Click here to enter a date.

Project info

Project ID	Structure ID(s)
Contract ID
Highway
Description
County

Introductions / pour day contacts

Name	Phone	Attended Meeting
Project Leader
Lead Inspector
Contractor
QC Testing
Concrete Supplier
WisDOT Materials
Contractor Materials
Independent Assurance
Additional Meeting Attendees

QMP Plan

Submitted	Click here to enter a date.	PCL Signed WS5014 to Contractor	Click here to enter a date.
Reviewed	Click here to enter a date.	Accepted QMP Plan Distributed to	QC Tester
Accepted	Click here to enter a date.	QV Tester

Concrete Mixtures AND MATERIALS

Concrete Plant Name/Location	Inspection Performed Click here to enter a date.
Back up Plant Name / Location	Inspection Performed Click here to enter a date.
Material Type	Producer/Location	Sample Needed	Test #
Cement	Select
Fly Ash	Select
Slag	Select
Water	Select
Fine Agg	Select
Coarse Agg	Select
Coarse Agg	Select

Concrete Mixtures AND MATERIALS, Con’t

Special Considerations	Yes	No	REMINDER: Batch tickets required with each load. (SS 501.3.5.4(2))
Seal pour
HPC
Modified HPC
Other (list)

Construction Schedule

Anticipated pour date	Click here to enter a date.	Estimated pour start
Back up date	Click here to enter a date.	Dry run date /check fogging equipment	Click here to enter a date.
Proposed Schedule

Temperature Control Plan

Hot Weather concreting (ss 501.3.8.2)

Temp Control Plan	Actions to Control Concrete Temperature	Yes	No	Remarks
Submitted	Click here to enter a date.	Cool Aggregate
Accepted	Click here to enter a date.	Cold Batch Water
Pour Time
Others (list)

If ICE is to be added, ALL OTHER METHODS MUST BE USED FIRST.

Timeframe for Ordering and Adding Ice
Ice Compensation Expectations [Per Section 501.3.8.2.1(1)]
EVAPORATION PLAN ( SS 501.3.8.2.2)
Date Submitted Click here to enter a date.
Date Accepted Click here to enter a date.

Cold Weather Protection (SS 502.3.9)

Yes	No	Remarks
Heat Forms
Heat Batch Water
Heat Aggregate
Temp Probe Frequency
Others (list)

Curing Process

Normal deck wet cure 7 days (502.3.8.2.3)
HPC wet cure for 14 days (see special provisions)
Deck overlay wet cure 3 days (509.3.9.3)
Strength Verification (502.3.10)	Maturity	Cylinders	Time	Other (list)

Placement

Truck Access
Placement Method	Bucket	Pump	Bucket & Pump	Mobile Mix Other (list)
If pump, air loss <1%	(502.3.5.1(11))
Truck Washout
Type of consolidation
# of people on pour
Fogging
Back-up equipment
Additional Traffic control

Sampling and testing

Testing Location
Cylinder Storage Location
Tester Access

REMINDER: Sampling must be at the point of placement and between 10% and 90% of the load.

Communication reminders

Test results
Delivery method
Frequency

Random Numbers computed on amount placed

QC Plan actions to be followed for failing tests

QV & QC are required to inform each other of failing results immediately

Nonconforming material to be discarded

Nonconforming material left in place to be quantified and agreed to with the engineer

Inspection Reminders

Surveyed by contractor and checked separately by inspectors

Deck Overlays max air temp of 88 degrees F (509.3.9.2)

Engineer must give written permission to proceed with pour (501.3.8.2.2(5))

Where can emergency header be placed?

Finishing texture (502.3.7.8)

Emergency cover material?

Bar steel checked for size, spacing, tying, clearances, and cleanliness

Forms checked and found clean, oiled, and locked

Bracing checked & secured

24-hr contact for curing issues
Name
Phone

Other Issues or Concerns