Annexure 1

Format 1- Part I

Format for information to SQM for Inspection of NABARD Work

PART I– Work Information (To be filled-up by PIU)

Work is Ongoing Completed

GENERAL:
1.1. Date of Inspection: DD MM YY
1.2. Name of State Quality Monitor:
1.3. District: Block:
1.4. Name of Road: From to
1.5. RIDF Tranche .:
1.6. Length: ….Km Flexible Pavement, ......Km. CC/other Pavement ……...m. =
Total……..Km
1.7. Sanctioned Cost (As cleared by GOI): Rs. Lakh
1.8. Technical Sanction Cost: Rs. Lakh

1.9. The Work is a Case of: New connectivity Up gradation

1.10. Terrain Plain Rolling Hilly

1.11. Date of Start of the Work:

1.12. Stipulated Date of Completion:
1.13. Actual Date of Completion (if work completed):
2. PHYSICAL PROGRESS: (In case of On going works only) Construction
Programme and Physical Progress:

Item Completed Dates for Start Completion Delay in

percentage of Item completion Date Date Months
Earth Work Due
Actual
CD Works Due
Actual
Sub base i/c Due
Shoulders Actual
Base Course (Non Due
Bitu.) Actual
Base /Wearing Due
Course(Bitu.) Actual
CC Pavement Due
Actual
Signage etc Due
Actual

20
3. QUALITY CONTROL:
3.1. Location of Field Laboratory:
3.2. Quality Control Register Part-I is maintained by:
3.3. Quality Control Register Part-II is maintained by:
4. INSPECTIONS BY SQM or SENIOR OFFICERS AND ACTION
TAKEN:
Inspection by SQMs and senior (i.e. SE or CE) departmental officers and action taken
statement:
Date of Inspected Observations Action Taken by PIU with
Visit By Date

Name and Signature of the Head of PIU, Date:………

21
 Format 1- Part II
Report of State Quality Monitor (SQM)
PART II– Observations of SQM for Ongoing/Completed Work
(To be filled-up by SQM, use additional sheets, if required.)
Stage of Work: I II III
1. SETTING OUT AND WORKING DRAWING: For all stages of work

# Whether Exact Whether Center Line of Whether properly

Bench Locations of Carriage Way accurately prepared Working
marks @ 4 the Bench established and Drawing for the work
per km Marks referenced with Marker under progress is
established Pegs and Chainage available (Y/N)
(Y/N) Boards (Y/N)

Grading: Grade: S SRI U If this item is graded SRI/U, write clear reasons and
suggestions for improvement:

2. SITE CLEARANCE AND GRUBBING: For Stage I of Work

# Whether Clearing and Whether the material Name the reusable material
Grubbing being done available from obtainable from clearance or
as per DPR and scarifying existing work scarification and indicate
Material obtained is or clearing operations approximate quantity and its
being disposed off can be salvaged and re-use by the PIU.
properly (Y/N) reused (Y/N)

Grading: Grade: S SRI U If this item is graded SRI/U, write clear reasons and
suggestions for improvement:

22
3. QUALITY ARRANGEMENTS AND ATTENTION TO QUALITY - For all
stages of work
Observations about Field Laboratory:

# Whether Field List the equipments Whether adequate Equipments as

laboratory available. per requirement of work are
Established (Y/N) available and are being used.
(Y/N)

Observations about Mandatory Tests - Detail out the quantities of various items of
works and list the tests required. (Refer to abstract of QC Register Part-I)

# Item of Work Quantity Name of No. of Tests No. of Tests

Executed Test required Conducted by
PIU/Contractor

# Based on executed Whether QC Register Part Whether QC Register Part

quantities whether all I maintained as per II maintained and test
mandatory tests provisions. results monitored as per
conducted. provisions.
Yes Partly No Yes Partly No Yes Partly No

Grading: Grade: S SRI U If this item is graded SRI/U, write clear reasons and
suggestions for improvement:

23
4. GEOMETRICS: The SQM should take at-least two measurements in 1 Km length
and if it is found that the roadway and carriageway is inadequate SQM may take more
observations:

Observations –Road way width, Carriage way and Camber.

Ref. Roadway Carriage Camber Ref. Roadway Carriage Camber
RD Width way Width in % RD Width way in %
(m) (m) (m) Width (m)

Observations – Super-elevation and Extra Widening at curves.

Ref. Super Extra Ref. RD Super Extra Widening
RD Elevation Widening Elevation provided (Y/N)
provided (Y/N)

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

OBSERVATIONS REGARDING THE QUALITY OF ITEMS OF

WORK: 5. Earthwork:
Observations –Quality of Material for Embankment/ Sub-grade:
# Location (RD) On Visual Classification identify Quality of material is
the Group Symbol and write acceptable. (Y/N)

24
 Grade: S U If this item is graded U, write clear reasons and
suggestions for improvement:

Observation –Workmanship for Embankment and Sub-grade Construction:

3
# Location MDD kN/m Field Degree of Compaction
(RD) (As per Moisture Field Density Dry Density Compaction
3 3
record) Content kN/m kN/m adequate.
(Y/N)

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

Observation – Side slopes and profile:

# Location (RD) Whether Side Slopes Whether profile is
Satisfactory (Y/N) Satisfactory (Y/N)

25
Observations - Earth work in Hilly/Rolling terrain or high Embankments:

# Location Cut Slopes & Profile, Adequate slope Formation is properly

(RD) whether appears to be protection works dressed and traffic
stable. (Y/N) executed. (Y/N) worthy. (Y/N)

Observations – Longitudinal Gradient in case of road in hilly/rolling terrain:

Ref. Between Longitudinal S/U Ref. Between Longitudinal S/U
RD…& RD… Gradient RD…& RD… Gradient

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

6. Sub-Base:
Observations - Quality of Material and Workmanship:
# Location Confirms Suitable Whether Observed Prescribed
(RD) to from compaction Thickness Thickness
Grading. plasticity is adequate. of Layer provided
(Y/N) angle. (Y/N) (in mm) (Y/N)
(Y/N)

26
 Grade: S U If this item is graded U, write clear reasons and suggestions
for improvement:

7. Base Course:
Observations- Quality of Material and Workmanship of WBM:

# Location Thickness Thickness Aggregate Filler Volume of Whether

of each is confirms to material is filler adequate
(RD) layer of adequate. Grading non-plastic material compaction
WBM (Y/N) (Y/N) to desired percent of is done.
(mm) extent. course (Y/N)
(Y/N) aggregate

Observations - Surface evenness: Surface evenness in about 200 m critical

representative length of completed WBM:

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

27
8. Bituminous Course: Premix Carpet/Surface Dressing/ BM/ MPM etc including
Seal Coat: Observations - Quality of Material and Workmanship of BT Layer (in
case of ongoing works):

Observations about level of cleanliness of WBM surface prior to application

of bituminous layer. (if work is ongoing observe the surface. If BT layer laid,
assess by carefully removing the BT layer.):

Observations about Quality of Prime Coat and Tack Coat with respect
to quality of material and workmanship - Visual Observation - if work is
ongoing:

In case of PMC/BM/MPM/ Seal Coat

# Location Whether Whether the Write Mixing Write Laying
(RD) Course binder is of Temperature Temperature
Aggregate approved grade. and whether it is and whether it
confirms to (Y/N) in permissible is in
grading. limits. (Y/N) permissible
(Y/N) limits. (Y/N)

28
Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

Observations - Workmanship of BT layer PMC/BM/MPM (in case of

completed works):
# Location Thickness Whether surface evenness is
(RD) Thickness in Whether thickness within acceptable limits. (Y/N)
mm is adequate. (Y/N)

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

9. Observations - Quality of Shoulders:

# RD of Thickness Whether Whether quality Whether Shoulders

observation of layer in quality of the of compaction being constructed
mm material is workmanship is simultaneously
acceptable. acceptable.(Y/N) with sub-base and
(Y/N) base course (Y/N)

29
10. Cross Drainage Works: Observations - Quality of CDs:
# RD at which Type of CD Whether quality of the Whether quality of
CD is located material is acceptable. workmanship is
(Y/N) acceptable. (Y/N)

