Drainage Gully Inspection Checklist

Drainage Gully Inspection Checklist
Complete this checklist to document the condition and maintenance needs of drainage gullies during inspection.
Inspector Name
First NameLast Name
Inspection Date and Time
MonthDayYear
Date
Hour MinutesAM/PM Option
Inspection Location (Address or GPS Coordinates)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Gully Identification/Reference Number
General Condition of Gully
Inspection Checklist
Rows Yes No Not Applicable
Debris present in gully
Blockage observed
Structural damage
Cover/grate secure
Evidence of flooding
Water flow unobstructed
Upload Photos of Gully (if applicable)
Cancelof
Actions Taken During Inspection
Other
Further Action or Follow-Up Needed?
Additional Comments or Observations
Inspector Signature
Powered by Jotform SignClear
Should be Empty:

Select theme: