Daily Report

• Type of report?

  Daily Report

• Contract Number:

• Conducted on

  Date

• Prepared by

• Location
  Address

• Project Foreman:

• Weather Conditions (Select all that apply)

  Select Clear Sunny Cloudy Rain Overcast Windy Snow Other Cold Hot Warm

  • Clear
  • Sunny
  • Cloudy
  • Rain
  • Overcast
  • Windy
  • Snow
  • Other
  • Cold
  • Hot
  • Warm

• What other weather conditions exist?

• Time Of Shift

  Day Shift

  Night Shift

Safety Meeting and Attendance Sign in

• Attach Photo of Daily Attendance Sheet

  Media

• Attach Photo of Daily Safety Meeting Sheet

  Media

• Attach Photo of Employee Temperature Log

  Media

• Please provide a detailed description of all work performed. (Including all tests, inspector interaction, equipment used, problems, unusual conditions, or safety issues)

• Were there any visitors to the site today?

  Yes

  No

• Please list all visitors: (Include time of arrival)

• Were there any deliveries to the site today?

  Yes

  No

• Please list all deliveries: (Include time of arrival)

• Was QA inspector on site at all times today?

  Yes

  No

Soft Tissue Injury Prevention

• Has daily stretching been performed by all employees prior to the start of any work?

  Yes

  No

  N/A

• Daily stretching is an employment requirement unless directed by a physician to not participate. If a crew member refuses to participate in the soft tissue injury prevention program, send them home and contact the EH&S Manager.

Project Signage

• Are all required OSHA and Department of Labor posters as well as our OSHA 300 Log posted in a conspicuous place?

  Yes

  No

• Please contact the office immediately for the job posters, this is a large fine for the company if we fail to have them posted!

  I understand

• Who did you contact in the office?

• Is the emergency contact list and directions to the nearest emergency room posted on site in a conspicuous place?

  Yes

  No

• These items must be posted at the start of the job and remain there until we are finished at the site.

• Are ALL containers on site properly labeled identifying contents?

  Yes

  No

• Are all areas where flammable materials are being stored properly identified?

  Yes

  No

  N/A

Personal Protective Equipment

• Are employees wearing hard hats, safety glasses, safety vests, and gloves at all times while working?

  Yes

  No

• Why not?

Fall Protection

• Is fall protection utilized by all employees working above six feet?

  Yes

  No

  N/A

• Is all fall protection equipment in use in good condition and inspected daily prior to use?

  Yes

  No

• Are independent safety ropes and/or cables installed where required?

  Yes

  No

• Are cable and/or rope grabs installed on safety lines?

  Yes

  No

• Are all safety anchorages in use in accordance with OSHA 1910.140(c) (13)(ii) or capable of supporting 5000 LBS?

  Yes

  No

Respiratory Protection

• Is respiratory protection utilized by all employees when required?

  Yes

  No

  N/A

• Are employees using respirators?

  Yes

  No

• What type of respirators are in use?

  Select Half Mask Negative Pressure Full Face Negative Pressure N95 Dust Mask Type CE (Blast Hood) Other

  • Half Mask Negative Pressure
  • Full Face Negative Pressure
  • N95 Dust Mask
  • Type CE (Blast Hood)
  • Other

• Are all respirators utilized by employees in acceptable condition?

  Yes

  No

• Are all employees utilizing respiratory protection clean shaven?

  Yes

  No

• Are respirators cleaned and stored in a plastic bag at the end of each work day?

  Yes

  No

Electrical Safety

• Are all power tools in use in acceptable condition with guards installed, cords free of damage, and strain relief intact?

  Yes

  No

  No power tools in use today

• Are all 120v power cords in use a minimum of 12 gauge wire and rated for hard use?

  Yes

  No

  No 120v power cords in use

• Are all 120v power cords free of cuts or tears in the insulation and have ground prong installed?

  Yes

  No

  N/A

• Are all 120v power cords plugged into a GFI (Ground Fault Interrupter)?

  Yes

  No

• Is all necessary equipment properly grounded? (Example: Fuel tanks, Spray Pumps, Blast Units, Flammable Storage Drums, Etc.)

