GPR Checklist / Inquiry Form

for Tri-state Concrete Scanning

Project Name
Project Location
Date / MM / DD YYYY
Requester's name
Phone - (###) - ### ####
Company Name
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email
Approximate Slab thickness
Number of scan locations
Approximate Size
Scanning Date / MM / DD YYYY
Concrete Type
Type of Scan
Top layer of material
Type of scan required
Secondary questions
Can both sides of the slab be accessed? Yes No
Is security check/clearance, vendor/subcontractor agreement, safety training or any other paperwork required prior to the commencement of scanning Yes No
If yes, what?
Are there live conduits or fire alarms in the slab? Yes No
Does the slab have post tension cables? Yes No
Does the slab have post tension cables? Yes No
Will scanning be done outdoors or in exterior weather conditions? Yes No
Is the concrete at least 6 months old? Yes No
Will a representative from your company be available to designate alternate locations for core if scanned areas are not clear and also to review results once scanning is complete? Yes No
Will payment be made within 30 days of invoice date? Yes No
Obstructions below the scanned slabs will be examined prior to scanning? Yes No