENT
TECHNICAL QUERY FORM 27 MAY 2024

RC Contract No. JCPDI R-3016 Date:

Subject TQ No.:

Reply
Dwg/Spec//Ref.: Required By:

Information Requested Civil ___ Mechanical ___ Electrical ___ Others ___

Initiated by Royal Commission

✔ Contractor Print Name Contact No Signature Date

TQ Validation/RC Field Engineer

Print Name Signature Date

FE
Comments

TQs initiated by Contractors shall be reviewed with the RC Field Engineer prior to submittal to preclude requesting information already available to the contractor.

Reply

Engineering Facility Engineer (If applicable)

Print Name Signature Date

Project Field Engineer (PFE)

Print Name Signature Date

Resident Engineer (RE)

Print Name Signature Date

Field Change Document (FCD) Required : YES NO

(Note : FCD used for Design Change, Cost and Schedule Impact)

Page 1 of 1

COPIES TO: CONTRACTOR/Contract Supervisor/Facility Contracts Supervisor/Field Engineer/Royal Commission

PDMC
 Royal Commission for Jubail and Yanbu RCJY MANAGEMENT PROCEDURE

Technical Query LOG.

RC
Submitted Transmittal #
Transmittal # TQ No. Description Discipline Originator Replied Date Status
Date
 ROYAL COMMISSION FOR JUBAIL & YANBU Sheet 1 of 1
SPECIFICATION COMPARISON
CONTRACT NO: JCPDI F-7011 CONTRACT TITLE : Construction of Infrastructure and Road 10 CONTRACTOR’S SUBMITTAL NO : DATE :

DOCUMENT NO: PREPARED BY: CHECKED BY:

SUBMITTAL TITLE:

SPEC,REF,I.E, MATERIAL SPECIFICATION REQUIREMENT PROPOSED MATERIAL REMARK

SECTION ETC SOURCE

CERTRIFY THAT ALL THE REQUIREMENTS OF THE QA/QC MANAGER: DATE:

SPECIFICATION FOR THE PROPSED PRODUCT HAVE NAME SIGNATURE
BEEN COMPARE AND THE DEVIATIONS FROM THE
SPECIFICATIONS HAVE BEEN SPECIALLY IDENTIFIED. PROJECT MANAGER: . DATE:
. NAME SIGNATURE
 REPORT REF #
DAILY QUALITY CONTROL REPORT
Contractor : BIGNET

ROYAL COMMISSION FOR Project Name: Construction of Contract No. : JCPDI R-3016
JUBAIL & YANBU
Directorate General for Jubail Project Infrastructure and Road 10 Date:

DAILY QUALITY CONTROL REPORT

INSPECTION DETAILS (including any Off-site Inspections)
Item Inspection Inspected By: R.C. Action
Description of Work Inspected Remarks.
No. Findings (Name/initials) Comments Taken

1.

2.

MATERIAL / EQUIPMENT RECEIVED & INSPECTED

Item Material/ Equipment Location Inspected R.C. Action

Report No.
No. Received By Comments Taken
From To
N/A
SAMPLES TAKEN / TESTS MADE
Item Details of sampling and Inspected R.C. Action Report
Location(s) Date
No. testing By Comments Taken No.

DETAILS OF ANY NON-CONFORMANCES OR INSTRUCTIONS RECEIVED OR CLOSED

OUT
Non-Conformance Reporter Field NCR / Field RC
Location Action Taken
Instruction Details Inst. No. Comments

QC Engineer: QC Manager: RC Representative:

Daily Quality Control Report-Rev 01

 NONCONFORMANCE REPORT
NCR #: CONTRACTOR NAME:BIG NET DATE:
(by DCC)

INFORMATIO
PROJECT TITLE: Construction of Infrastructure and Road 10
PROJECT
PAY ITEM #:
NUMBER: JCPDI R-3016

N
DRAWING/SPECIFICATION/ITEM NUMBER REV ITEM DESCRIPTION
0
1
NON CONFORMING CONDITION DESCRIPTION Mechanical Civil Electrical Architecture

ISSUANCE
Contractor
Royal
Commission

CONTRACTOR DISPOSITION:

Disposition By:
Contractor’s

DISPOSITION
QC Manager Print Name Signature
Date

Contractor’s Proposed Disposition:

Rework Repair Use As Is Reject

PFE Concurrence:

Print Name Signature Date

CONTRACTOR’’S
QC MANAGER
Print Name Signature Date

RC Field Engineer
Inspection
and Closure Print Name Signature Date

CLOSUR
EST.REWORK VALUE :
(IN SAUDI RIYAL)
CAUSE OF NON

E
CONFORMANCE

REMARKS

RC PFE Acceptance
for Final Closure
Print Name Signature Date
 Royal Commission for Jubail and Yanbu RCJY MANAGEMENT PROCEDURE

