Inspection & Test Plan

Contract Name:
Contract Number: Name Role Date Signature/Initials
ITP Title: Source / Requirements Reference Revision
ITP Ref: Pre-Construction Information ITP Produced by:
ITP Rev: Drawings
ITP Scope Description Specifications ITP Produced by:
This ITP relates to the following works: Manufacturer's requirements
1)
2) Contract requirements ITP Reviewed by:
It should be noted that this ITP does not cover the following aspects: Quality Management Plan
a)
Environmental Management Plan ITP Reviewed by:
Construction Phase Plan
Task Method Statement ITP Authorised for use by:
Abbreviations
PC: Principal Contractor; S / C: Subcontractor SFA: Submit for Approval H: Hold Point AU: Audit I (100): Inspection 100% S (100): Surveillance 100% W (100): Witness 100%
Inspection / Test Key SFI: Submit for Information A: Archive n / a: Not Applicable I (10): Inspection 10% S (10): Surveillance 10%) W (10): Witness 10%
DC: Daily Check WC: Weekly check W: Witness point

Inspection / Test Details & Parties Involved

Who has responsibility for
STAGE

Ref. Activity Material/Document Requirement Reference Acceptance Criteria Inspection Method Testing Method Location Records closing out this
requirement? S/C PC Client Other 1 Other 2
Pre Construction

Subcontractor: Confirmation of ITP Completion Principal Contractor

We confirm that to the best of our knowledge and with respect to the stated scope of works all activities have been completed in accordance with the relevant requirements. We have maintained an We confirm that with respect to the stated scope of works and to the best of our knowledge works been completed in
adequate 'weight of evidence' to demonstrate compliance which has been made available to relevant parties. accordance with all relevant requirements. An adequate 'weight of evidence' has been maintained to demonstrate
compliance and made available to relevant parties.

Name Role Date Signature/Initials Name Role Date Signature/Initials

Version 1 CG3-CEP-002F01 July 2019

 January 2021

Inspection & Test Plan

Contract Name:
Contract Number:
ITP Title: ITP Input Information Name Role Date Signature/Initials

ITP Ref: Source / Requirements Reference Revision

ITP Rev: Pre-Construction Information (PCI) ITP Produced by:
Drawings (DWG)
ITP Scope Description Specifications (Spec) e.g. EDS 07 -0105/D20 Revision D ITP Produced by:
This ITP relates to the following works: Manufacturer's requirements
1)
2) Contract requirements ITP Reviewed by:
It should be noted that this ITP does not cover the following aspects: Programme/Project Plan
a)
Legal requirements ITP Reviewed by:
Construction Phase Plan (CPP)
Task Method Statement ITP Authorised for use by:
Abbreviations
PC: Principal Contractor; S / C: Subcontractor SFA: Submit for Approval H: Hold Point AU: Audit I (100): Inspection 100% S (100): Surveillance 100% W (100): Witness 100%
Inspection / Test Key SFI: Submit for Information A: Archive n / a: Not Applicable I (10): Inspection 10% S (10): Surveillance 10%) W (10): Witness 10%
DC: Daily Check WC: Weekly check W: Witness point DR: Document Review N: Notification Point

Inspection / Test Details & Parties Involved

Who has responsibility for
STAGE

Item # Activity/Quality Input Material/Document Requirement Reference Acceptance Criteria Inspection Method Testing Method Location Records closing out this
requirement? Client PC S/C Other 1 Other 2
Sub
1 RAMS Documents CPP As per approved document Document Review H SFA n/a
2 Site investigation Report Spec/D20/110 As per approved report Document Review N/a Site Folder PCI Project Manager H
3 Existing services Documents Spec/D20/150 As per utility drawings provided CAT Scan/Utility Drawings N/a Cloud CAT Downloads Project Manager H
Excavation and Filling

Subcontractor: Confirmation of ITP Completion Principal Contractor

We confirm that to the best of our knowledge and with respect to the stated scope of works all activities have been completed in accordance with the relevant requirements. We have maintained an adequate We confirm that with respect to the stated scope of works and to the best of our knowledge works been completed in
'weight of evidence' to demonstrate compliance which has been made available to relevant parties. accordance with all relevant requirements. An adequate 'weight of evidence' has been maintained to demonstrate
compliance and made available to relevant parties.

Name Role Date Signature Name Role Date Signature/Initials

Version 1 CG3-CEP-002F01 July 2019

 The Clancy Group Ltd Business Management System
Inspection & Test Plan
Contract Name:
Contract Number: Name Role Date Signature/Initials
ITP Title: Source / Requirements Reference Revision
ITP Ref: Pre-Construction Information ITP Produced by:
ITP Rev: Drawings
ITP Scope Description Specifications ITP Produced by:
This ITP relates to the following works: Manufacturer's requirements
1)
2) Contract requirements ITP Reviewed by:
It should be noted that this ITP does not cover the following aspects: Quality Management Plan
a)
Environmental Management Plan ITP Reviewed by:
Construction Phase Plan
Task Method Statement ITP Authorised for use by:
Abbreviations
PC: Principal Contractor; PCO: S / C: Subcontractor SFA: Submit for Approval H: Hold Point AU: Audit I (100): Inspection 100% S (100): Surveillance 100% W (100): Witness 100%
Inspection / Test Key SFI: Submit for Information A: Archive n / a: Not Applicable I (10): Inspection 10% S (10): Surveillance 10%) W (10): Witness 10%
DC: Daily Check WC: Weekly check W: Witness point

Inspection / Test Details & Parties Involved

STAGE

Item # Activity Material/Document Requirement Reference Acceptance Criteria Inspection Method Testing Method Location Records Who has responsibility for
closing out this requirement? S/C PC Client Other 1 Other 2

Subs
Conformity
Material
Manufacture
Off Site
Site Construction
Commissioning
Testing &
Post Construction

Subcontractor: Confirmation of ITP Completion Principal Contractor

We confirm that to the best of our knowledge and with respect to the stated scope of works all activities have been completed in accordance with the relevant requirements. We have maintained an We confirm that with respect to the stated scope of works and to the best of our knowledge works been completed in accordance
adequate 'weight of evidence' to demonstrate compliance which has been made available to relevant parties. with all relevant requirements. An adequate 'weight of evidence' has been maintained to demonstrate compliance and made
available to relevant parties.

Name Role Date Signature/Initials Name Role Date Signature/Initials

Version 1 CG3-CEP-002F01 July 2019