Grade: S SRI U If this item is graded SRI/U, write clear reasons and suggestions
for improvement:

11. Side Drains and Catch water Drains: Observations:

# Reference of RD at Whether general quality Whether side drains
RDs where side which of the side drains/ catch- are integrated to
drain observation water drains is cross drains. (Y/N)
constructed. made. acceptable. (Y/N)

Grade: S SRI U If this item is graded SRI/U, write clear reasons and
suggestions for improvement:

30
12. CC/ Semi-Rigid (SR) Pavements and Associated Pucca Side Drains:

# Reference of RD at Thickness General General

RDs, CC/SR which Thickness Acceptable quality of quality of
Pavements observati in mm (Y/N) material is workmanship
provided. on made. acceptable. acceptable(Y/
(Y/N) N)

Comments about adequacy of face/main walls, wings and retaining walls:

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

31
13. Road Furniture and Markings
Observations - Item No. 14 a: Quality Road Furniture and Markings:
Main Informatory Board Fixed: Yes No
Citizen Information Board Fixed: Yes No

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

Observations - Quality Road Furniture and Markings:

13.1.1. Logo Boards Fixed: Yes No

13.1.2. 200m. Stones fixed: Yes No
13.1.3. 1 Km. Stone fixed: Yes No
13.1.4. Guard Stones fixed on Curves: Yes No
13.1.5. Mandatory and Cautionary Signage Yes No

Grade: S U If this item is graded U, write clear reasons and suggestions for
improvement:

14. General Observations of SQM, (including the observations made during the
interaction with PIU staff and Contractor’s/ Consultant’s Engineers):

14.1. Observations about deficiency in project preparation (Give detailed

observations about deficiencies in general and items which have been left but are
required as per site conditions):

32
14.2. Whether the work has been completed/is in progress as per work
programme or the delay has occurred. If delay has occurred, whether the
liquidated damages have been withhold or recovered:

14.3. Whether the work has been completed within the sanctioned cost, if not,

what is the action taken by the PIU (in case of complete works):

14.4. Observations about the action taken by the PIU on the observations of
inspecting officers including SQMs. (Clearly offer comments about the action
taken on the observations of Departmental Officers, State Quality Monitors .

33
15. Other observations, if any:

34
16. Quality Grading of items and sub-items of work: The grading of every sub-item
and item of work is given below.

Awardable Awarded
# Sub Item for Observation Stage of Work Grades Grades
1 2 3 4 5
Item 1 – Setting Out and Working Drawing
a Bench Mark and Centre Line All Stages S/SRI/U
Availability of Working
b All Stages S/SRI/U
Drawing
Item Grade S/SRI/U
Item 2 – Site Clearance and Grubbing
a Site Clearance and Grubbing Stage-I S/SRI/U
b Re-use of Salvageable Material Stage-I S/SRI/U
Item Grade S/SRI/U
Item 3 - Quality Arrangements
a Quality Arrangements All Stages S/SRI/U
Number of Mandatory Tests as
b All Stages S/SRI/U
per prescribed frequency
c Maintenance of QC Registers All Stages S/SRI/U
Item Grade S/SRI/U
Item 4 – Geometrics
2 per Km in every
a Road way width S/U
inspection
2 per Km in every
b Carriageway width S/U
inspection
c Camber 2 per km S/U

Super-elevation & Extra

d 1 curve in each km S/U
Widening at Curves

Item Grade S/U

Item 5A - Earth Work and Sub-grade in Embankment/ Cutting
In Stage-I, 1 per km/
Quality of Material for
a In Stage- II or III, 1 per S/U
Embankment/ Sub-grade
km
In Stage-I, 2 per km/
b Compaction In Stage- II or III, 2 per S/U
km
c Side Slopes and Profile 2 per km in Stage III S/U

