| Project Address |
|
| General Contractor |
|
DOB Job No. |
|
| SSM Name |
|
SSM License No. |
|
| CSM Name |
|
CSM License No. |
|
| Date of Pour |
|
Time of Inspection |
|
| Pour Location (Floor / Member) |
|
Est. Volume (CY) |
|
| Concrete Mix Design No. |
|
Specified f'c (PSI) |
|
| Approved Formwork Drawing No. |
|
| Formwork Design Compliance — ACI 347 / BC §3303.7 | YES | NO | N/A |
| 1 | Licensed PE-stamped formwork and shoring design documents present on site and reviewed with field crew prior to work | | | |
| 2 | Formwork designed for full concrete dead load plus minimum 50 psf construction live load | | | |
| 3 | Shore spacing and layout matches approved drawings — no field modifications without PE approval | | | |
| 4 | Reshoring plan reviewed; reshored floors below confirmed to carry combined design loads | | | |
| Component Inspection — ACI 347.2R | YES | NO | N/A |
| 5 | All form panels, decking, and wales in good condition — no excessive bow, splits, or rot | | | |
| 6 | Shore legs plumb; base plates bearing on firm surface — no shoring on asphalt or soft fill | | | |
| 7 | Adjustable screw jacks set within allowable extension range — thread exposure does not exceed manufacturer's published limit | | | |
| 8 | Horizontal bracing and cross-bracing installed per drawings; all connections fully secured | | | |
| 9 | Base lift-off plates and wedges fully engaged; all form tie rods, bolts, and locking pins in place | | | |
| 10 | All openings, sleeves, and embeds properly formed, positioned, and secured | | | |
| Day-of-Pour Checklist | YES | NO | N/A |
| 11 | Reinforcing steel placed per structural drawings; lap splices, cover, and clearances confirmed | | | |
| 12 | Conduit, sleeves, and embedded items secured — will not shift during vibration | | | |
| 13 | Concrete delivery tickets match approved mix design; test cylinder samples prepared | | | |
| 14 | Concrete pump line or discharge chute placed so that no individual form panel or shore bears load beyond design capacity | | | |
| 15 | Vibration procedure discussed with crew — no over-vibration near form ties or edges | | | |
| 16 | Contingency shoring materials on site — spare shores, base plates, wedges, and screw jacks available for emergency use | | | |
Deficiencies & Corrective Actions — All items must be resolved before pour commences
"By signing below, I certify that the formwork and shoring have been inspected and, in my professional judgment as the responsible safety professional, are prepared for concrete placement in accordance with approved drawings and applicable codes."
| SSM Name (print) | | License No. | |
| SSM Signature | | Date & Time | |
| CSM Name (print) | | License No. | |
| CSM Signature | | Date & Time | |