Water Well Maintenance Checklist
Complete this checklist to ensure thorough water well inspection and maintenance.
Well Identification Number
*
Location of Well
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
General Condition of Well
*
Excellent
Good
Fair
Poor
Checklist of Maintenance Tasks
*
Rows
Completed
Needs Attention
Not Applicable
Check pump operation
1
2
3
Inspect electrical wiring
4
5
6
Test water quality
7
8
9
Examine well cap and seal
10
11
12
Check for signs of contamination
13
14
15
Inspect pressure tank
16
17
18
Flush the system
19
20
21
Lubricate moving parts
22
23
24
Observed Issues (if any)
Actions Taken During Maintenance
Recommendations for Follow-up
Upload Photos or Documents (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Inspector Signature
*
Submit Checklist
Submit Checklist
Should be Empty: