Anti-Static Flooring Assessment

Anti-Static Flooring Assessment
Please complete this assessment to document the condition and compliance status of anti-static flooring at your facility.
Facility Name*
Facility Address*
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Assessor's Full Name*
First NameLast Name
Assessor's Email Address*
example@example.com
Date of Assessment*
MonthDayYear
Date
Type of Anti-Static Flooring Installed*
Installation Date of Flooring
MonthDayYear
Date
Surface Resistance TestPoint-to-Point ResistanceWalking TestVisual InspectionOther

Assessment Results Matrix*