HTML Preview Bridge Inspection page number 1.
FS 1052C HTH 2008/03
DISTRIBUTION: WHITE — Region; CANARY — District; PINK — Inspector
PAGE
STRUCTURE NO. FSR
km
N
DATE OF
THIS
INSPECTION
YYYY - MM
DATE OF
NEXT
INSPECTION
YYYY - MM
BRIDGE CLASS
CROSSING DISTRICT PROJECT NO.
NOTE: a) Spans, abutments and piers are numbered from the left bank, facing downstream; piles, posts, curbs and stringers are numbered
from upstream of bridge; use additional forms for multi-span bridge.
b) Use back of form or separate sheet to sketch and detail problem area and/or materials required for repairs.
c)
CONDITION: 1 - Very Good (new); 2 - Good; 3 - Fair; 4 - Poor; 5 - Very Poor; 6 - N/A (not applicable)
BRIDGE INSPECTION REPORT
STEEL / CONCRETE / GLULAM,
BRIDGE INSPECTION SUMMARY
Permanent Bridge Semi-permanent Bridge
BRIDGE ELEMENT
REMARKSCONDITION
INSPECTOR'S SIGNATURE
NEW LOAD RATING
REVIEWED AND NOTED BY (SIGNATURE) DATE SIGNED
tonnes
P.Eng.
NUMBER OF SPANS
Running Planks
Structural Decking
Concrete Deck
Gravel Surfacing
Ties (incl. Shims)
Nails
Curbs and Blocks
Hand Rails
Deck to Girder Bolts
Hardware
Delineators
Girders / Slabs
Diaphragms
Bracing
Trussing
Hardware
Caps
Piles or Posts
Concrete
Bracing or Sheathing
Cribs
Hardware
Riprap
Overall
DECK
SUPER-
STRUCTURE
SPAN # ____
PIERS
Cribs
Tie-backs
Bin Walls
Caps or Sills
Piles or Posts
Concrete
Bulkhead Planks
Wing Wall Planks
Bracing
Hardware
Fill
Riprap
Overall
PRESENT
WATER
LEVEL
m
ESTIMATED
HIGH-WATER
LEVEL
m
PRESENT
WATER
CLEARANCE
m
HAZARD(S) DESCRIPTION
HAZARDS:
rHigh water Debris Scour Ice None
REPAIR
REQUIRED?
Yes No
Yes No
REPAIR DESCRIPTION AND COST ESTIMATE
PROFESSIONAL
INSPECTION
REQUIRED?
COMMENTS
at new load rating: at original
AS-BUILT CHECKED?
NUMBER OF
PICTURES
TAKEN
NARROW STRUCTURE SIGNS?
Yes No Yes No
PRESENT POSTED RATING
tonnes
SUGGESTED REPLACEMENT DATE
APPROACHES
ABUTMENTS
YYYY - MM - DD YYYY - MM - DD