Quality Control Plan for Painting Form

I. Project Information

Project Name

Contract ID

State/Federal Project Number

Bridge Number

District

County

Bridge Color - Reference

II. Contractor/Fabricator Information

Contractor/Fabricator Name

Contractor/Fabricator Phone Number

Contractor/Fabricator Address

Contact Person

Official Responsible for Quality Control

Liaison with Division of Highways Personnel

III. Coating Information

Name of Coating Supplier

Primer Name/Quantity

Quantity of Coatings to be Used

Intermediate Name/Quantity

WV DOH Material/System Approval Number

Top Coat Name/Quantity

Type and Amount of Thinner, if Needed

Concrete Coating Name/Quantity

Area of Steel to be Coated Per Plans

Area of Concrete to be Coated Per Plans

IV. Corrective Action Information

Correction of Coating Flaws

Procedure for Equipment Clean Up

Procedure for Spillage Clean Up

V. Inspection Information

Person(s) Conducting Inspection

Level of Surface Preparation Required

Areas to be Inspected

Instrument Used for Profile Height/Anchor Pattern

Method for Determining Relative Humidity

Ambient Temperature

Steel Temperature/Concrete Temperature

Dew Point

Magnification Inspection

Wet Film/Dry Film Thickness Gauge

Dry Film Thickness Measurement Documentation

Upon completion of this form, please submit to the West Virginia Division of Highways, Materials Control, Soils and Testing using the submit button below. An email will be generated with the plan attached and the address populated for sending. Please attach any supporting documentation at that time.

Person Completing Form

Contact Phone Number

Contact Email Address