Form 000.653.F0317
Good Faith Roof Assessment
COVER SHEET
Project:
Task Order No.:
Building or Trailer No.:
Intended Load:
Location/Area:
No. of Employees:
Type of Structure:
Weight of Equipment:
+
Age of Structure:
Weight of Materials:
+
=
Occupied?
Yes
No
Total Weight:
Maintained?
Yes
No
Date of Assessment:
X 300 lbs. =
The roof described above has been assessed by representatives of construction and HSE. The result of this assessment is:
Passed
Conditionally Passed (see attached checklist and findings sheet for specific information)
Did Not Pass
(requires further evaluation before P2S and/or P2S-managed subcontractor employee access.)
Note: See attached checklist and findings sheet for deficiencies.
Superintendent
Date
Construction Engineer
Date
HSE Representative
Date
Building Administrator/Designee
Date
Received by
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Page 1 of 5
Health, Safety, and Environmental
Form 000.653.F0317
Good Faith Roof Assessment
CHECKLIST (check “” as applicable)
I.
WALLS/ROOF SUPPORT
A. Exterior Walls
1. Concrete
a. Tilt-up panels
b. Cast-in-place
c. Precast panels
2. Masonry
a. Block (CMU)
b. Brick
3. Steel frame w/_______________________siding
a. Preengineered building
4
Wood frame w/______________________siding
5. Other ______________________________________
B.
II.
Interior Walls/Columns
1. Concrete
a. Cast-in-place
b. Tilt-up panels
c. Precast panels
2. Masonry
a. Block (CMU)
b. Brick
3. Steel frame w/siding
4. Wood frame w/siding
5. Other _______________________________________
ROOF
A. Roofing
1. Metal type
2. Built-up type
3. Single-ply type
4. Urethane
5. Asphalt shingle
6. Other _______________________________________
B.
Decking
1. Reinforced concrete slab
2. Precast concrete plank
3. Prestressed concrete plank and deck
4. Composite concrete slab
5. Steel w/concrete fill
6. Steel
7. Composite steel
8. Plywood
9. T&G wood plank
10. Other _______________________________________
C. Roof Structure
1. Concrete
a. Waffle slab
b. Concrete beam
c. Precast concrete plank
2. Masonry beam
3. Steel
a. Framework type
b. Joists
c. Trusses
C.
Roof Structure (cont.)
4.
Wood
a. Joists
b. Manufactured joists type
c. Beams type
5.
Other
III. ROOF CONDITION
A. General Appearance
1. .Debris
2. Drainage
3. Visible damage from roof
a. Concave/convex
b. Surface uniformity
- Loose material
- Deviations from one area to another
c. Sun damage from interior
4. Visible damage from interior
a. Concave/convex
b. Notable ceiling damage
- Water stains on ceiling panels
5. General condition
6. New equipment/alterations
7. Other ____________________________
8. OK
B. Surface Condition
1. Bare spots in gravel/ballast displaced
2. Visible light from below (through ceiling)
3. Alligatoring/cracking
4. Spalling concrete surfaces
5. Slippage
6. Tripping hazards, obstacles on roof
7. Other ____________________________
8. OK
C. Membrane Condition
1. Blistering
2.
Splitting
3.
Ridging/wrinkling
4.
Fishmouthing
5.
Loose felt laps/seams
6.
Punctures, fastener backout
7.
Securement to substrate
8.
Membrane shrinkage
9.
Membrane slippage
10. Other_________________________
11. OK
GENERAL: Plant maintenance or building custodian should be consulted for building history and known hazards.
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Page 2 of 5
Health, Safety, and Environmental
Form 000.653.F0317
Good Faith Roof Assessment
COMMENTS (add additional sheets as necessary):
Building or Trailer No.:
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Location/Area:
Page 3 of 5
Health, Safety, and Environmental
Form 000.653.F0317
Good Faith Roof Assessment
FINDINGS SHEET
Roof Sketch Legend:
Roof Access Allowed
Roof Access NOT ALLOWED
Top View Sketch:
Roof Sections
(see Note No. 1)
Side/End View:
Inspected
(Y/N)
Passed*
(Y/N)
NOTES:
1.
Number each different roof section on the above
sketches to correspond with the roof sections number
and the comments entries.
2.
If roof has not passed, explain (in detail) under
comments the deficiencies associated with the roof. If
possible, show the general “area deficiencies” on the
sketch above.
1.
2.
3.
3.
4.
See completed example on next page.
5.
*If not passed,
see Note No. 2
Comments (add additional sheets as necessary):
Building or Trailer No.: ___________________________
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Location/Area: _____________________________________________________
Page 4 of 5
Health, Safety, and Environmental
Form 000.653.F0317
Good Faith Roof Assessment
FINDINGS SHEET
Example Only
Roof Sketch Legend:
Example Only
Roof Access Allowed
Roof Access NOT ALLOWED
Top View Sketch:
Side/End View:
Roof Sections
(see Note No. 1)
Inspected
(Y/N)
Passed*
(Y/N)
1.
X
Y
Y
2.
X
Y
N
3.
X
Y
N
4.
X
Y
N
5.
X
Y
NOTES:
1.
Number each different roof section on the above sketches
to correspond with the roof sections number and the
comments entries.
2.
If roof has not passed, explain (in detail) under comments
the deficiencies associated with the roof. If possible, show
the general “area deficiencies” on the sketch above.
N
*If not passed,
see Note No. 2
Comments
1. Roof is adequate for 2 persons any place on the roof. Bldg. has 2 unsupported eaves. DO NOT
ACCESS THESE AREAS – See Comments.
2. Lean-To Roof – Panel support purlins need engr. review due to rust and the possibility of poor welding at support joints.
3. Lean-To Roof – Fiberglass panels need to be removed and replaced w/metal roofing – these panels cannot be viewed
from the roof surface and will not support a person’s weight.
4. Office Area – Roof has obvious cracks and roofing material has been torn away. Roof needs engr. review –
DO NOT ACCESS.
5. South Bldg. Entrance Cover – DO NOT ACCESS THIS ROOF – Roof was not designed to carry weight of persons.
Building or Trailer No.: ______________________
Note:
Location/Area: ___________________________________________
This form is referenced in Practice 000.653.3304.
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Page 5 of 5
Health, Safety, and Environmental