Attachment 3_QA FORMS_.xlsx

XLSX spreadsheet 60 KB Posted Sep 4, 2024

Attached to: DRYDOCK: USCGC KATHLEEN MOORE DD FY25
Solicitation number: 70Z08024QPBPL0043
Issued by: Department of Homeland Security US Coast Guard

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Written by GovTribe AI · Sep 4, 2024

This document is a Preservation Plan Instructions and Quality Assurance Forms for a federal contract opportunity.

The Preservation Plan Instructions detail the requirements for contractors to provide a complete description of the coating systems that will be used to complete the Statement of Work (SOW) for the USCGC KATHLEEN MOORE DRYDOCK FY2025 contract opportunity. Key information required includes vessel details, work item numbers, coating system names, brand names, storage requirements, color, surface preparation standards, dry film thickness ranges, and environmental conditions.

The Quality Assurance Forms QA1, QA2, and QA3 outline the procedures for the contractor to record surface preparation methods, soluble salt measurements, environmental conditions, and final coating thickness measurements. These forms must be filled out, signed by the contractor and Coatings Inspector, and submitted as evidence of compliance with the contract requirements.

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Other files

File	Type	Posted
Amendment 0005_ext.pdf	PDF	Sep 23, 2024
Amendment 0004_QA.pdf	PDF	Sep 17, 2024
Amendment 0003_QA.pdf	PDF	Sep 13, 2024
QA Attachment.pdf	PDF	Sep 9, 2024
Amendment 0002.pdf	PDF	Sep 9, 2024
Attachment 3_WISS v1.0 & VCS v1.0.pdf	PDF	Sep 4, 2024
Amendment 0001.pdf	PDF	Sep 4, 2024
Attachment 1_BLANK Schedule of Services.xlsx	XLSX spreadsheet	Sep 3, 2024
Attachment 2_Specification.pdf	PDF	Sep 3, 2024
70Z08024QPBPL0043.pdf	PDF	Sep 3, 2024

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PRESERVATION PLAN

INSTRUCTIONS

GENERAL - Provide a complete description of each "coating system" that will be used to complete this SOW. Submit this spreadsheet, or provide the same information in a word doc, PDF, etc. A "Sample" Preservation Plan is provided on the "Sample PRESERVATION PLAN" tab of this Excel doc.

1a. List the vessel name that will be coated, 1b. the name of the prime contractor, and 1c. if coatings application work will be subcontracted the name of the subcontractor who will be prepping surfaces or applying the coatings. 2. Identify each work item number the coating system will be used in. 3. List either the preservation Tasks from the work item, or the surfaces that will be coated. 4. Provide the "Coating System Name" that is being applied (e.g., PolySLXN4, RollOn1(FlxMbrn), WthrDck1(STL-BG), etc.). These are either listed in the SOW with the Task (will map to Section 6 of VCS), and listed in Section 6 or Section 8 of Coast Guard Vessel Coatings Specifications (VCS).

5. Brand Name List each brand name of paint that will be used. Ideally, these will be listed in Section 7 of VCS, but may also be listed in Section 8 of VCS if appropriate. If it is not possible/practicable to use a coating from either of those lists an alternate coating may be proposed. Indicate that a new coating is being proposed and provide justification for using an alternate in the NOTES/ADDENDUMS section of the affected coating system below. That proposed coating may be approved for use, pending.

6. Storage TEMP/Humifity Requirements - Describe the storing Storage TEMP/Humifity Requirements specified on the Product Data Sheet of each coating that will be used. This is certifying/acknowledging that the coatings will be stored in accordance with the manufacturer's requirements.

7. Color - List the colors that will be procured and used as described in the SOW for each system.

8. Acceptable Anchor Tooth Profile Range - Describe the acceptable anchor tooth profile range described in the Product Data Sheet for the primer coating. This range must be achieved prior to applying the primer coat. Discrepancies with the existing anchor tooth profile of a surface must be reported immediatly so that corrective action can be authorized.

9. Preparation/Cleanliness Standard(s) - List or describe the preparation standards (e.g., SSPC SP-10, SSPC SP-11, SSPC-SP WJ-2(L), etc.) that will be met, as specified on the applicable coating Product Data Sheet.

10. Target DFT Range - List/describe the DFT ranges that will be met for each coat as prescribed on the applicable on the applicable coating Product Data Sheet.

11. Cure Time/Recoat Window - List/describe the Cure Time/Recoat Window that will be met for each coat as prescribed on the applicable coating Product Data Sheet.

12. Enviromental Range - List/Describe the enviromental temperatures and humidity ranges that are allowable for coating application as prescribed on the applicable coating Product Data Sheet.