  Yes

  No

Abrasive Blasting Safety

• Is abrasive blasting performed today?

  Yes

  No

• Are whip checks installed on all hose connections?

  Yes

  No

• Are all crewmembers equipped with the proper PPE? (PWC, Gloves, Blast Hood, Etc?

  Yes

  No

• Supplied air system operating?

  Yes

  No

  N/A

• Are CO monitors in use?

  Yes

  No

• Are the CO monitors in use inspected and calibrated?

  Yes

  No

• Are the CO monitors periodically checked during use to ensure they are working correctly?

  Yes

  No

• Air purification installed in supplied air and located between air supply and the CO monitor?

  Yes

  No

• CO monitor must be in use at all times while crew is using supplied air respirators. Please contact Allied Painting's Health And Safety Department immediately if one is not in use!

  I understand

First Aid & Fire Protection

• Are first aid stations on site with signs posted to identify where they are located?

  Yes

  No

• Are all first aid supplies on site within their expiration date?

  Yes

  No

• Are eyewash stations on site with signs posted to identify where they are located?

  Yes

  No

• Are all eyewash solutions within their expiration dates?

  Yes

  No

• Are fire extinguishers located near all areas where flammable materials are stored and in use?

  Yes

  No

  N/A

• Are fire extinguishers located near all running equipment?

  Yes

  No

• Are all fire extinguishers on site charged, certified, and with pin installed?

  Yes

  No

• Are all fire extinguishers on site inspected at a minimum once a week and inspection tags initialed monthly?

  Yes

  No

Stairways & Ladders

• Are stairways and ladders in use whenever there is a change of elevation of 19 inches or more?

  Yes

  No

  N/A

• Are all stairways and ladders in good working condition?

  Yes

  No

• Are portable ladders being utilized in accordance with original manufacturers recommendations?

  Yes

  No

• Are portable ladders in use properly secured and at least three feet above the working surface?

  Yes

  No

  N/A

• Are safety ropes installed on fixed ladders?

  Yes

  No

  N/A

• Rope grabs installed on safety ropes?

  Yes

  No

Maintenance & Protection of Traffic

• Is a lane closure being utilized?

  Yes

  No

• Please describe traffic activity, (Include street name, direction of traffic, number of lanes closed, etc.)

• Are employees dropped off at the work location safely?

  Yes

  No

• Are all employees inside the lane closure at all times?

  Yes

  No

• Are all employees in and around lane closure equipped with the required traffic in accordance with the MUTCD, OSHA, FHWA, and all other regulations. (Including Contract Specifications)?

  Yes

  No

• MPT Items paid per unit?

  Yes

  No

• Please select types of MPT equipment in use:

  Select Attenuator Truck Pickup Truck Message Board Traffic Signs Traffic Drums Traffic Cones Other

  • Attenuator Truck
  • Pickup Truck
  • Message Board
  • Traffic Signs
  • Traffic Drums
  • Traffic Cones
  • Other

• Quantity of attenuator trucks:

• Quantity of pickup trucks:

• Quantity of message boards:

• Quantity of traffic signs:

• Quantity of traffic drums:

• Quantity of traffic cones:

• Please list other type and quantities of MPT equipment:

• Is a flagger being utilized?

  Yes

  No

• Please list the names of the employees that are directing traffic.

Confined Space

• Are employees working within a confined space at any point during the work shift?

  Yes

  No

• Is the area a Permit-Required confined space?

  Yes

  No

• Test atmospheric conditions inside the space before entry and monitor the space during entry. <br> Oxygen—Test for oxygen first in order to be sure you get an accurate LEL reading. Most combustible gas meters are oxygen dependent and will not provide reliable readings in an oxygen-deficient atmosphere. Oxygen levels should be between 19.5 and 23.5%.<br>LEL—Test flammable gas and vapor levels due to the threat of fire or explosion, which can be immediate and life threatening.<br>Toxic air contaminants—Test for impurities such as carbon monoxide (CO), hydrogen sulfide (H2S) and chlorine (Cl2). <br> A permit must be filled out each day and proper signage posted at the entrance of any Permit-Required confined space. An entry attendant must be present at all times while employees are working inside the space.