35
 Item 5B - Earth Work in Cutting in Hilly/ Rolling Terrain

Stage I and II, at 2

Stability and Workmanship of critical locations with
a Cut Slopes maximum height of S/U
cutting in each km

b Adequacy of Slope Protection All Stages - In general S/U

At Stage III, at 2 critical

Upon completion of formation
c cutting, dressing, traffic locations with maximum S/U
height of cutting in each
worthiness
km

Stage II/III - 1 critical

and fairly representative
d Longitudinal Gradient stretch of 200m in each S/U
Km

Item Grade S/U

Item 6 - Sub-Base
Quality of Material

a Grain Size In Stage- II or III, 1 per S/U

b Plasticity km S/U
In Stage- II or III, 1 per
c Compaction S/U
km
d Total Thickness of Layer 2 per Km S/U

Item Grade S/U

Item 7 - Base Course – Water Bound Macadam
Grain Size of Course
a S/U
Aggregate
In Stage- II or III, 1 per
Test for Liquid Limit and km
b Plasticity Index in case fine S/U
aggregates are crushable type

Volumetric Analysis for

In Stage- II or III, 1 per
c assessment of compaction of S/U
km
WBM
Surface Evenness using In completed WBM 2
d S/U
straight edge tests per km
Thickness of every layer of
e 2 per Km S/U
WBM.
Item Grade S/U

36
 Item 8 - Bituminous Layer – Premix Carpet (PMC)/ Surface Dressing (SD)
Level of cleanliness of WBM
a surface prior to application of 1 per Km S/U
bituminous layer
Quality of Prime Coat/ Tack
1 observation on the day
b Coat with respect to quality of S/U
of inspection
material and workmanship

Gradation Test for Course

Aggregate (if the work in the
1 test on the day of
c item is ongoing)/visual S/U
observation in case of inspection
completed item of work

Grade of bitumen and

temperature at the time of 1 test on the day of
d mixing and laying (if the work inspection S/U
in the item is ongoing)

Bitumen Extraction Test if

e 1 test per Km S/U
PMC is complete

f Thickness of layer 2 per Km S/U

Surface Evenness in case of
g 2 per Km S/U
completed BT work
Item Grade S/U
Item 9 – Shoulders
Quality of material for In Stage- II or III, 1 test
a S/SRI/U
shoulders per Km
In Stage- II or III, 1 test
b Degree of compaction S/SRI/U
per Km
In Stage- II or III, 2 tests
c Thickness of layer per km S/SRI/U

Item Grade S/SRI/U

Item 10 - Cross Drainage Works – Causeways of all spans and Culverts upto 6 m.
span.

Quality of Material – Concrete,

a Stone/ brick masonry, Hume All Stages S/SRI/U
pipes including size etc.

Quality of Workmanship such

as positioning of pipes, wing
b walls, cushion over H Pipes All Stages S/SRI/U
etc.

Item Grade S/SRI/U

37
 Item 11 - Side Drain and Catch Water Drain

General quality of Side Drains/

a Catch Water Drains and their All Stages S/SRI/U
integration with CDs.

Item Grade S/SRI/U

Item 12 - CC/ Semi Rigid Pavements and Associated Pukka Drains
Quality of Material – Concrete, In Stage- II or III, 1 per
a Stone/ Concrete Block 100 m. Length of S/U
Pavement etc. Pavement
Strength of CC in Concrete In Stage- II or III,1 per
b Pavement/ Concrete Block 100 m. Length of S/U
Pavement Pavement
Quality of Workmanship –
Wearing surface texture,
c Adequacy of setting of In Stage- II or III S/U
concrete, Joints, Edges etc.
In Stage- II or III, 1 per
d Thickness of Layer 100 m. Length of S/U
Pavement
Item Grade S/U
Item 13 - Road Furniture and Markings
Citizen Information Board,
Main Informatory Board,
a Quality and whether fixed Stage-I S/U
during construction.
Logo boards, 200 m stones and
b Km stones, quality and Stage-III S/U
whether fixed after completion.
Whether the information in
c boards is given in local Stage-I and III S/U
language.
Item Grade S/U

38
17. Overall Grading of Work: The overall grading calculated on the basis of item and
sub-item wise grading is given below:

Awarded
Item No. Sub Item for Observation
Grade
Item No 1 Setting Out and Working Drawing
Item No 2 Site Clearance and Grubbing
Item No 3 Quality Arrangements
Item No 4 Geometrics
Earth Work and Sub-grade in Embankment/
Item No 5 A
Cutting
Item No 5 B Earth Work in Cutting in Hilly/ Rolling Terrain
Item No 6 Sub-Base
Item No 7 Base Course – Water Bound Macadam
Bituminous Layer – Premix Carpet (PMC)/
Item No 8
Surface Dressing (SD)
Item No 9 Shoulders
Cross Drainage Works – Causeways of all
Item No 10
spans and Culverts upto 6 m. span.
Item No 11 Side Drain and Catch Water Drain
CC/ Semi Rigid Pavements and Associated
Item No 12
Pukka Drains
Item No 13 Road Furniture and Markings
Overall Grading

Signature:
Name:
Date: ..……….

39
 Annexure 2
Statement Showing Sub-Item and Item wise Observations to be made, their Method, Frequency
and Awardable Quality Grade
Sub Item for
# Observation Method of Observation Frequency Grades
1 2 3 4 5
Item 1 – Setting Out and Working Drawing
Bench Mark and
a Centre Line Visual All Stages S/SRI/U
Availability of
b Working Drawing Visual All Stages S/SRI/U
Item Grade S/SRI/U
Item 2 – Site Clearance and Grubbing
Site Clearance and
a Grubbing Visual Stage-I S/SRI/U
Re-use of Salvageable
b Material Visual Stage-I S/SRI/U
Item Grade S/SRI/U
Item 3 - Quality Arrangements
a Quality Arrangements Visual All Stages S/SRI/U
Number of Mandatory
b Tests as per prescribed Examination of Record All Stages S/SRI/U
frequency
Maintenance of QC Verification of QC
c All Stages S/SRI/U
Registers Register I and II
Item Grade S/SRI/U
Item 4 – Geometrics
2 per Km in every
a Road way width Measurements inspection S/U
2 per Km in every
b Carriageway width Measurements inspection S/U
c Camber Measurement 2 per km S/U
Super-elevation &
d Extra Widening at Measurement 1 curve in each km S/U
Curves
Item Grade S/U
Item 5A - Earth Work and Sub-grade in Embankment/ Cutting
Quality of Material for
Visual Classification of In Stage-I, 1 per km/
a Embankment/ Sub- S/U
Soils In Stage- II or III, 1 per km
grade
Field Density Test by
In Stage-I, 2 per km/
b Compaction sand replacement/core- S/U
In Stage- II or III, 2 per km
cutter method.

Side Slopes and

c Measurement 2 per km in Stage III S/U
Profile

40
 Sub Item for Method of
# Frequency Grades
Observation Observation
1 2 3 4 5
Item 5B - Earth Work in Cutting in Hilly/ Rolling Terrain
Stage I and II, at 2 critical
Stability and
locations with maximum
a Workmanship of Cut Visual Observation S/U
height of cutting in each
Slopes
km
Adequacy of Slope
b Visual Observation All Stages - In general S/U
Protection
Upon completion of At Stage III, at 2 critical
formation cutting, locations with maximum
c dressing, traffic Visual Observation height of cutting in each S/U
worthiness km
Stage II/III - 1 critical and
fairly representative
d Longitudinal Gradient Measurements stretch of 200m in each S/U
Km
Item Grade S/U
Item 6 - Sub-Base
Quality of Material
a Grain Size Gradation Test S/U
Test of LL, PI / Hand- In Stage- II or III, 1 per
b Plasticity feel test of ball making km S/U
with moisture content
Field Density Test by
In Stage- II or III, 1 per
c Compaction sand replacement/ core S/U
km
cutter method.
Measurement by taking
Total Thickness of
d pit for full layer 2 per Km S/U
Layer thickness
Item Grade S/U
Item 7 - Base Course – Water Bound Macadam
Grain Size of Course
a Aggregate Gradation Test S/U
Test for Liquid Limit In Stage- II or III, 1 per
Test of LL, PI / Hand-
and Plasticity Index in km
b feel test of ball making S/U
case fine aggregates
with moisture content
are crushable type
Volumetric Analysis
Hand-feel test - In Stage- II or III, 1 per
c for assessment of S/U
volumetric analysis. km
compaction of WBM
Surface Evenness In completed WBM 2 tests
d using straight edge Straight Edge per km S/U
Thickness of every Actual Measurement by
e 2 per Km S/U
layer of WBM. taking pit
Item Grade S/U