13. Notes/Addendums - List/describe all other pertanant information applicable to the application of the coating system (e.g., proposals for alternate coatings, a description of tents/enclosures that will be constructed to control climate/prevent overspray/etc., min time between top-coat and undocking, required deviations from coating MFG’s instructions, etc.)

PRESERVATION PLAN

1a. Vessel Name

1b. Prime Contractor

1c. Subcontractor

Coating System 1
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Acceptable Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. Notes/Addendums

Coating System 2
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 3
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 4
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 5
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 6
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 7
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 8
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 9
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 10
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 11
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 12
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

Coating System 13
2. Work Item Number(s)
3. Task(s)/Surfaces
4. Coating System Name
	Coat 1 (Primer)	Coat 2	Coat 3	Coat 4	Coat 5	Coat 6
5. Brand Name
6. Storage TEMP/Humifity Requirements
7. Color
8. Anchor Tooth Profile Range
9. Preparation/Cleanliness Standard(s)
10. Target DFT Range
11. Cure Time/Recoat Window
12. Enviromental Range
13. NOTES/ADDENDUMS

QA1 (PREPARATION DATA)

INSTRUCTIONS
	GENERAL - These forms must be filled out and submitted when tasked to perform COATINGS QUALITY ASSURANCE CHECKPOINTS (631b) and submit COATINGS QA FORMS (631b) by the SOW. The intent is for the Contractor to "print off" paper copies of QA FORMs 1-3 so that data can be recorded on or near the vessel, immediately after preparation and coatings application data has been taken, and so that the data can be certified accurate by the Coatings Inspector (CI). Then, after the forms are completed and signed, scan the forms back into the computer and Submit the final signed/dated version as a .pdf electronic document upon completion of work.
1	Write into the form the information identifing the vessel, work item, surface being coated, etc. An individual representing the contractor must print his/her name, sign (sig), and then provide an initial (int) that will be used to certify the data points being taken. The designated Coatings Inspector (CI) must do the same.
2	SURFACE PREPARATION METHODS AND ABRASIVES - List all of the surface preparation methods (e.g., SSPC SP10, SSPC SP11, etc.) that were used to prepare the designated surfaces/components. If abrasive blasting is used, describe the abrasive type/manufacturer/sieve-size.
3	ABRASIVE BLAST EQUIPMENT TESTING - If 1) abrasive blasting is required, or 2) the Contractor elects to use abrasive blasiting, and if the SOW designates that ABRASIVE BLAST EQUIPMENT TESTING (631b) is required then certify that the blasting equipment is properly adjusted and profiled the disposable coupon as required by the applicable standard and the coatings manufacturer's instructions. This must be performed prior to blasting Coast Guard owned components/surfaces to ensure they are not damaged, and that the correct profile is ultimately obtained. Certify that this testing has been accomplished satisfactoriy before proceeding.
4	LOCATION and AREA - At least 3 measurement sets must be recorded (i.e., each numbered row in the table below is 1 measurement set) . An additional measurement set must be recorded every 500 sqft of prepared surface beyond 1500 sqft (e.g., up to 1500 sqft requires at least 3 measurement sets, 1501 sqft requires at least 4 measurement sets, 2001 sqft requires at least 5 measurement sets, etc.) . The locations of the measurement sets must be approximately equally spaced and taken in locations that are representative of the actual mean surface profile in the subject area. Describe the location of the measurement set in the space provided (i.e., “FREEBOARD, ~FR40, midway between main deck/boot-top, 500sqft”, etc.). See the SAMPLE QA1 tab in this spreadsheet for a sample data sheet that has been filled out properly.
4a	Method (ASTM D4417) - Record in the blank the method used ("B" or "C") to take the readings for the measurement set, either ASTM D4417 Method B or ASTM D4417 Method C.
4b	Allowable Range (mils) - Record the acceptable profile range. This should already be designated on the PRESERVATION PLAN (Submission), and will either be specified in the Coatings Manufacturer's Instructions or in the SOW.
4c	Profile Measurement Set - Record the actual measured minimum, maximum, and mean of all surface profile readings taken per ASTM D4417 Methods B & C for that measurement set.
4d	Surface Cleanliness & Profile Are In Tolerance - Certify that the LOCATION and AREA belonging to the measurement set is ready for primer-coat application prior to proceeding (i.e. surface is clean, possesses a proper profile, etc) by checking the SAT box.
5	VERIFICATION INITIALS - Both the KTR and the designated CI must certify the accuracy of each Certify that each test/measurement is accurate and meets standards by 1) initialing, 2) dating, and 3) time-stamping each measurement. Do not apply coatings to a surface/area that has not been certified satisfactory.