  I Understand

• Please list the manufacturer and model of testing and/or monitoring equipment.

• Serial number:

• Has a "Bump Test" been performed prior to use, verifying the monitor is operating correctly?

  Yes

  No

• Results of test:

  Select Unit is operating correctly Unit is not operating correctly

  • Unit is operating correctly
  • Unit is not operating correctly

• If the unit is malfunctioning in any way, you must cancel the Confined Space Permit and must not allow anyone to enter the space until it has been tested! Please contact the office immediately!

  I understand

• Who did you inform that the unit is not operating correctly?

• First and Last name of entry attendant:

• Please take a photo of each page of the completed permit at the end of shift.

  Media

Scaffold Safety

• Is scaffolding in use?

  Yes

  No

• What type of scaffolding is in use?

  Select Supported Scaffolding (Pipe Scaffold) Catenary (Pick Board & Cable) Single Point Adjustable (Spider Basket) Single Point Adjustable (Boatswains Chair) Two Point Adjustable (Swing Stage) Engineered Suspension (Safe-Span) Other New England Boom

  • Supported Scaffolding (Pipe Scaffold)
  • Catenary (Pick Board & Cable)
  • Single Point Adjustable (Spider Basket)
  • Single Point Adjustable (Boatswains Chair)
  • Two Point Adjustable (Swing Stage)
  • Engineered Suspension (Safe-Span)
  • Other
  • New England Boom

• Are all catenary scaffolds securely fastened to cables, ensuring accidental displacement does not occur?

  Yes

  No

• All catenary scaffolds in use, planking free of any visual damage?

  Yes

  No

• All scaffolds in use, side rails free of any visual damage?

  Yes

  No

• All scaffolds in use, rungs free of visual damage?

  Yes

  No

• Safety lines are independently tied back to an adequate anchor point, and padded to protect from abrasion?

  Yes

  No

• Are rope and/or cable grabs installed on safety lines?

  Yes

  No

• Are the scaffolds being used tagged for use?

  Yes

  No

• Scaffolding being used must have a green tag on it identifying it is safe for use. If you do not have tags please contact Allied Painting's Health And Safety Department.

  I understand

• Are the scaffolding and cables in use in acceptable condition and free of damage?

  Yes

  No

• Lifelines are independently tied back to an adequate anchor point, and padded to protect from abrasion?

  Yes

  No

• All accessories (platform connections, wall rollers, toe boards, guard rails) of the scaffold have been installed and tightened with the proper hardware. Cotter/Hitch Pins Installed ?

  Yes

  No

• Are rope and/or cable grabs installed on safety lines and in acceptable condition?

  Yes

  No

• Was the boatswains chair in use bought as new or built by a qualified person?

  Bought as new

  Built by qualified person

• (1)(A) Boatswain's Chair. The chair shall be suspended from its four corners by means of rope slings. It shall have a seat not less than 24 inches long by 10 inches wide and, if of soft wood, 2 inches thick (1 1/8 inches if of oak or ash). It shall be reinforced across the full width by cleats securely fastened to each end. A rope or strap guard across the front and rear approximately 18 inches above the seat shall be provided. The seat may be constructed of material other than wood, provided the material is equivalent in strength to 2 inches of soft wood or 1 1/8 inches of oak or ash. If constructed of material of equivalent strength, cleats across the full width of the seat shall be provided unless structural analysis indicated they are not necessary. Other design and construction may be substituted if it can be shown to provide equal safety and strength.

  

• Lifelines are independently tied back to an adequate anchor point, and padded to protect from abrasion?

  Yes

  No

• Are all components of scaffolding and cables in acceptable condition?

  Yes

  No

• Please explain what is wrong and what the corrective action is.

• Are OSHA compliant handrails installed to prevent accidental falls of personnel and/or tools and equipment?

  Yes

  No

• Are independent safety ropes and/or cables installed?

  Yes

  No

• Are all swing stages equipped with OSHA compliant handrails?

  Yes

  No

• Are rope and/or cable grabs installed on safety lines?

  Yes

  No

• Lifelines are independently tied back to an adequate anchor point, and padded to protect from abrasion?

