MU S 2

CNG HA X HI CH NGHA VIT NAMc lp T do Hnh phc--------------

(a danh), ngy thng nm

BIN BN KIM TRA CHT LNG SN PHM

S ..

Tn loi cng vic (hoc cng on) kim tra:

Thuc Cng trnh (D n hoc Thit k k thut d ton):

H v tn ngi i din c quan kim tra:

Chc v:

C quan kim tra:

H v tn ngi i din n v c kim tra:

Chc v:

n v c kim tra:

Kim tra nhng loi ti liu sau: (Tng hp t cc Phiu ghi kin kim tra, nu r khi lng cng vic m ngi kim tra thc hin)

Kt qu kim tra:

Nhn xt: (cht lng sn phm theo tiu chun, quy chun, quy phm, quy trnh, quy nh k thut, D n, Thit k k thut d ton, tu chnh ti liu (nu l kim tra ti liu))

Yu cu i vi n v c kim tra:

kin ca i din n v c kim tra:

Bin bn lp thnh . bn, 01 (mt) bn giao cho .., 01 (mt) bn giao cho .., 01 (mt) bn giao cho

Ngi c kim tra(K v ghi r h, tn, chc v nu c)Ngi kim tra(K v ghi r h, tn, chc v nu c)