Quality Action Notice

Quality Action Notice

Contract Number: JCPDI R-3016 QAN Number:
Area: □SPR&R □Power, Pipeline & Site Development □Major Building & HE □Services
Site location:

□ Documentation □ Storage □ Material □ Installation

□ Architectural □ Civil □ Mechanical □ Electrical □ Special Systems
Monitoring type: □ Hold □ Witness □ Surveillance □ Review (for Documentation)

Action: □ Rework Required □ NCR Required □ Complied

Description (RC CSI Code:)
□ 1. General Requirement □ 5. Metals □ 9. Finishes □ 2. Special Construction
□ 2. Site Work □ 6. Woods & Plastics □ 10. Specialties □ 2. Conveying System
□ 3. Concrete □ 7. Thermal & Moisture □ 11. Equipment □ 2. Mechanical
Protection
□ 4. Masonry □ 8. Doors & Windows □ 12. Furnishings □ 2. Electrical

Deficiency Item: Part Number/ Drawing:

Brief Description (Complete for Rework Required, NCR, Complied)

Proposed Solution (Optional)

Open by: (Name/Signature)

RC Rep Contractor Rep. Date Issue

Open by: (Name/Signature)

RC Rep Contractor Rep. Date Closed
Note : All blanks shall be filled mandatorily White Copy: Originator Pink Copy: Contractor Yellow Copy: Area Admin.

IC-TA-CD-00-03 Attachment C.1 Page 1 of 1 REV-1

 Royal Commission for Jubail and Yanbu RCJY MANAGEMENT PROCEDURE

Corrective Action Notice (CAN) IC-TA-CD-00-03 Attachment D.1

CORRECTIVE ACTION NOTICE CAN No:

CONTRACT No: JCPDI R-3016 CONTRACTOR: BIG NET Issue Date:
CONTRACT TITLE: Construction of Infrastructure and Road 10 Response Date:

CONTRACTOR REPRESENTATVES: Audit Ref:

CONTROLLING DOCUMENT(S) – (Title, Section, Revision): RC Auditor(s):

REQUIREMENTS:

FINDING:

Signature(Auditor): Name: Date:

CORRECTIVE ACTION REQUIREMENTS:
Provide a Corrective Action response, or an Action Plan with completion dates, to the RC within 15 days of receipt of the Audit Report. The Corrective Action Plan
should describe the actions to be taken to correct the CAN, actions to determine the possibility of additional similar findings, actions to prevent the finding from
recurring, and an expected completion date for fully implementing the Corrective Actions.
(When the Corrective Actions result in new or revised documents or procedures, such as a change or addition to the Contractor’s Quality Control Plan, please
allow the RC Quality Assurance Manager or his designate, to review the new or revised document prior to formal submittal to the RC)
CONTRACTOR’s CORRECTIVE ACTION STATEMENT:

Signature: Name: Title: Response Date:

RC CORRECTIVE ACTION VERIFICATION:

(RC Quality Assurance Department will schedule a follow-up audit to verify that the response action has been included into the QC Program, and is
effectively being implemented. With these verifications, this CAN will be closed);

Signature (Auditor): Name: CAN Close-out Date:

IC-TA-CD-00-03 Attachment D.1 Page 1 of 1 REV-1

 Project Name: Construction of Infrastructure and Road 10
CONTRACT NO.: JCDPDI R-3016
MERS FORM #

MATERIAL / EQUIPMENT RECEIPT AND STORAGE REPORT

DESCRIPTION OF MATERIAL / EQUIPMENT :

PAY ITEM NO.: SUPPLIER: ELSEWEDY CABLES

RECEIVING INSPECTION PROCEDURE :

1. CHECK THE MATERIAL AS PER ATTACHED DOCUMENTS.
2. INSPECT THE CABLES FOR ANY PHYSICAL DAMAGE, DEFECTS, SECURELY PACKED, ETC.
3. VERIFY THE LOCATION & SPACE OF STORAGE.
4. USE PROPER LIFTING EQUIPMENT FOR LOADING & UNLOADING OF CABLE DRUMS.

DOCUMENTATION REQUIREMENTS :
1. RC APPROVAL
2. MANUFACTURER INSTRUCTION & RECOMMENDATION.

STORAGE AND MAINTENANCE REQUIREMENTS:

SR.
DATE DOCUMENTATION
NO. DESCRIPTION QUANTITY INSPECTED BY REMARKS
RECEIVED OK
STORED
PROPERLY
 INSPECTION, MEASURING AND TEST EQUIPMENT CALIBRATION RECORD

CALIBRATION CALIBRATION DUE

S.N.O MANUFACTURER INSTRUMENT DESCRIPTION MODEL NO SERIAL NO CALIBRATION DATE REMARKS
CERTIFICATE DATE