  Yes

  No

• All accessories (platform connections, wall rollers, toe boards, guard rails) of the scaffold have been installed and tightened with the proper hardware. Cotter/Hitch Pins Installed ?

  Yes

  No

• Hoist/stirrup and platform connections properly secured with Grade 5 bolts, thread-locking nuts or cotter pins used?

  Yes

  No

• Was the suspended platform installed in accordance with an engineered drawing or plan? (if Yes, complete the following checklist daily.)

  Yes

  No

• Check all decking for loose sheets and use self tapping screws to secure overlaps.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all decking for missing or loose clips.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all post bracket hardware for tension.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all main cable clips and ensure they are tight.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all shackle plates for loose hardware.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all shackle plates and ensure they have a lock nut installed.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all the tie up connections to existing steel and cable / decking and ensure they are secure.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all rigid tie up assembly connections and ensure all nuts and jamb nuts are installed.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all rigid tie up connections to existing steel and cable / decking, ensuring the attachments are secure.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all upper intermediate tie up beam flange clamp hangers for secure attachment.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all perimeter railing posts for stability.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all perimeter 1/4" cable for tension. (Top rail shall not deflect below 39" above deck)

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all perimeter 1/4" cable for cable clamps.

  Completed

  Repaired

  Follow Up Required

  N/A

• Check all railing posts for caps

  Completed

  Repaired

  Follow Up Required

  N/A

• Check decking for unused parts, tools, or debris.

  Completed

  Repaired

  Follow Up Required

  N/A

• Please list any remarks, including any concerns.

• Scaffold Tag Installed & Signed Daily On Supported Scaffold?

  Yes

  No

• This must be completed each day!

• Scaffold erected in accordance with approved drawings?

  Yes

  No

• Supported scaffold installed level and plumb?

  Yes

  No

• Mud sills installed under each screw jack?

  Yes

  No

• Mud sills nailed down with at least two nails?

  Yes

  No

• If more than one mud sill plank under each screw jack, are they secured together using screws or duplex nails?

  Yes

  No

  N/A

• Two pins installed on each frame?

  Yes

  No

• All cross bracing installed at each complete level?

  Yes

  No

Mobile Elevated Work Platforms (MEWP'S)

• Are MEWP's in use?

  Yes

  No

• Are all MEWP's on site in good condition, free of damage, and used in accordance with the Operators Manual?

  Yes

  No

• Are are all employees who operate the MEWP's properly trained, certified, and have their credentials on site?

  Yes

  No

• Are all operators and passengers of MEWP's in use wearing proper fall protection and utilizing the correct safety anchorage in basket?

  Yes

  No

• Please ensure all persons are using the proper anchorage located in basket and not tying off to the basket handrails or an adjacent structure.

• Are employees being supervised during the use of MEWP's to ensure safe operation?

  Yes

  No

Lead Safety & Compliance

• Is lead being disturbed in any way today?

  Yes

  No

Work Activity

• Select work being performed

  Select Abrasive Blasting Vacuuming Emptying Dust Collector Emptying Blast Unit Blow Down Containment Building Tarp handling Power Tooling Pressure Washing

  • Abrasive Blasting
  • Vacuuming
  • Emptying Dust Collector
  • Emptying Blast Unit
  • Blow Down
  • Containment Building
  • Tarp handling
  • Power Tooling
  • Pressure Washing

• Is water used for washing being collected?

  Yes

  No

  N/A

Containment And Ventilation System

• What containment Guide is being used?

  SSPC Guide 6

  Other

• What containment guide is used?

• Attached is Guide 6 for reference

• What containment class is being used?

  Select 1A 2A 3A 4A N/A Other

  • 1A
  • 2A
  • 3A
  • 4A
  • N/A
  • Other

• What type of entryway is being used?

  Sealed

  Air Lock (Double Door)

  Overlap

  N/A

• Is dust collection/ventilation running continuously?

  Yes

  No

  N/A

• List the CFM of dust collector being used.

