Leak Assessment Form

• TNR Representative

• POC Representative

• Jobsite Name

• Location
  Address

• Date & Time

  Date

Ladders & Stairways

• Correct Ladder and Properly Used for the Task

  Yes

  No

  N/A

• Ladders in Good Condition

  Yes

  No

  N/A

• Secured and at a 4:1 Pitch

  Yes

  No

  N/A

Personal Protective Equipment

• Work Boots Worn

  Yes

  No

  N/A

• Hard Hats - Overhead Hazard

  Yes

  No

  N/A

• Safety Glasses - Task Specific

  Yes

  No

  N/A

• Gloves Worn - Different Types Available Per Task

  Yes

  No

  N/A

• Current Active Leak(s)

  Yes

  No

• Ceiling

  Media

• Purlins - Distance Apart

Leak Location Reference Point (Internal)

• Linear Feet From N or S

• Linear Feet From E or W

Roof System

• Metal

  Yes

  No

  N/A

• Built Up Roofing (BUR)

  Yes

  No

  N/A

• Modified Bitumen

  Yes

  No

  N/A

• Thermoplastic Polyolefin (TPO)

  Yes

  No

  N/A

Surface Damage & Pitch

• Are there any tears, holes, or punctures?

  Yes

  No

• Pitch

Leak Location Reference Points (External)

• Linear Feet From N or S

• Linear Feet From E or W

• Images

  Media

• Anomaly Description

4 Corner Photos (Roof)

• North West Corner

  Media

• North East Corner

  Media

• South West Corner

  Media

• South East Corner

  Media

Roof Analytic

• Width

• Length

• Area SqFt

• Purlin Distance

• Curb

• Drain

• Skylight

• Gas Line

• Antenna

• Pipe Vent

• Fiberglass

• HVAC Unit

• Exhaust Fan

Parapet Wall

• Wall Height

• Wall Width

• Wall SQFT

Metal Roof

• Panel Width

• Valley Linear Feet

• Vertical Panel Linear Feet

Condition (Metal Roof)

• Skylights

  Good

  Fair

  Poor

  N/A

• Fiberglass

  Good

  Fair

  Poor

  N/A

• Ridge Cap

  Good

  Fair

  Poor

  N/A

• Coping Cap

  Good

  Fair

  Poor

  N/A

• Hip & Ridge

  Good

  Fair

  Poor

  N/A

• Vertical Seams

  Good

  Fair

  Poor

  N/A

• Horizontal Seams

  Good

  Fair

  Poor

  N/A

• Expansion Joint (structural movement)

  Good

  Fair

  Poor

  N/A

• Protruding Fasteners (loose backing out)

  Good

  Fair

  Poor

  N/A

Condition (Single Ply, Mod-Bit, BUR)

• Ponding Water

  Good

  Fair

  Poor

  N/A

• Drains (overflow)

  Good

  Fair

  Poor

  N/A

• Sealant Deterioration (curbs/penetrations)

  Good

  Fair

  Poor

  N/A

• Voids (improper weld)

  Good

  Fair

  Poor

  N/A

• Loose Laps Seam Separation

  Good

  Fair

  Poor

  N/A

• Shrinkage, Peeling, Bubbling

  Good

  Fair

  Poor

  N/A

• Aging & Material Deterioration (discoloration, blistering, cracking)

  Good

  Fair

  Poor

  N/A

Other Conditions

• Gas Line

  Good

  Fair

  Poor

  N/A

• Antennas

  Good

  Fair

  Poor

  N/A

• Derbris (debris, branches, scrap material, etc.)

  Good

  Fair

  Poor

  N/A

Additional

• Photos

  Media

• Notes

Additional Contractor

• #1 Other

• #2 Other

• Inspection Review With

  Sign

• Audit Completion

  Date