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/ ConstructionConcrete Pavement Placement Checklist
Instructions for Use: This checklist is not intended to assure that all conditions defined by the contract are met. This checklist is a tool used for each project built with Federal Aid Funds, to document minimum quality assurance activities that are performed by the LPA and/or NDOR at critical times during construction.
This form should be completed by LPA RC and/or NDOR State Representative during visits 1) prior to concrete pour, 2) during the concrete pour, 3)after the concrete pour. During this review, the LPA RC and/or State Representative must also visit the concrete plant. The LPA RC and/or NDOR State Representative is responsible for adding a copy of the completed checklist to the project correspondence log in SiteManager.
Local Public Agency (LPA):
/ LPA Responsible Charge:
State Project No.:
/ Project Name and Location:
State Control No.:
/ Date of Review:
/ This Form was Completed By:
Before Placement
Date of Site Visit: Date of Plant Visit:
Item# / Task Description or Questions / Completed / If No, Define Corrective Action / Information Used to Verify Content / Additional Comments /
Yes / No / N/A /
1. / Has paving equipment been checked for hydraulic leaks?
2. / Does the subgrade template meet the plans and specification requirements?
3. / Is base smooth, compacted and moistened?
4. / Is the concrete plant certified?
5. / Are aggregate stockpiles well separated and protected from contamination?
6. / Are stockpiles at the concrete plant drained and kept at the appropriate moisture?
7. / Do all of the concrete trucks that will deliver concrete to the project appear on the batch plant certification list?
During Placement
Date of Site Visit:
Item# / Task Description or Questions / Completed / If No, Define Corrective Action / Information Used to Verify Content / Additional Comments /
Yes / No / N/A /
8. / Is proper care taken to ensure base is protected from rutting or other damage during hauling operations?
9. / Is the time interval between batching and placing of concrete within specs?
10. / Are materials being tested at the correct frequency? / Material Sampling Guide
11. / Is concrete air content within specifications?
12. / Are inspectors who are conducting material testing certified?
13. / Is stationing stamped at correct locations?
14. / Are material tests at the concrete plant and job site, being properly performed?
15. / Has the inspector periodically verified the number and speed of mixing revolutions for truck mixers?
16. / Are correct concrete placement procedures being followed, including vibration, continuous delivery, proper keyways, etc.?
17. / Are dowel bars and tie bars being placed in accordance with Plans and Specification?
18. / Are the pavement thickness, width, crown, super elevation, edge slump, joint match and yield being monitored?
19. / Does the saw cut alignment and depth match what is shown on the plans?
20. / Was hand finishing strictly controlled to prevent overworking?
21. / Are records maintained for air, slump, cylinder data, stations paved, depth, width, yield, weather, temperature and problems encountered?
22. / Was curing compound applied uniformity and at the correct application rate?
23. / Were lot numbers and quantity used of curing compound recorded?
24. / Was cold weather protection applied as required?
25. / Is pavement tining performed in accordance with the Plans and Specification?
Final Inspection
Date of Site Visit:
Item# / Task Description or Questions / Completed / If No, Define Corrective Action / Information Used to Verify Content / Additional Comments /
Yes / No / N/A /
26. / Do the curbs have a uniform, appearance and meet the dimensional requirements of the plans?
12-66, May 2010 Version 1.00 Checklist No. 12-66