  Select 20000 CFM 30000 CFM 40000 CFM 50000 CFM 60000 CFM 80000 CFM

  • 20000 CFM
  • 30000 CFM
  • 40000 CFM
  • 50000 CFM
  • 60000 CFM
  • 80000 CFM

• Is negative pressure verified?

  Yes

  No

  N/A

• How was it verified?

  Visually

  Manometer

  Magnehelic Gauge

• What was the reading?

• What was the reading on the gauge?

• Sensible air duct layout? (Shortest distance possible from dust collector to containment, with minimal turns and elevation of ducting)

  Yes

  No

• Interior of containment visually clean of settled dust?

  Yes

  No

• Make-up air inlets operational?

  Yes

  No

• Are all tarps and seals used for containment intact?

  Yes

  No

  N/A

Containment Air Flow Measurement

• Below please record containment air flow data.

• Instrument used?

• Model Number:

• Foot per minute?

Emissions Log

• Unacceptable emissions shall be cause for immediate project shutdown until corrections to the containment are made. Visible emissions shall be determined in accordance with 40 CFR 60, Method 22, and shall not exceed 1% of the work day.

• Provide all data required, including: Observation locations, start times and length of observations, any emissions observed, and Wind speed and direction at the time of observation.

Regulated Area

• Is the area clearly identified?

  Yes

  No

• Signs posted?

  Yes

  No

• Has personal air monitoring been completed on this project?

  Yes

  No

Personal Protective Equipment

• Assigned work clothes/coveralls worn?

  Yes

  No

• What type of respirators are being used?

  Half Mask Negative Pressure

  Full Face Negative Pressure

  N95 Dust Mask

  Type CE (Blast Hood)

  Other

• Are the respirators in use cleaned daily, in good condition, and stored properly?

  Yes

  No

• Are all employees using respirators clean shaven?

  Yes

  No

• Employees who use a respirator must be clean shaven at all times, with no more than one day facial growth. Please list names of any employees who fail to maintain this requirement, explain to the employees that they must shave before continuing any work that requires a respirator. This is considered a verbal warning. Please document the verbal warning on the remarks section of the Daily Safety Report.

Hygiene Practices

• Food and beverages in lunch area only?

  Yes

  No

• All personal clothing being stored separate from work clothes?

  Yes

  No

• Gross decontamination completed prior to leaving regulated area?

  Yes

  No

• Washing completed prior to eating or drinking?

  Yes

  No

• Final decontamination, including shower prior to leaving project site?

  Yes

  No

• Lunch area, sanitary facilities, & decontamination units clean and with D-lead soap and water available?

  Yes

  No

Housekeeping Procedures

• Debris, unused equipment, and tools removed from containment?

  Yes

  No

• Hazardous waste disposed of in proper containers and separate from regular trash?

  Yes

  No

• Visible dust accumulation cleaned from regulated area using certified HEPA vacuum?

  Yes

  No

• End of shift cleanup adequate?

  Yes

  No

Coating Application

Surface Preparation and Coatings Application

• Is surface preparation and/or coating application being performed?

  Select Yes No Yes, However I am not QC for this project

  • Yes
  • No
  • Yes, However I am not QC for this project

• Are DFT readings being taken today?

  Yes

  No

• Please select manufacturer and model of gauge used to record readings.

  Positector 6000 (Standard)

  Positector Smart Link

  Other.

• What gauge is being used?

• Was field accuracy verification completed in accordance with SSPC-PA2 prior to retrieving readings?

  Yes

  No

• What size shim was used to verify?

  1 Mil (Orange)

  2 Mils (Red)

  5 Mils (Blue)

  10 Mils (Brown)

  20 Mils (Yellow)

• What was the reading taken on shim?

• Did the gauge require adjustment?

  Yes

  No

• After adjustment, did the gauge read accurately?

  Yes

  No

• Please list serial number of gauge.

• Please list serial number of probe.

Post DFT gauge verification

• What size shim was used to verify?

  1 Mil (Orange)

  2 Mils (Red)

  5 Mils (Blue)

  10 Mils (Brown)

  20 Mils (Yellow)

• Did the gauge read accurately?

  Yes

  No

• Attached is SSPC-PA2 for reference.

