Gregory Porter

Less than 20

Information needed for WV DOH when conducting an inspection on structures less than 20’ in length.

Use this Template

Print as PDF

Use this Template

Title Page

Conducted on
Prepared by
Location

County
Route
SubRoute
Milepost
Road Type
Road Name
Structure Type
Construction Material
Stream
Structure Number
Structure Name
Year Built (if known)
Spaning
Span Length (FT-IN)
Width (FT-IN)
Waterway Height (FT-IN)
ADT
Overall Rating
Substructure
Superstructure
Deck
Wearing Surface
Railing
Alignment
Waterway
Paint
Posting
Posting
Posting Date
Does this structure have any of the following defects
- Spalling Concrete
- Scaling Concrete
- Cracking Concrete
- Efflorescence
- Seperation
- Undermining
- Pot Holes
- Cracking Pavement
- Wear Rutting
- Shoulder Erosion
- Steel Section Loss
- Rust Scale
- Rust Packing
- Encroachment
- Utility
Encroachment Notes
Utility Notes
Sediment Deposition
Replacement
Major Work
Minor Work
Notes:
Inspected By:
Date of Inspection
Next Inspection
Comments:
Approach Photo
Profile Photo
Photo 3
Photo 4
Photo 5
Photo 6
Photo 7

Gregory Porter

Less than 20

Information needed for WV DOH when conducting an inspection on structures less than 20’ in length.

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.