ŞANTIERUL _______________________

OBIECTIVUL ______________________

PROCES – VERBAL
PENTRU LUCRĂRILE CE DEVIN ASCUNSE

Nr. ________data __________

Faza din lucrare supusă verificării:_____________________________________________________

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Elementele de identificare (sector, porţiune, ax, cote, etc)___________________________________

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Verificările s-au făcut pe baza prevederilor proiectului nr. ____________ planşele

nr.______________ sau a dispoziţiei de şantier nr._____________din data de __________________

Concluzii:
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Nume Prenume Semnătura

CONSTRUCTOR: ______________ ______________ _______________

BENEFICIAR: ______________ ____________ _______________

Formular cod FO11–05 rev.0