1. DESCRIPTION OF AREAS & WORK PERFORMED

• Provide a detailed description of areas where work is being performed. (List span numbers, girder numbers, structure numbers, interior/exterior, Etc.)

2. HOLD POINT INSPECTIONS PERFORMED

• 1. Pre-surface preparation/Conditioning & Cleanliness

  Completed

  Not Completed

  N/A

• 2. Surface preparation monitoring

  Completed

  Not Completed

  N/A

• 3. Post surface preparation/Cleanliness & Profile

  Completed

  Not Completed

  N/A

• 4. Pre-application preparations/Surfaces cleanliness

  Completed

  Not Completed

  N/A

• 5. Application Monitoring/Wet film thickness (WFT)

  Completed

  Not Completed

  N/A

• 6. Post application/Application defects

  Completed

  Not Completed

  N/A

• 7. Post cure/Dry Film Thickness (DFT)

  Completed

  Not Completed

  N/A

• 8. Non-conformance/Corrective Actions Follow-up

  Completed

  Not Completed

  N/A

• 9. Final Inspection Approved by: (List QA Inspectors Name)

3. AMBIENT CONDITIONS

Ambient Condition

• Time

  Date

• Dry Bulb Temp °F

• Wet Bulb Temp °F

• Relativity Humidity %

• Surface Temp °F

• Dew Point Temp °F

• Are all atmospheric conditions listed acceptable and in accordance with project specification?

  Yes

  No

• Atmospheric conditions must be in accordance with project specification.

  I Understand

• What corrective actions were taken to correct the unacceptable conditions?

4. SURFACE PREPARATION

• Is surface preparation being performed today?

  Yes

  No

• Level of surface preparation required in project specification?

  Select Pressure Wash Solvent Cleaning (SSPC-SP1) Hand Tool Cleaning (SSPC-SP2) Power Tool Cleaning (SSPC-SP3) Abrasive Blast Cleaning Power Tool Cleaning To Bare Metal (SSPC-SP11) Other

  • Pressure Wash
  • Solvent Cleaning (SSPC-SP1)
  • Hand Tool Cleaning (SSPC-SP2)
  • Power Tool Cleaning (SSPC-SP3)
  • Abrasive Blast Cleaning
  • Power Tool Cleaning To Bare Metal (SSPC-SP11)
  • Other

• Is dust collection used at all times during abrasive blasting?

  Yes

  No

• What level of abrasive blast is required in specification?

  Select SSPC-SP5 (White Metal Blast) SSPC-SP10 (Near White Metal Blast) SSPC-SP6 (Commercial Blast Cleaning) SSPC-SP14 (Industrial Blast Cleaning) SSPC-SP7 (Brush Off Blast)

  • SSPC-SP5 (White Metal Blast)
  • SSPC-SP10 (Near White Metal Blast)
  • SSPC-SP6 (Commercial Blast Cleaning)
  • SSPC-SP14 (Industrial Blast Cleaning)
  • SSPC-SP7 (Brush Off Blast)

• What is the anchor profile specified?

• What is the anchor profile measurement achieved?

• How was the anchor profile measured?

  Select Testex Coarse Replica Tape (0.8 - 1.5 Mils) Testex X-Coarse Replica Tape (2.5 - 4.5 Mils) Testex X-Coarse Plus Replica Tape (Greater than 4.5 Mils) Electronic Surface Profile Guage

  • Testex Coarse Replica Tape (0.8 - 1.5 Mils)
  • Testex X-Coarse Replica Tape (2.5 - 4.5 Mils)
  • Testex X-Coarse Plus Replica Tape (Greater than 4.5 Mils)
  • Electronic Surface Profile Guage

• Please list Manufacturer and Model:

• Serial Number:

  Yes

  No

  N/A

• What time did they begin surface preparation?

  Date

• What time did they finish surface preparation?

  Date

• Has a blotter test in accordance with ASTM D 4285 been completed on the compressed air supply to ensure no water or oil contamination is present?

  Yes

  No

• This must be completed daily prior to the start of abrasive blasting.

  I Understand

• Results of blotter test?

  No oil or water detected

  Oil or water detected

• You must notify foreman, as well as Allied Painting's Quality Control Department immediately about your findings.

