General Info

  • Label

  • Structure Name

  • Road Name

  • BSN

  • Length

  • Number of barrels

  • Dimensions (__m w x __m h / __m dia)

  • Culvert Type

  • Year Constructed

  • Inspected by

  • Date inspected

  • Location

Superstructure Elements

Primary load carrying element (Element No 1)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Secondary elements:Transverse beams (Element No 2)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Secondary elements: Other (incl deck) (Element No 3)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Load-bearing Substructure Elements

Foundations (Element No 8)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Head wall (Element No 10)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Durability Elements

Superstructure drainage (Element No 15)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Movement / expansion joints (Element No 17)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Painting : Superstructure elements (Element No 18)

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Painting : barriers/guardrails (Element No 20)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Safety Elements

Access / walkways / gantries (Element No 21)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Guardrail / handrail / safety fences (Element No 22)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Carriageway surfacing (Element No 23)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Footway / verge / footbridge surfacing (Element No 24)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Waterway Elements

Invert / river bed (Element No 25)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Aprons (Element No 26)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

River bed upstream (Element No 27)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

River bed downstream (Element No 28)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Scour (Element No 29)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

River banks (Element No 30)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Retaining Elements

Wing walls (Element No 32)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Retaining walls (Element No 33)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Embankments (Element No 34)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Other Elements

Approach rails / barriers / walls (Element No 35)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Approach adequacy (Element No 36)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Signs (Element No 37)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Lighting (Element No 38)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Services (Element No 39)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Appearance (Element No 40)

  • Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A

  • Brief description of fault and comments

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

  • Relevant photos

  • Photo
  • Photo number

  • Photo description

Maintenance/Repairs

Comments and Recommendations for Maintenance/Repairs

  • Suggested Remedial Works

  • Remedial Work
  • Element No.

  • Suggested Remedial Work

  • Priority

  • Estimated Cost

Follow-up

  • Remedial work recommended in last inspection has been completed

  • Comment on previously recommended remedial work

  • NZTA Database changes required

  • Comment on database changes required

  • Comments and recommendations relating to future management (transfer to current report)

All photos not already included

  • Road views, elevations, and any other photos not yet attached to the report

  • Photo
  • Photo number

  • Photo description

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.