41
 Sub Item for Method of
# Frequency Grades
Observation Observation
1 2 3 4 5
Item 8 - Bituminous Layer – Premix Carpet (PMC)/ Surface Dressing (SD)
Visual Observation - if
Level of cleanliness of work is ongoing observe
a WBM surface prior to the surface. If BT layer 1 per Km S/U
application of
laid assess by carefully
bituminous layer
removing the BT layer
Quality of Prime Coat/
Tack Coat with
Visual Observation - if 1 observation on the day of
b respect to quality of S/U
material and work is ongoing. inspection
workmanship
Gradation Test for
Course Aggregate (if
the work in the item is
Grain Size Analysis 1 test on the day of
c ongoing)/visual S/U
observation in case of (Gradation Test). inspection
completed item of
work
Grade of bitumen and
temperature at the Measurement of
1 test on the day of
d time of mixing and temperature by S/U
laying (if the work in thermometer. inspection
the item is ongoing)
Bitumen Extraction
e Test if PMC is Bitumen Extraction Test 1 test per Km S/U
complete
Measurement by taking
f Thickness of layer pit 2 per Km S/U
Surface Evenness in
g case of completed BT By straight edge 2 per Km S/U
work
Item Grade S/U
Item 9 – Shoulders
Quality of material for In Stage- II or III, 1 test
a shoulders Visual Observation S/SRI/U
per Km
Field Density Test by
In Stage- II or III, 1 test
b Degree of compaction sand replacement/core- S/SRI/U
per Km
cutter method.
In Stage- II or III, 2 tests
c Thickness of layer Measurement per km S/SRI/U
Item Grade S/SRI/U
Item 10 - Cross Drainage Works – Causeways of all spans and Culverts upto 6 m. span.
Quality of Material –
Visual observation ( for
Concrete, Stone/ brick
a CC verify cube test All Stages S/SRI/U
masonry, Hume pipes
results from records)
including size etc.

42
 Sub Item for
# Method of Observation Frequency Grades
Observation
1 2 3 4 5
Quality of
Workmanship such as
b positioning of pipes, Visual observation All Stages S/SRI/U
wing walls, cushion
over H Pipes etc.
Item Grade S/SRI/U
Item 11 - Side Drain and Catch Water Drain
General quality of
Side Drains/ Catch
Water Drains and their Visual observation All Stages S/SRI/U
integration with CDs.
Item Grade S/SRI/U
Item 12 - CC/ Semi Rigid Pavements and Associated Pukka Drains
Quality of Material –
In Stage- II or III, 1 per
Concrete, Stone/
a Visual Observation 100 m. Length of S/U
Concrete Block
Pavement
Pavement etc.
Strength using
Strength of CC in
appropriate rebound
Concrete Pavement/ In Stage- II or III,1 per 100
b hammers/ verification of S/U
Concrete Block m. Length of Pavement
cube test results from
Pavement
test records.
Quality of
Workmanship –
Wearing surface
c texture, Adequacy of Visual observation In Stage- II or III S/U
setting of concrete,
Joints, Edges etc.
In Stage- II or III, 1 per
d Thickness of Layer Measurements 100 m. Length of S/U
Pavement
Item Grade S/U
Item 13 - Road Furniture and Markings
Citizen Information
Board, Main
Informatory Board,
a Quality and whether Visual observation Stage-I S/U
fixed during
construction.
Logo boards, 200 m
stones and Km stones,
b quality and whether Visual observation Stage-III S/U
fixed after completion.
Whether the
information in boards
c is given in local Visual observation Stage-I and III S/U
language.
Item Grade S/U
43