Title Page

  • Site conducted

  • BMP ID

  • Project

  • Conducted on

  • Start Time

  • Stop Time

  • Inspector

  • Address
  • Inspection Status Codes:
    S = Satisfactory
    D = Deficient
    * = Refer to Form B (Specials) and/or Form C (Notes).

  • Are there any special conditions and/or maintenance requirements noted for BMP(s)?

  • If Yes, attach Form B for Project. See 2nd Page

Drainage

  • Drawdown - Drainage - Vector Risk - Pump OutBlockage

  • D1 Evidence of standing or ponding of water in the BMP area after 72 hours of dry weather?

  • D2 Does the high flow bypass function as designed?

  • D3 Is there sediment acumination in or around BMP?

  • D4 Has water been observed flowing in the pervious concrete section during a low intensity storm?

Erosion

  • Hydraulic Function - Failure - Sediment Clogging

  • E1 Is there under cutting or washouts along the sidewalks and/or curbs abutting the planter area?

  • E2 Is there channelization (gully) forming along the length of the planter area?

  • E3 Is there accumulation of sediment (sand, dirt, mud) in the planter area ?

  • E4 Observed or potential transport of mulch to drainage system?

  • E5 Are there voids or holes present in the BMP?

  • E6 Is there evidence of animal activity?

Vegetation

  • Excessive Mowing - Herbicide Overuse - Health of Desired Vegetation -

  • V1 Is the vegetation clogging the inlet or flow path?<br>

  • V2 Evidence of Excessive Mowing and/or Herbicide Overuse?

  • V3 Are there dead or dry plants or excessive weeds?

  • V4 Is there an absence of correct vegetation?

General

  • Trash and Debris - Improper Modifications - Damage

  • G1 Is there debris/trash accumulation in the BMP or high flow by pass?

  • G2 Missing or damage structural features? (Grates, pipes, walls, curbs, etc.)

  • G4 Evidence of improper modifications or removal of BMP?

Special Features

  • See Additional Special Conditions or Features Check List Requirement Form B. Tap NEXT >>>

Special Feature or Conditions

    Special Feature or Conditions
  • Additional Special Maintenance Inspection Criterial

Form C

    BMP
  • BMP ID

  • Reference Code

  • Notes

Sign Off

  • Office Use: Complete

  • Issues Corrective Action

  • Re-Inspection Required:

  • Prepared by

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.