Form Cs-4137 - Final Inspection
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1CS-4137 (4-11)
FINAL INSPECTION FORM
S.R. ___________
Sec. ____________
County __________________________
District ________________
Contract No. _______________________
Contractor ________________________________________________
A Final Inspection of the above project or substantial project section was held on ____________________________.
ATTENDEES:
1. All physical work is satisfactorily completed.
Date of Physical Work Completed _____________________________.
____________________________________________________________________
(PennDOT)
2. The inspection revealed that physical work items, as noted on the attached punchlist form must be completed or corrected to
ensure compliance with the contract. With the exception of those physical work items identified on the punchlist form, the
Contractor is relieved of responsibility for further physical work and maintenance, for satisfactorily completed work items
on the project
____________________________________________________________________
(PennDOT)
3. The contractually required certificated and/or documents, as noted on the attached list, must be furnished and completed in
order to prepare the project for final acceptance.
____________________________________________________________________
(PennDOT)
4. All contractually required certificated and/or documents have been furnished and are satisfactory.
____________________________________________________________________ Date _________________
(PennDOT)
5. On the following designated section of the project, physical work items have been satisfactorily completed and contractually
required certificates and/or documents have been furnished; with the exception of those physical work items and/or required
documents identified on the attached punchlist form. The Contractor is relieved of responsibility for further work,and
maintenance, for satisfactorily completed work items on the section.
Section Description ______________________________________ Sta. to Sta. _________________________
____________________________________________________________________ Date _________________
(PennDOT)
6. All physical work items have been satisfactorily completed and all contractually required certificates and/or documents have
been furnished. I recommend an Acceptance Certificate be processed relieving the contractor of further responsibility on
this project.
____________________________________________________________________ Date _________________
(PennDOT)
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