Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Bridge #
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Select date
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Photo 1 - Upstream Face
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Photo 2 - Downstream Face
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Photo 3 - Approach From North/West
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Photo 4 - Approach From South/East
BOX BRIDGE (OR CULVERT)
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Structural Condition
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Sidewalks
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Live Load Deflection/Vibration
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Debris Accumulation
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Condition Cell 1
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Condition Cell 2
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Condition Cell 3
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Condition Cell 4
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Upstream Apron/Wings
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Downstream Apron/Wings
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Additional Photo If Necessary
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Additional Photo If Necessary
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Additional Photo If Necessary
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Additional Photo If Necessary
NBI RATING
Scour/Waterway Appraisal
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Scour Critical (113)
- N-Bridge Not Over Water
- 9-All Piling on Dry Land
- 8-Br. Stable w/ Scour Above Top of Footing
- 7-Countermeasures Installed
- 6-Not Calc/Assessed
- 5-Br. Stable w/ Scour Within Limits of Footing
- 4-Action Req'd, Exposed Foundation
- 3-Scour Critical, Below Footing
- 2-Extensive Scour
- 1-Failure Imminent
- 0-Bridge Failed
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Scour Indicator Notes: (Describe scour condition)
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Scour Countermeasures in Place?
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Debris/Drift Upstream?
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Debris/Drift Site?
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Debris/Drift Downstream?
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Overall Channel Condition
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Indications that High Waters Overtop Structure and/or Approach Roadway?
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Route Functional Classification (26)
- 1-Rural Principal Arterial Interstate
- 2-Princ. Art. Other
- 6-Rural Mnr Art.
- 7-Rural Mjr Collector
- 8-Rural Mnr Collector
- 9-Rural Local
- 11-Urban Princ. Art Interstate
- 12-Urban Princ. Art Freeway
- 14-Urban Princ. Other
- 16-Urban Mnr Arterial
- 17-Urban Collector
- 19-Urban Local
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General Waterway/Scour Comments:
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Additional Photo if Necessary
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Inspection Team Summary
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General Notes
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Additional Photo if Necessary
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Team Leader