Title Page
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
Type of Floor system
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Epoxy type system
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Urethane cement system
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Polish system
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Other
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List other
Conditions of Existing Floor
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Existing epoxy to remove
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Existing epoxy, no removal, prep for overcoat
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Removal of carpet, VCT or a mastic
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Removal of a ceramic or mortar
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Was a concrete hardness test performed by sales prior to the job start?
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Is the concrete or substrate hard or soft?
Floor contaminants
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Is there excessive dirt?
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Are there any oils, fluids or stains in the floor?
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Is there any standing or leaking water on the floor?
Engineering Obstacles
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Are there any type of bolts or metals that need to be removed? If yes how many and add photos
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Are anchor joints or keyways needed? If so list what areas in notes
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Are control joints being prepped or filled for this job?
- Yes
- No
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Are control joints being re opened after repairs?
- Yes
- No
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Are control joints being caulked?
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How many linear feet of control joints?
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Are cracks being filled or repaired on this project?
- Yes
- No
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How many linear feet if crack repairs?
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Is there any areas that require a slurry or skim coat to repair spalling or exposed aggregate?
- Yes
- No
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List the approximate square footage
Product information
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Have the tech data sheets been reviewed for proper application?
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Have the mixing ratios and times requirements been reviewed?
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List the mixing ratio and mixing time requirements
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What is the required surface profile for the products being applied? (CSP READING)
Machine hazards
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Deflected concrete or unlevel concrete.
- Yes
- No
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Bolts, rebar or protruding rebar
- Yes
- No
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Floor drains or inlaid obstructions?
- Yes
- No
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Note any other hazards or obstructions
Contract Variances
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Are the any areas of repair, changes or others items noted in this report not in the original bid or contract scope of work? Please note items in notes