UNITATEA ___________________________________________________________________

SANTIER _____________________________________________________________________
PUNCT DE LUCRU_____________________________________________________________
OBIECTUL____________________________________________________________________

PROCES VERBAL
PENTRU VERIFICAREA CALITATII LUCRARILOR CE DEVIN ASCUNSE

Nr.___________ Data____________

Faza din lucrare supusa verificarii:

______________________________________________________________________________
______________________________________________________________________________
Elementele de identificare (sector, portiune, ax, cota etc.):
______________________________________________________________________________
______________________________________________________________________________

Verificarile s-au facut pe baza prevederilor proiectului nr._________________ plansele

nr._______________________ sau a dispozitiei de santier nr.___________________ din data de
_________.

Concluzii:
______________________________________________________________________________
CONSTRUCTOR: BENEFICIAR PROIECTANT:
/DIRIGINTE DESANTIER:
Numele: ____________ ____________ ____________
Prenumele: ____________ ____________ ____________
Semnatura: ____________ ____________ ____________

Atestam refacerea (remedierea) lucrarilor conform prevederilor proiectului.

CONSTRUCTOR: BENEFICIAR PROIECTANT:

/DIRIGINTE DESANTIER:
Numele: ____________ ____________ ____________
Prenumele: ____________ ____________ ____________
Semnatura: ____________ ____________ ____________