1.	VESSEL NAME/HULL#: WORK ITEM # TITLE: SURFACE/COMPONENT/TASK NAME:
	CONTRACTOR (KTR) NAME (print) (sig) (int)
	COATINGS INSPECTOR (CI) NAME (print) (sig) (int)

		2. SURFACE PREPARATION METHODS AND ABRASIVES
									5. VERIFICATION INITIALS
		3. ABRASIVE BLAST EQUIPMENT TESTING	□ SAT \| □ UNSAT \|□ Not Applicable						KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		4. LOCATION and AREA	4a. Method (ASTM D4417)	4b. Allowable
Range (mils)	4c. Profile Measurement Set		4d. Surface Cleanliness & Profile Are In Tolerance
					MAX (mils)	MIN (mils)	MEAN (mils)
		1						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		2						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		3						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		4						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		5						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		6						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		7						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		8						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		9						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		10						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		11						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		12						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		13						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		14						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		15						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		16						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		17						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		18						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		19						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		20						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		21						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		22						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		23						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		24						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		25						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		26						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		27						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		28						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		29						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		30						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		31						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		32						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		33						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		34						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		35						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		36						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		37						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		38						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		39						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		40						□ SAT \| □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		Notes:

&"-,Bold"&22&A

QA2 (APPLICATION DATA)

INSTRUCTIONS
	GENERAL - These forms must be filled out and submitted when tasked to perform COATINGS QUALITY ASSURANCE CHECKPOINTS (631b) and submit COATINGS QA FORMS (631b) by the SOW. The intent is for the Contractor to "print off" paper copies of QA FORMs 1-3 so that data can be recorded on or near the vessel, immediately after preparation and coatings application data has been taken, and so that the data can be certified accurate by the Coatings Inspector (CI). Then, after the forms are completed and signed, scan the forms back into the computer and Submit the final signed/dated version as a .pdf electronic document upon completion of work.
1	Write into the form the information identifing the vessel, work item, surface being coated, etc. An individual representing the contractor must print his/her name, sign (sig), and then provide an initial (int) that will be used to certify the data points being certified. The Coatings Inspector (CI) designated in the SOW must do the same.
2	Final Soluble Salt Conductivity Measurements (FSSCM) - Record the total Prepared Surface Area in sqft. Immediately prior to applying the primer-coat record at least 5 total “Final Soluble Salt Conductivity Measurements”, and for areas over 1,125 sqft, takes at least 1 measurement for every 225 sqft (approx 15' x 15' area) of prepared surface in accordance with SSPC-Guide 15. These measurements must be equally spaced across the entire prepared surface.

Maximum allowable value for a Submerged Surface: 30 microsiemens/cm Maximum allowable value for a Non-Submerged Surface: 70 microsiemens/cm

2a	VERIFICATION INITIALS - Certify that the measured/recorded FSSCM data is accurate and satasafcory.
3	Enviromental and Surface Conditions - In conjunction with completing FSSCM, record and certify accurate and satisfactory an initial set of ambient climate/surface readings; must be certified immediately prior to applying the primer-coat. Then a least one set of ambient climate/surface readings must be recorded at the start of each shift until the top-coat has dried/cured. A set of ambient climate/surface readings must also be taken immediately prior to applying each subsequent coat of paint. There are 3 types of sets of ambient climate/surface readings: 1) Initial – This is the first set of readings logged immediately prior to applying the primer coat; requires CI witness/initials. 2) Application Time (A) – This is logged immediately prior to applying any subsequent coat; requires CI witness/initials. 3) Periodic (P) – This is any other periodic set of readings taken while a coat is drying/curing; CI initials may be left blank. Check the Reading Type below (“A” or “P”). ΔT = This is the Dew Point minus the Surface Temp. RH = Relative Humidity
4a	Initial Reading Set - certify that the prepared surface is clean, dry, and FSSCM readings are satisfactory, per Product Data Sheet requirements, immediately prior to applying the primer coat.
4b	Application Time Reading Set - certify that the prepared surface is clean and dry, per Product Data Sheet requirements, immediately prior to applying all subsequent coats.
4c	Periodic Reading Set - certify that the prepared surface is clean and dry readings, per Product Data Sheet requirements, as prescribed in 3 above.
5	VERIFICATION INITIALS - Certify the accuracy of each reading set and record the date and time the readings were taken.

