All fields marked with * are mandatory. Your Name * Email * Enter the email you want the completed checklist to be sent to Date * Concrete Contractor * Homebuilder * Concrete Pour Location Address * Is the Foreperson a Certified ACI Advanced Concrete Flatwork Finisher / Concrete Flatwork Associate / Red Seal Journeyman Concrete Finisher? * Yes No Are the Crew Certified ACI Advanced Concrete Flatwork Finishers / Concrete Flatwork Associates? * Yes No Concrete Supplier * Concrete Supplier Contact Name * Concrete Supplier Contact Phone Number * Concrete Supplier Dispatch Phone Number * Is the Concrete Supplied From a Certified Plant? Yes No Site Preparation, Specified Products and Finish, Tools, Curing, Protection Success equals the right products, tools, experience, and a well thought out contingency plan. Site Preparation All organic material removed/positive drainage slope set? * Yes No Appropriate granular material supplied and compacted to optimum moisture and density base moistened before placing? * Concrete Subgrades and Subbases Tutorial Yes No Forms oiled, staked and set to ensure uniform slab depth and isolation joint material applied to existing concrete? * Yes No All ground and formwork thawed, free of ice, snow, water? * Yes No Rebar tied and chaired and joint layout marked on forms? * Longest side of any panel no more than 1.5 Times the shortest and tooled 1/4 slab depth Yes No Stonework/Siding/Windows/Doors/Vehicles masked from exposure to airborne finishing aids/curing compounds? * Yes No Pictures of Site Preparation * Please include one photo taken from the foot of the driveway toward the garage showing all aspects of what’s been checked in this section and if possible the house number usually visible at this stage. And another photo showing masking provisions of windows, siding and any adjacent vehicles. Choose File No file chosen Specified Products and Finish Mix * Concrete Alberta recommends DURA-MIX® - The DURA-MIX® name is a registered trademark and CAN ONLY be labeled and supplied as such by Concrete Alberta Members who follow the DURA-MIX® formula in preparing a batch of concrete. Slump (mm) * Air (%) * Concrete Tested By * Broom Finish? * Yes No Broom Fibre Type Exposed Aggregate Finish? * Yes No Exposed Aggregate Finish Mock-Up Approved By Stamped Finish? * Yes No Stamped Finish Mock-Up Approved By Finishing and Protection Products Evaporation Retarder / Fogging Provisions? * Yes No Storm Tarps? * Yes No Exposed Aggregate Retarder? Yes No Concrete Stamp Release? * Yes No Pictures of Finishing and Protection Products * Please include one photo of the pick-up parked in front of the same house as the previous photo with the pail of Evaporation Retarder and sprayer, storm tarps, all of the placing and finishing tools intended to be used and even the pail of curing compound and another sprayer. Choose File No file chosen Tools Select All the Tools Used: * Concrete Rakes Magnesium Bull Floats Magnesium Hand Floats Vibrators Joint Groovers Edgers Finish Brooms Sprayers Rollers Fresno Trowels Was accelerator admixture used? * Yes No At what point were the tools used, before the bleed water has removed, or after? * Before After Curing and Protection Water / Burlap / Poly? * Yes No If yes, number of days: Tarps / Blankets? * Yes No If yes, number of days: Insulated? * Yes No If yes, number of days: Curing Compound? * Yes No If yes, brand: Cure and Seal? * Yes No If yes, brand: Sealer? * Yes No If yes, brand: If yes, date sealer applied: Personal Protective Equipment Select All the Personal Protective Equipment Used: * Safety Footwear High Visibility Clothing Fall Protection Safety Eyewear Hard Hat Hearing Protection Gloves Respiratory Protection Extra Clothing Environment Windy? * Yes No Rain / Thunderstorms Forecasted? * Yes No Temperature Expected to Fall Below 5C Within Next 24 Hours? * Yes No Pictures of Environment Confirmation * Please include one photo of of the weather radar application forecast supporting responses to this section as well as to the Risk Management Assessment section that follows. Choose File No file chosen Risks and Controls Rate each risk low, medium or high and identify if control measures were implemented. Plastic Shrinkage Level of Plastic Shrinkage Risk: * Low Medium High Control: Evaporation Retarder? * Yes No Rain / Thunderstorms in Forecast Level of Rain / Thunderstorms Risk: * Low Medium High Control: Weather Forecast / Weather Radar Application Consulted / Tarps? * Yes No Curling Level of Curling Risk: * Low Medium High Control: Evaporation Retarder? * Yes No Random Cracking Level of Random Cracking Risk: * Low Medium High Control: Proper Joint Spacing / Tool Depth? * Yes No Control: Isolation Materials in Place? * Yes No Mortar Flaking Level of Mortar Flaking Risk: * Low Medium High Control: Curing / Sealing Plan? * Yes No Scaling / Pealing Level of Scaling / Pealing Risk: * Low Medium High Control: Use Magnesium Floats, Not Steel? * Yes No Slab Heaving Level of Slab Heaving Risk: * Low Medium High Control: Slope and Drainage? * Yes No Slab Sinking Level of Slab Sinking Risk: * Low Medium High Control: Subgrade Compacted to Optimum Moisture and Density? * Yes No Later Surface Issues Level of Later Surface Issues Risk: * Low Medium High Control: Sealing Planned? * Yes No Other Other Risk Other Controls S.T.A.R.T. STOP, Step Back and Observe Do you understand the scope of work? * Yes No THINK Through the Task Do you know how you're going to do the task? * Yes No Do you have the appropriate tools? * Yes No ASSESS How Things Might Go Differently Have you assessed what can go wrong? * Yes No Have you assessed and minimized the risks? * Yes No REVIEW and Document Findings Have you addressed all the risks and controls on this checklist? * Yes No TALK it Through and Complete the Task Have you discussed the risks and controls with everyone who might be affected by this task? * Yes No Leave Blank