  I Understand

• Has an abrasive cleanliness test in accordance with SSPC AB-2 (Vial Test) to ensure no oil or dirt contamination is present?

  Yes

  No

• Results of test?

  Select Abrasive is acceptably clean with no visible contaminates present Oil detected in abrasive Abrasive is unclean and must be replaced Other

  • Abrasive is acceptably clean with no visible contaminates present
  • Oil detected in abrasive
  • Abrasive is unclean and must be replaced
  • Other

• What are the results of the test?

• Start Time Power Tool Cleaning:

• Finish Time Power Tool Cleaning:

• Is the pressure washing being performed in accordance with project specification?

  Yes

  No

• Please list any required water additives and their batch numbers. (Example: Chlor-rid.)

• Is the level of surface preparation achieved acceptable and in accordance with project specification?

  Yes

  No

• What corrections were made to achieve an acceptable surface cleanliness?

5. SURFACE CLEANLINESS

• Are the areas being coated visually free of dust, debris, or other surface contaminates prior to application?

  Yes

  No

  N/A

• How was this achieved?

  Select Compressed Air Vacuum Brooms , Rags

  • Compressed Air
  • Vacuum
  • Brooms , Rags

• The surface must be free of dust and debris to ensure proper adhesion of coating. Applying coating over a dirty substrate will dramatically decrease the service life of the coating system.

  I Understand

• What corrective actions were used to achieve an acceptable surface cleanliness?

• Soluble salt testing performed?

  Yes

  No

• List location, results, type of tests, and quantity of tests performed

ILLUMINATION OF WORK AREA

• Is the work area adequately lighted and in accordance with SSPC Guide 12?

  Yes

  No

  N/A

• Please list the reading of the luxometer in foot candles.

7. COATING APPLICATION AND WET FILM THICKNESS

• Are coatings being applied?

  Yes

  No

• Start of application:

  Date

• Finished application:

  Date

• Coat applied: If touch up is being performed please select "Touch Up" as well as the coat being applied.

  Select Prime Coat Stripe Coat Intermediate Coat Finish Coat Touch-up

  • Prime Coat
  • Stripe Coat
  • Intermediate Coat
  • Finish Coat
  • Touch-up

• What is the acceptable range of Dry Film Thickness listed in project specification?

• How was the coating applied

  Select Brush Roller Airless Spray Plural Component Pump Other

  • Brush
  • Roller
  • Airless Spray
  • Plural Component Pump
  • Other

• Quantity of coating applied

• What is the target Wet Film Thickness listed in project specification?

• Wet Film Thickness readings:

• Mix Method

  Mechanical Drill

  Plural Component Pump

  Other

• How was it mixed?

8. MATERIAL/BATCH #

• Manufacturer

• Generic Coating Type

• Product Name

• Batch # Part A:

• Part A Expiration Date:

• Batch # Part B:

• Part B Expiration Date:

• Are there Additional Component Batch Numbers (Example: Zinc Powder, Part F, Etc.)?

  Yes

  No

• Component name:

• Batch Number:

• Color Name/Code

• Reducer Added?

  Yes

  No

• Reducer Name

• Reducer Batch Numbers

• Quantity Added (Oz per Gallon or percentage)

• Sweat in time required for material?

  Yes

  No

• How long?

• Pot Life

• Material Temp °F

Material Storage

• Are coatings being stored on site?

  Yes

  No

• Minimum Temperature *F

• Maximum Temperature *F

• Are the temperatures where material is being stored acceptable in accordance with project specification?

  Yes

  No

• Please detail why the temperatures are not acceptable and explain the corrective action taken to maintain acceptable conditions.

10. INSPECTION INSTRUMENTS

• List all instruments used for QC inspection.

