Medium Density Daily Work Record

General Information

Daily Work Record # *

Date *

Contractor *

Email *

Installer *

Installer Certification # *

Apprentice

Apprentice Registration #

Project Information

Project Name *

Street Address *

City *

Province *

Customer Name *

Construction *

Ventilated 0.3 ACH *

Spray Area Isolated *

Building Permit Posted *

If Yes Provide The Building Permit #

Warning Signs Posted *

Company responsible for thermal barrier *

Material Information

Manufacturer *

Product Trade Name/Number *

Product Type *

Material CCMC # *

Lot # - A Component *

Expiry Date - A Component *

Lot # - B Component *

Expiry Date - B Component *

Quantity of foam used (today) *

Equipment Information

Proportioner Model *

Hose Length (feet or meter) *

Primary Heater Temperature (°C or °F) *

Hose Temperature (°C or °F) *

Pressure - A Side (psi) *

Pressure - B Side (psi) *

Environmental Conditions

Ambient Temp (°C or °F) *

Relative Humidity (%) *

Wind Velocity (km/h) *

Substrate Temp (°C or °F) *

Substrate Conditions

Substrate Type *

Was The Substrate Clean *

Was The Substrate Dry *

Properly Fastened / Proper Adhesion *

Special Conditions

Primer Required *

If Yes Provide Details

Exterior Coating Required *

Interior Thermal Barrier *

On-Site Test Results

Weight of Sample (m) *

Volume of Sample (v) *

Calculated Density (kg/m³) NOTE: Density = m ÷ v x 1000 *

Minimum Required Density (kg/m³) *

Site Density equal or greater *

Adhesion Test *

Cohesion Test *

Number of Passes *

Thickness per Pass (mm) *

Total Foam Thickness (mm) *

Job Site Label Installed *

I hereby agree that the above information provided is true. This action takes the place of your signature.

* These fields are required.