General Info
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Label
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Structure Name
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Road Name
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BSN
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Length
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Number of barrels
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Dimensions (__m w x __m h / __m dia)
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Culvert Type
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Year Constructed
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Inspected by
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Date inspected
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Location
Superstructure Elements
Primary load carrying element (Element No 1)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Secondary elements:Transverse beams (Element No 2)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Secondary elements: Other (incl deck) (Element No 3)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Load-bearing Substructure Elements
Foundations (Element No 8)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Head wall (Element No 10)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Durability Elements
Superstructure drainage (Element No 15)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Movement / expansion joints (Element No 17)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Painting : Superstructure elements (Element No 18)
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Painting : barriers/guardrails (Element No 20)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Safety Elements
Access / walkways / gantries (Element No 21)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Guardrail / handrail / safety fences (Element No 22)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Carriageway surfacing (Element No 23)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Footway / verge / footbridge surfacing (Element No 24)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Waterway Elements
Invert / river bed (Element No 25)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Aprons (Element No 26)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
River bed upstream (Element No 27)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
River bed downstream (Element No 28)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Scour (Element No 29)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
River banks (Element No 30)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Retaining Elements
Wing walls (Element No 32)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Retaining walls (Element No 33)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Embankments (Element No 34)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Other Elements
Approach rails / barriers / walls (Element No 35)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Approach adequacy (Element No 36)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Signs (Element No 37)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Lighting (Element No 38)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Services (Element No 39)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Appearance (Element No 40)
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Mark (0=Not Inspected, 1=Satisfactory, 2 Monitor Next Insp, R=Routine Maint, S=Structural Maint, N=N/A
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Brief description of fault and comments
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
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Relevant photos
Photo
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Photo number
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Photo description
Maintenance/Repairs
Comments and Recommendations for Maintenance/Repairs
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Suggested Remedial Works
Remedial Work
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Element No.
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Suggested Remedial Work
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Priority
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Estimated Cost
Follow-up
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Remedial work recommended in last inspection has been completed
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Comment on previously recommended remedial work
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NZTA Database changes required
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Comment on database changes required
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Comments and recommendations relating to future management (transfer to current report)
All photos not already included
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Road views, elevations, and any other photos not yet attached to the report
Photo
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Photo number
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Photo description