ZBIORCZY PROTOKÓŁ - RAPORT
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z okresowej kontroli stanu technicznego (i przydatności do
użytkowania)
obiektu budowlanego przeprowadzonej w
roku.........................
1. Raport sporządził..............................................................................................................................
2. Nazwa obiektu..................................................................................................................................
lokalizacja:......................................................................................................................................
Zakres i data ostatniego remontu.......................................................................................................
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Dodatkowe informacje o remoncie.....................................................................................................
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3. Zestawienie protokółów z badań diagnostycznych (nr i data badania) ...............................................
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4. Wyniki badań i zalecenia...................................................................................................................
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5. Ocena stanu technicznego (i przydatności do użytkowania)..............................................................
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(Inspektor diagnosta ds. nawierzchni i podtorza)
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(data)