SANTIERUL____________________

PUNCT DE LUCRU ______________

OBIECT ________________________

PROCES VERBAL
DE VERIFICARE A CALITATII
LUCRARILOR CE DEVIN ASCUNSE
Nr. ________ Data __________

Cu ocazia verificarii efectuate la : ___________________________________

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Elemente de identificare ( sector, portiune, ax, cota, etc. ) : ________________
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Verificarile s-au facut pe baza prevederilor proiectului nr. ________________
plansele nr. __________________________________________________________
sau a dispozitiei de santier nr. __________ din data de ________________________
Au fost stabilite urmatoarele masuri ( concluzii ) :
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Numele si prenumele Semnatura

CONSTRUCTOR: ________________________ ____________
BENEFICIAR: ________________________ ____________
Atestam refacerea ( remedierea ) lucrarilor, conform prevederilor proiectului ( daca
este cazul ).
Data : _________________

Numele si prenumele Semnatura

CONSTRUCTOR: ________________________ ____________
BENEFICIAR: ________________________ ____________