Dam Inspection Form
Inspection Information
National Inventory of Dams ID
Inspection date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Next inspection date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Inspector
First Name
Last Name
Name of Consultant
Hazard Code
Dam Inspection
Overall Physical Condition of Dam
Unsafe
Poor
Fair
Satisfactory
Good
Spillway Capacity (% SDF)
%10
%20
%30
%40
%50
%60
%70
%80
%90
%100
Design Methodology
Design records are not available
No design or post-design analyses conducted
No analyses, but dam features seem suitable
Dam meets most criteria
Dam meets all criteria
Level of Maintenance
Unsafe
Poor
Fair
Satisfactory
Good
Emergency Action Plan
No plan or idea of what to do in the event of an emergency
Some idea but no written plan
No formal plan but well thought out
Available written plan that needs updating
Detailed, updated written plan available and filed with MADCR, personnel undergoes annual training
Seepage (Embankments, Foundations, & Abutments)
Severe piping and/or seepage with no monitoring
Evidence of monitored piping and seepage
No piping but uncontrolled seepage
Controlled seepage. Minor seepage or high volumes of seepage with filtered collection
No seepage or minor seepage with filtered collection
Embankment Condition
Severe erosion and/or large trees
Significant erosion or significant woody vegetation
Brush and exposed embankment soils, or moderate erosion
Unmaintained grass, vermin activity and maintainable erosion
Well maintained healthy uniform grass cover
Concrete Condition
Severe cracks, misalignment, discontinuities causing leaks, seepage or stability concerns
Cracks with misalignment inclusive of transverse cracks with no misalignment but with potential for significant structural degradation
Significant longitudinal cracking and minor transverse cracking
Spalling and minor surface cracking
No apparent deficiencies
Low Level Outlet Discharge Capacity
No low level outlet, no provisions (e.g. pumps, siphons) for emptying pond
No operable outlet, plans for emptying pond, but no equipment
Outlet with insufficient drawdown capacity, pumping equipment available
Operable gate with sufficient drawdown capacity
Operable gate with capacity greater than necessary
Low Level Outlet Physical Condition
Outlet inoperative - needs replacement, is non-existent or inaccessible
Outlet inoperative - needs repair
Outlet operable - needs repair
Outlet operable - needs maintenance
Outlet operable - well maintained
Spillway Design Flood Capacity
0 - 50% of the SDF or unknown
50-90% of the SDF3. 90 - 100% of the SDF
>100% of the SDF with actions required by caretaker (e.g. open outlet)
>100% of the SDF with no actions required by caretaker
Overall Safety Rating of Dam
Unsafe
Poor
Fair
Satisfactory
Good
Estimated Repair Cost
Photos of dam
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