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 Stabilisation - Must be maximum of 4000m2 or 1 Days Production. (Enter Length x Width = Area)
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Has the Area been physically marked out on the ground?
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Photo of area marked prior to stabilisation
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Has Material Docket Been inspected? (Lime / Cement / Bitumen / Other)
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Photo of Delivery Docket
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Are there any Longitudinal Joints in this lot?
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Have they been overlapped by 300mm?
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Type of Binder Used?
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What Type of Binder was used?
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Amount of Binder Kg/m2 or L/m2
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Photo of Mat Test (Weight of Binder / m2) or other on site field test
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Maximum Allowable Working Time is 4 Hours per patch. What was the start and finish Time of Each Stab Run / Patch?
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Stabilisation Run
Stabilisation Run
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Start Time of Stabilisation
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Finish Time of Stabilisation
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Was water free of impurities and added to the mix homogeneously?
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Depth Of Stabilisation? (mm)
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Photo of Stabilisation Depth Check
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Has the Length and Width been checked against offset pegs and within tolerance?
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What are the compaction results 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).
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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
