Stormwater Drainage Infrastructure Inspection Form
Date:
Time:
Inspector Name:
Location/Address:
Structure Type:
Inlet
Manhole
Culvert
Catch Basin
Outfall
Other
Structure ID/Number:
Condition:
Good
Fair
Poor
Structural Damage:
None
Minor
Major
Debris Present:
Yes
No
Evidence of Blockage:
Yes
No
Description of Issues:
Actions Taken:
Additional Notes:
Inspector Signature:
Date: