Billboard Structure Inspection 4.0

• Conducted on

  Date

• Prepared by

• Location
  Address

• City or Town

• Structure #

• Permit #

• Electrical Meter #

• Panel/Face Number(s)

• Structure Type

  Select Monopole I-Beam Wood Pole A-Frame Wall Mount

  • Monopole
  • I-Beam
  • Wood Pole
  • A-Frame
  • Wall Mount

• Face Size

  Select 14x48 Poster 12x24 10'6"x36' 10x30 12x48 Other

  • 14x48
  • Poster
  • 12x24
  • 10'6"x36'
  • 10x30
  • 12x48
  • Other

• Take Picture Of Structure

  Media

Walk Around Inspection

• Obvious defects, i.e. is structure leaning?

  Safe

  At Risk

  N/A

• Note any obvious hazards:

  Safe

  At Risk

  N/A

All Foundations: (Important! Must dig down to concrete if it is below ground level)

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

• * Are there any obvious cracks in concrete?

  Yes

  No

  N/A

• * Are there any voids between concrete and Monopole

  Yes

  No

  N/A

• * Are there any voids where concrete meets ground?

  Yes

  No

  N/A

• * Are all nuts on anchor bolts and are they tight?

  Yes

  No

  N/A

• * Is there excessive rust on anchor bolts, plates, gussets or I-Beams? (Important! Using a hammer,<br>check the integrity of the steel on any areas showing rust, no matter how minor. Areas of<br>deterioration must be noted on this form and dealt with immediately)

  Yes

  No

  N/A

• * Are all welds around base plate in good shape?

  Yes

  No

  N/A

• * Are all welds around gusset plates in good shape?

  Yes

  No

  N/A

• * Is grout under the base plate(s) in good condition?

  Yes

  No

  N/A

• Comments

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

Transitions:

• Are There Telescoping transitions?

  Yes

  No

• * Fillet weld to upper pipe

  Safe

  At Risk

  N/A

• * Fillet weld to lower pipe

  Safe

  At Risk

  N/A

• * Plug welds

  Safe

  At Risk

  N/A

• * Gusset welds

  Safe

  At Risk

  N/A

Butt splices on column/I-Beam:

• Are There Butt Splices?

  Yes

  No

• * Check all welds around column/I-Beam for obvious cracks

  Safe

  At Risk

  N/A

• * Any voids in welds

  Yes

  No

• * Any material failure

  Yes

  No

• * Any shimming in weld area with foreign objects

  Yes

  No

• * How is overall quality of the welds?

  Safe

  At Risk

  N/A

• * How is condition overall?

  Safe

  At Risk

  N/A

• Comments:

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

• Are There Plate To Plate Bolted Splices?

  Yes

  No

• * Are there any deformations in the plates?

  Yes

  No

  N/A

• * Are the bolts tight?

  Yes

  No

  N/A

• * Are any bolts missing?

  Yes

  No

  N/A

• * Are bolts in need of replacement?

  Yes

  No

  N/A

• * Are gussets in good condition?

  Yes

  No

  N/A

• * Are all welds in good condition?

  Yes

  No

  N/A

• * Are there any cracks in any welds?

  Yes

  No

  N/A

• Comments:

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

Welds:

• * Column plate to pipe

  Safe

  At Risk

  N/A

• * Gusset plates to pipe

  Safe

  At Risk

  N/A

• * Gusset plates to column plate

  Safe

  At Risk

  N/A

• * Torsion pipe to riggers

  Safe

  At Risk

  N/A

• * Is there any visible space between column plate to head plate?

  Yes

  No

  N/A

• * Are there any nuts or bolts missing?

  Yes

  No

  N/A

• * Are all connecting nuts and bolts tight?

  Yes

  No

  N/A

• * Is there excessive rust on nuts and bolts?

  Yes

  No

  N/A

• * Is there any visible shimming of foreign material between plates?

  Yes

  No

  N/A

• * Is there excessive visible rust between plates?

  Yes

  No

  N/A

• * How is overall condition?

  Safe

  At Risk

  N/A

• Comments

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

• Welds at beam to pipe connection above head plate

  Safe

  At Risk

  N/A

• Welds at outrigger connections to pipe

  Safe

  At Risk

  N/A

• Condition of pipe

  Safe

  At Risk

  N/A

• * Is pipe dimpled anywhere?

  Yes

  No

  N/A

• * Is pipe torn anywhere?

  Yes

  No

  N/A

• Comments:

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

Materials:

• * Is there any deformation of clips to uprights?

  Yes

  No

  N/A

• * Is there any deformation of gussets to uprights?

  Yes

  No

  N/A

• *Is there any twisting or deformation of uprights?

  Yes

  No

  N/A

Condition of welds:

• * Clips to uprights

  Safe

  At Risk

  N/A

• * Clips to outrigger

  Safe

  At Risk

  N/A

• * Clips to stringers

  Safe

  At Risk

  N/A

• * How is overall condition?

  Safe

  At Risk

  N/A

• Comments:

• Structure Type

  Monopole

  I-Beam

  Wood Pole

  A-Frame

Angle Iron:

• * Check all welds around angle for obvious cracks

  Safe

  At Risk

  N/A

• * Any voids in welds

  Yes

  No

• * Any material failure

  Yes

  No

• * Any shimming in weld area with foreign objects

  Yes

  No

• * Are there any nuts or bolts missing?

  Yes

  No

• * Are all connecting nuts and bolts tight?

  Yes

  No

  N/A

• * Is there excessive rust on nuts and bolts?

  Yes

  No

• * How is overall quality of the welds?

  Safe

  At Risk

  N/A

Materials:

• * Is there any deformation of clips to uprights?

  Yes

  No

• * Is there any deformation of gussets to uprights?

  Yes

  No

• * Is there any twisting of deformation of uprights?

  Yes

  No

Condition Of Welds:

• *Clips to uprights

  Safe

  At Risk

  N/A

• *Clips to outriggers

  Safe

  At Risk

  N/A

• * Clips to stringers

  Safe

  At Risk

  N/A

• * How is overall condition?

  Safe

  At Risk

  N/A

• Are The Fixed Access Ladders?

  Yes

  No

Materials:

• * Are there an ladder rungs missing?

  Yes

  No

  N/A

• * Are any ladder rungs bent?

  Yes

  No

  N/A

• * Are all bolted connections secured?

  Yes

  No

  N/A

• * Welds on tabs from ladder to structure

  Safe

  At Risk

  N/A

• * How is overall condition?

  Safe

  At Risk

  N/A

• *Are the ladder safety cables installed properly and in good condition

  Yes

  No

  N/A

• Comments:

• Are There Catwalks Installed?

  Yes

  No

• * Connections - catwalk to walk arms

  Safe

  At Risk

  N/A

• * Connections - catwalk to walk around catwalk

  Safe

  At Risk

  N/A

• * Condition of steel grating

  Safe

  At Risk

  N/A

• * Are safety cables-life lines in good condition?

  Yes

  No

  N/A

• * Are safety cables secured correctly on all catwalks?

  Yes

  No

  N/A

• * How is overall condition?

  Safe

  At Risk

  N/A

• Comments:

• Is There An Electric Service

  Yes

  No

• * The condition of the light fixtures

  Good

  Fair

  Poor

  N/A

• * The condition of electrical service

  Good

  Fair

  Poor

  N/A

• * Are all lights working?

  Yes

  No

  N/A

• * Is the time clock set to the correct time?

  Yes

  No

  N/A

• * Are there any power line problems?

  Yes

  No

  N/A

• * Does the structure need painting?

  Yes

  No

• * Is the Adams logo fastened correctly (centered on skirt)

  Yes

  No

  N/A

• How is overall condition of Skirt/apron?

  Good

  Fair

  Poor

  N/A

• Note any areas of importance or concern

• Additional Photos

  Media

• Signature of Inspector

  Sign