Click here to enter a date.

Project info

Project ID	Highway
Contract ID	County	Choose an item.
Description

Introductions / pour day contacts

Name	Phone	Attended Meeting
Project Leader
Lead Inspector
Contractor
QC Testing
Surveyor
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.	Number of trucks /rate of delivery (501.3.5.2)
Start Location
Proposed Schedule

Thickness acceptancE (SS 415.3.16)

MIT Scanner
Basic units received	Click here to enter a date.
Estimated number of plates
Special Units
Proposed Method (Max 350 SY)

Sampling and testing

Random Numbers (need prior to placement)
Random Numbers by lane feet received	Yes	No	NA
Random numbers by cubic yard received	Yes	No	NA
QC sublots match IRI ride	Yes	No	NA

GAPS

Paving through mainline gaps	Yes	No	If, yes need 2500 PSI mix
GAP width 6’< gap <15’
Anticipated GAP locations

COMMUNICATION REMINDERS

QC Plan corrective 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

OPENING TO SERVICE (415.3.15)

Yes	No
Compressive Strength	If so, need verified 3000 PSI
Cylinders
Cores
Maturity method
Equivalent Curing Days	Determined by mix grade & temperature

OTHER MATERIAL REQUIREMENTS

Item	Yes	No	Accepted	Comments
Dowel Bars
Tie Bars
Curing Compound
Joint Filler
Other

MISC. ITEMS

Joint Detailed Received	Yes	No	Reviewed
Joints	Sawed	Tooled	Both
Header	Sawed	Formed
Surface Finish (415.3.8)	Turf only	Turf & Tine
Integrally placed items

Inspection Reminders

Base: trimmed & compacted

Dowel baskets: level, well aligned, secured down (415.3.5)

No “blessing” concrete

Curb & Gutter:

All flow lines checked

no dip in head

grade to flow line 5’ each direction

Vibrating screed must be used for hand pours (415.3.6.3(2))

Emergency cover material?

Cold weather (415.3.13)

Protecting concrete (415.3.14)

Forms checked and found clean, oiled, and locked

24-hr contact for curing issues
Name
Phone

Other Issues or Concerns