TNR - 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

• Priority

• 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

• Purlin Distance

• Vertical Distance

• Horizontal Distance

• Area SqFt

• Pipe Vents

• Drains

• Skylights

• HVAC Units

• Exhaust Fans

• Curbs

• Antennas

• Parapet Wall

• Gas Line

• Gutter

Condition

• Vertical Seams

  Good

  Fair

  Poor

  N/A

• Horizontal Seams

  Good

  Fair

  Poor

  N/A

• Pipe Vents

  Good

  Fair

  Poor

  N/A

• Drains

  Good

  Fair

  Poor

  N/A

• Skylights

  Good

  Fair

  Poor

  N/A

• HVAC Units

  Good

  Fair

  Poor

  N/A

• Exhaust Fans

  Good

  Fair

  Poor

  N/A

• Curbs

  Good

  Fair

  Poor

  N/A

• Antennas

  Good

  Fair

  Poor

  N/A

• Parapet Wall

  Good

  Fair

  Poor

  N/A

• Gas Line

  Good

  Fair

  Poor

  N/A

• Gutter

  Good

  Fair

  Poor

  N/A

Questions

• Loose Laps Seam Separation

  Yes

  No

• Weathering Damage (discoloration, blistering, alligatoring, cracking)

  Yes

  No

• Structural Movement (expansion joints)

  Yes

  No

• Protruding Fasteners (back out nails)

  Yes

  No

• Sealant Deterioration (penetrations)

  Yes

  No

• Voids (Improper Weld)

  Yes

  No

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

  Yes

  No

• Overflow (drainage issues)

  Yes

  No

• Ponding Water

  Yes

  No

Additional

• Photos

  Media

• Notes

Additional Contractor

• #1 Other

• #2 Other

• Inspection Review With

  Sign

• Audit Completion

  Date