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Publication Number: FHWA-RD-02-095

Appendix C

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Example QC Plan for Structural PCC (16)

1. The following outlines the contractor's plan for insuring QC in accordance with contractual requirements for the production, shipment, placement, and curing of PCC which will be used in the listed contract items.

1.1 Item xxxx-Bridge.

1.2 Item xxxx-Headwalls.

1.3 Item xxxx-Curb & gutter.

2. Personnel.

2.1 Qualified sampling, testing and inspection personnel who are certified through agency accepted programs will be used.

2.2 Technicians (enter name and certification number of technician(s)).

2.3 The QC Liaison with the agency (enter name, certification number and telephone number).

2.4 The QC Supervisor (enter name, qualification and telephone number).

3. Recognized statistical concepts for material data analysis as allowed by agency will be used.

4. Documentation of QC activities will be available at (enter the location at which the documentation will be maintained).

5. A copy of typical report forms used documenting QC work is attached. (The agency should attach appropriate forms.) These forms will include:

5.1 Identification-Name of material, equipment, or process being evaluated.

5.2 Location of sample procurement or inspection or testing.

5.3 Type of test or inspection.

5.4 Name of inspector, sampler, tester and reviewer.

5.5 Results-Observation of inspection or test value result.

5.6 Analysis of Acceptability.

5.7 Action taken and results.

5.8 Signature of QC supervisor.

6. Typical control charts used for documenting QC work are attached. (The agency should attach appropriate forms.) These charts will include the following data:

6.1 Identification-Name of material, equipment, or process being evaluated.

6.2 Results-Date, and report number of data used on chart.

6.3 Upper & lower control limits.

6.4 Analysis of acceptability.

6.5 Action taken and results.

6.6 Signature of responsible QC lead employee.

7. Other documentation used for QC analysis will include the following:

7.1 Batch tickets.

7.2 Other records not addressed above.

8. In the event QC test data indicates that noncomplying material has been incorporated into the work, the agency will be notified immediately and a plan will be submitted for agency concurrence, to identify the defective material and determine its disposition.

9. Mix Design(s), (enter class and identification of mix designs to be used on items in the contract).


Example Table for Frequency of Sampling and Testing for QC of PCC Components

Fine and Coarse Aggregates






As required for control


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