1.	VESSEL NAME/HULL#: WORK ITEM # TITLE: SURFACE/COMPONENT/TASK NAME:
	CONTRACTOR (KTR) NAME (print) (sig) (int)
	COATINGS INSPECTOR (CI) NAME (print) (sig) (int)

2. Final Soluble Salt Conductivity Measurements (FSSCM) in (microsiemens/cm)		2a. VERIFICATION INITIALS
	Prepared Surface Area (sqft)	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM

			1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
			16	17	18	19	20	21	22	23	24	25	26	27	28	29	30
			31	32	33	34	35	36	37	38	39	40	41	42	43	44	45
			46	47	48	49	50	51	52	53	54	55	56	57	58	59	60
			61	62	63	64	65	66	67	68	69	70	71	72	73	74	75
			76	77	78	79	80	81	82	83	84	85	86	87	88	89	90
			91	92	93	94	95	96	97	98	99	100	101	102	103	104	105
			106	107	108	109	110	111	112	113	114	115	116	117	118	119	120
			121	122	123	124	125	126	127	128	129	130	131	132	133	134	135
		3. Enviromental and Surface Conditions
			Reading Set
Type	Temperatures Readings (˚F)				RH
%	4. Observed Condition of Surface
				Dew Point	Surface	Ambient	ΔT				5. VERIFICATION INITIALS
		1	Initial						□ SAT Clean □ SAT Dry
□ SAT FSSCM		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		2	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		3	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		4	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		5	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		6	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		7	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		8	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		9	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		10	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		11	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		12	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		13	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		14	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		15	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		16	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		17	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		18	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		19	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		20	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		21	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		22	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		23	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		24	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		25	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		26	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		27	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		28	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		29	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		30	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		31	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		32	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		33	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		34	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		35	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		36	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		37	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		38	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		39	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
		40	□ A □ P						□ SAT Clean □ SAT Dry		KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM

&"-,Bold"&22&A

QA3 (FINAL DFT DATA)

INSTRUCTIONS
	GENERAL - These forms must be filled out and submitted when tasked to perform COATINGS QUALITY ASSURANCE CHECKPOINTS (631b) and submit COATINGS QA FORMS (631b) by the SOW. The intent is for the Contractor to "print off" paper copies of QA FORMs 1-3 so that data can be recorded on or near the vessel, immediately after preparation and coatings application data has been taken, and so that the data can be certified accurate by the Coatings Inspector (CI). Then, after the forms are completed and signed, scan the forms back into the computer and Submit the final signed/dated version as a .pdf electronic document upon completion of work.
1	Write into the form the information identifing the vessel, work item, surface being coated, etc. An individual representing the contractor must print his/her name, sign (sig), and then provide an initial (int) that will be used to certify the data points being taken. The designated Coatings Inspector (CI) must do the same.
2	Coating Thickness Measurement Instrument Data - Describe in this block: A) the type of instrument used, including manufacturer, model number, serial number, and date of calibration, B) the type of certified standard used to verify gage accuracy, including manufacturer, model number, serial number, and thickness value(s), C) the thickness of the measured shim(s) used to adjust a Type 2 gage, D) the average BMR (if appropriate).
3	Coating Thickness Measurements - Conform to SSPC PA-2. Fill out the measurement table.

At least 1 measurement set (i.e., each row in the table below is 1 measurement set) must be recorded per 100 sqft of coated surface. An additional measurement set must be recorded every 100 sqft of coated surface beyond 100 sqft (e.g., up to 100 sqft requires at least 1 measurement set, 101 sqft requires at least 2 measurement sets, 201 sqft requires at least 3 measurement sets, etc.) . The locations where the measurement sets are taken must be approximately equally spaced and must be representative of the actual mean coating thickness in the subject area.

Location: Describe the location of the measurement set (i.e., “FREEBOARD, ~FR40, centered 5ft below main deck”, etc.).

SPOT MEASUREMENTS: See SSPC PA-2 for instructions. Certify the measurements are in tolerance by circling “SAT”.

4 VERIFICATION INITIALS - Certify the accuracy of each reading set and record the date and time the readings were taken.

1.	VESSEL NAME/HULL#: WORK ITEM # TITLE: SURFACE/COMPONENT/TASK NAME:
	CONTRACTOR (KTR) NAME (print) (sig) (int)
	COATINGS INSPECTOR (CI) NAME (print) (sig) (int)

2. Coating Thickness Measurement Instrument Data							4. VERIFICATION INITIALS
							KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
3. Coating Thickness Measurements
Location	SPOT MEASUREMENTS
	(each is an avg of 3 readings)
	1	2	3	4	5
1						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
2						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
3						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
4						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
5						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
6						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
7						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
8						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
9						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
10						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
11						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
12						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
13						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
14						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
15						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
16						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
17						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
18						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
19						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
20						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
21						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
22						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
23						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
24						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
25						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
26						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
27						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
28						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
29						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
30						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
31						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
32						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
33						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
34						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
35						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
36						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
37						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
38						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
39						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM
40						□ SAT □ UNSAT	KTR ______ (int) CI _______ (int) Date:______/______/______ Time: _____:_____ AM/PM

&"-,Bold"&22&A

File details come from the government source that posted it. Updated Sep 4, 2024.