Title Page
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Site conducted
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Date of Inspection
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Contractor Name
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Contractor's Inspector Name
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Contractor Project Manager Name
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Project Name
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Project Number
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Permit Number
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Region
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Project Code (SA #)
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Reason for Inspection
- Required Maximum 7 Calendar Day Inspection
- Required 30 Calendar Day Inspection for Completed Projects
- Required Maximum 14 Calendar Day Inspection
- Required Storm Event Inspection
- Complaint
- Other
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State Complaint here
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Specify Other Reason for Inspection
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Precipitation Since Last Inspection
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Has there been a storm event since the last inspection?
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Storm event start date, precipitation amount, and storm event duration
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Source
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Current Conditions at Time of Inspection
CONSTRUCTION SITE ASSESSMENT
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Construction site perimeter contained and offsite tracking minimized?
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Disturbed areas contained?
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SWMP available online?
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Areas used for material and waste storage and fueling?
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Active stormwater at time of inspection?
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Estimated disturbed area at the time of the inspection?
SWMP MANAGEMENT
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Changes made to the SWMP during construction?
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Changes approved and noted on the plans?
CONTROL MEASURES
EROSION CONTROL
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Seed & Mulch
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Temporary Mulching
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Seed & Blanket
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Check Dams
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Diversion Berm
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Diversion Channel
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Surface Roughening
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Outlet Protection
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Additional Stabilization
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Other Control Measure
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Specify BMP Type
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
SEDIMENT CONTROL
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Inlet Protection
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Perimeter Control
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Curb Checks
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Cut Back Curb/Grade Drop
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Silt Fence
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Rock Socks
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Wattles
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Erosion Bales
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Temporary Sediment Basin
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Stabilized Construction Entrance
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Sweeping at Construction Entrance
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Other Control Measure
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Specify Control Measure Type
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
MATERIALS HANDLING & SPILL PREVENTION, WASTE MANAGEMENT AND GENERAL POLLUTION PREVENTION
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Stockpile Management
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Materials Delivery & Storage
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Spill Prevention & Control
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Concrete Washout
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Concrete Saw Water Containment
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Solid Waste
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Sanitary Waste
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Maintenance & Fueling
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Street Sweeping Vacuuming
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Dewatering
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Practice Required/Used?
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Active discharge today?
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Discharge Location
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Observations (visual quality, characteristics of discharge: color; odor; floating, settled or suspended solids; foam; oil sheen; and other indicators of stormwater pollutants.)
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Sample taken today?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
Other Control Measure
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Specify Control Measure Type
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Practice Required/Used?
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Maintenance or Sediment Removal Needed?
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Date for Action to be Completed?
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Select date
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Date Action Completed?
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Date Action No Longer Needed?
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Select date
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Additional Comments
INSPECTIONS AND MAINTENANCE PROGRAM
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Inspection Frequency
- Inspections occurring at least every 7 calendar days
- Inspections occurring at least every 14 calendar days
- Inspections occurring after storm events that result in runoff
- Inspections occurring at least every 30 calendar days since project completion
- Inspection reports retained at the construction project
- Inspection reports retained online
- Corrective measures completed within 7 calendar days of inspection
CERTIFICATION STATEMENT
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“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”
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Contractor's Inspector Sign Off
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Certification of all issues completed are on individual findings as each is completed with date.
