Anti-Slip Surface Treatment Requirement & Site Assessment

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1. CLIENT & SITE CONTACT DETAILS

Contact & Facility Information

Company / Establishment Name

Contact Person Name & Title *

Phone Number / Email *

Site Address / Location

Facility Type Select all that apply

Commercial Hotel/Resort Hospital/Healthcare Commercial Kitchen/Restaurant Residential Complex House Shopping Mall/Retail Industrial/Factory Other:

2. FLOOR SUBSTRATE & MATERIAL IDENTIFICATION

Selecting the correct substrate type is mandatory to prevent stone damage or glaze loss.

Primary Flooring Material (Check all that apply)

Vitrified / Porcelain Tiles Glazed Ceramic Tiles Polished Natural Marble Limestone / Travertine Terrazzo / Agglomerate Stone Granite Concrete / Cementitious Screed Epoxy / Polyurethane Coating Other:

Current Surface Finish

High-Gloss Polished Semi-Gloss / Honed Matte / Unpolished Textured / Anti-Skid Other:

Existing Surface Treatments / Coatings

Has the floor been sealed, waxed, or coated with any polish or sealer in the last 12 months?

Yes No Unknown

If Yes, specify coating type (if known):

3. AREA SCOPE & OPERATIONAL ENVIRONMENT

Target Application Area(s) (Check all applicable zones)

Main Lobby / Reception Restrooms / Washrooms Pool Deck / Wet Recreation Kitchen / Food Prep Area Ramps / Walkways Staircases / Steps Balconies / Terraces Industrial Shop Floor Other:

Total Estimated Area Total Square Feet / Square Meters:

Environmental Exposure

Indoor (Enclosed) Outdoor (Direct Sun / Rain) Covered Outdoor / Semi-Exposed

Primary Slip Hazard Contaminants Present

Plain Water / Rainwater Soap / Shampoo / Body Wash Cooking Oil / Food Grease Industrial Oils / Lubricants Dust / Fine Powders

4. SAFETY OBJECTIVES & PERFORMANCE EXPECTATIONS

Traffic Type & Footwear (Select all that apply)

Barefoot Traffic (Poolsides, Spa, Residential Bathrooms) Standard Footwear / Shoes (Lobbies, Malls, Offices) Heavy Work Boots / Safety Shoes (Kitchens, Factories) High Heels / Dress Shoes (Event Venues, Banquet Halls) Flip-Flops / Slippers (Pool Decks, Residential) Wheelchair / Mobility Aid Users (Hospitals, Malls) Trolleys / Wheeled Equipment (Retail, Kitchens)

Gloss Maintenance Requirement (Select all that apply)

Is maintaining original high-gloss shine critical for this area?

Critical (Zero gloss reduction permitted — Marble/Granite) Moderate (Minor micro-texture allowed — Tiles/Lobbies) Not Critical (Maximum friction priority — Kitchens/Ramps) Gloss Not a Priority (Industrial / Outdoor) Anti-Slip Priority Over Aesthetics

Additional Safety Objectives

Emergency Exit / Evacuation Routes Food Hygiene / Sanitation Compliance Accessibility Requirements (Elderly / Differently-abled) Forklift / Heavy Equipment Traffic Pet Traffic (Residential, Outdoor)

Slip Incident History / Audit Needs

Have there been recent slip-and-fall incidents in this area?

Yes No

Is this treatment required for a specific safety compliance audit?

Yes No

5. SITE ACCESS & LOGISTICAL CONDITIONS

Requirement	Site Availability
Running Clean Water Access	Available within 10 meters Available on same floor Not directly available
Floor Drainage System	Active floor drains present No drains (Requires wet-vac extraction)
Power Supply (16A / 220V)	Available Not Available
Ventilation Status	Good cross-ventilation / Open air Closed AC environment (Requires forced exhaust)
Permitted Application Hours	Regular Working Hours (9 AM – 6 PM) Night Shift Only (10 PM – 6 AM) Weekend Only Not Applicable
Max Permitted Shutdown Time	1 to 2 Hours 4 to 6 Hours Overnight (8+ Hours) Not Applicable

6. CURRENT CLEANING & MAINTENANCE ROUTINE

Daily Cleaning Chemical Used

Neutral Floor Cleaner Bleach/Chlorine Acidic Cleaner Degreaser Plain Water

Cleaning Equipment Used

Manual Mop Auto-Scrubber Dryer High-Pressure Washer Single-Disc Floor Machine

7. AUTHORIZATION & SIGN-OFF

Form completed by — Name:

Designation:

Date:

Required fields are marked. Please do not include passwords, payment-card information, or other sensitive data. Enquiries are reviewed during normal business operations; response time depends on the request.

1. THE SLIPPING PROBLEM

Why is the floor slipping?

Describe the problem * e.g. people slipping when the floor is wet, staff avoid a walkway, a claim was raised, etc.

Why do you need the SCOF value? e.g. verify that a coated floor passes a standard, compare before/after treatment, regulatory audit, etc.

2. FLOOR & SITE DETAILS

Where is the floor and what is it made of?

Site / building / floor location *

Floor material

Premises type

Current surface condition

3. CONTACT & PREFERRED TIMING

How can we reach you?

Your name *

Phone / WhatsApp *

Preferred inspection date

Preferred time slot

Other details

Anti-Slip Surface Treatment Requirement & Site Assessment Form