Title Page
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Site Work Order Number
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Site Name
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Date and Time
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Location
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Chainage From
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Chainage To
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Lot Number
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Define Lot Size / Area of Pavement Layer - Must be maximum of 4000m2 or 1 Days Production. M2
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Has the Area been physically marked out on the ground?
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Photo of area marked prior to running rock
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Has the crushed rock material docket been inspected?
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Photo of Delivery Docket
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Is the Rock being wheeled out per load?
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Is the compacted depth at the correct design height and within + / - 8mm ? (Use surveyor, laser, string lines or GPS)
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Has the crown and width been checked against offset pegs and within 50mm?
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Is the pavement layer depth as per the design?
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Show photo of crushed rock depth & measuring tape
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What is the overall compaction result for this lot?
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Has this Lot been Proof Rolled with a loaded Water Cart and what was the result?
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Description and comments on failed or non proof rolled area(s). What treatments were used and what chainages?
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NEMA Authorised Signature confirming the above is true and correct
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Client / Superintendent / Other Signature agreeing the above is true and correct