  Select Type 2 Electronic DFT Gauge Electronic Sling Psychrometer Inspection Mirror Testex Tape & Spring Micrometer Rotating Vane Anemometer Sling Psychrometer Infrared Thermometer Surface Thermometer Needle Pressure Gauge Luxometer Low Voltage Holiday Detector High Voltage Holiday Detector Electronic Surface Profile Gauge Wet Film Thickness Gauge Chalk/Marker Gas Monitor

  • Type 2 Electronic DFT Gauge
  • Electronic Sling Psychrometer
  • Inspection Mirror
  • Testex Tape & Spring Micrometer
  • Rotating Vane Anemometer
  • Sling Psychrometer
  • Infrared Thermometer
  • Surface Thermometer
  • Needle Pressure Gauge
  • Luxometer
  • Low Voltage Holiday Detector
  • High Voltage Holiday Detector
  • Electronic Surface Profile Gauge
  • Wet Film Thickness Gauge
  • Chalk/Marker
  • Gas Monitor

• Serial number:

• Serial Number:

• Serial Number:

• Serial Number:

• Serial Number:

• Serial Number:

• Serial Number:

• Serial Number:

• Are airless spray pumps in use today?

  Yes

  No

• Are spray tip and trigger guards installed on spray guns?

  Yes

  No

• Spray guns must have both guards in place whenever they are in use to protect from unintentional discharge and/or injection of material into skin.

  

Housekeeping & General Site Conditions

• Are personal vehicles parked away from the work area?

  Yes

  No

• Is the work area adequately lighted?

  Yes

  No

• Is the site left in a clean and organized condition at the end of the day?

  Yes

  No

• Why not?

Hot Work

• Is welding, cutting, or grinding being performed?

  Yes

  No

• Hot work permit must be completed!

• Fire extinguishers present in work area at all times?

  Yes

  No

• Warning signs posted?

  Yes

  No

• Take photo of completed hot work permit

  Media

Waste Management

• Is there any non hazardous waste stored on site?

  Yes

  No

• What type of storage containers are currently in use on site?

  Select Roll-off open top containers 55 Gallon Drums Residential Type Waste Containers Other

  • Roll-off open top containers
  • 55 Gallon Drums
  • Residential Type Waste Containers
  • Other

• What size container is on site?

  Select 2 Cubic Yards 10 Cubic Yards 20 Cubic Yards 30 Cubic Yards 40 Cubic Yards Other

  • 2 Cubic Yards
  • 10 Cubic Yards
  • 20 Cubic Yards
  • 30 Cubic Yards
  • 40 Cubic Yards
  • Other

• How many open top roll-off containers are currently in use?

• How many drums are currently in use?

• How many residential type waste containers are currently in use?

• What type of container is being used to store non-hazardous waste?

• How many of this type of container is currently in use?

• Are there any other containers on site used to store Non-Hazardous waste?

  Yes

  No

• Please list what other containers are in use.

• Is there Hazardous Waste currently stored on site?

  Yes

  No

• Are waste containers being stored in accordance with 40 CFR 262?

  Yes

  No

  N/A

• How many containers are currently being stored on site?

• Are all storage areas secure, and properly identified using signs, caution tape, etc.?

  Yes

  No

• What type of containers are being used for hazardous waste storage?

  Select Open Top Roll-off Container Sealed Roll-off Container (Vacuum Box) 55 Gallon DOT Approved Drums

  • Open Top Roll-off Container
  • Sealed Roll-off Container (Vacuum Box)
  • 55 Gallon DOT Approved Drums

• Are all drums used for storage sealed and free of corrosion?

  Yes

  No

• Are drums containing hazardous material being stored on pallets with ground cover underneath?

  Yes

  No

• Are all drums equipped with bolted ring style lids?

  Yes

  No

• Are all containers in use properly labeled, including EPA ID # and generator information?

  Yes

  No

  N/A

• Is all hazardous waste stored on site less than 90 days old?

  Yes

  No

  N/A

• What is the date of accumulation on the oldest container?

  Date

• Provide photo of hazardous waste storage area

  Media

Documented Verbal Warnings

• Were any safety non compliance verbal warnings issued today?

  Yes

  No

• Please list the first and last name of those who were issued a warning and describe what happened.

Signatures and Certification

• Please provide any additional remarks.

• By signing this report, I certify that this report is complete, correct, and that I am an authorized safety representative of Allied Painting Inc.

  Sign

• For QC Manager Review Only

• Date Reviewed

  Date

• QC Manager Signature

  Sign