Culvert Maintenance Checklist
Document inspection status, observed conditions, and maintenance actions for culvert maintenance operations.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Culvert Location (Address or GPS Coordinates)
*
Culvert Type
*
Please Select
Box
Pipe
Arch
Bridge
Other
Structural Condition
*
Good
Fair
Poor
Blockage or Debris Present?
*
None
Minor
Moderate
Severe
Inlet and Outlet Condition
*
Clear and Stable
Partially Blocked
Damaged
Erosion or Scour Observed?
*
None
Minor
Severe
Maintenance Actions Performed
*
Debris Removal
Sediment Removal
Structural Repair
Vegetation Control
None Needed
Other
Severity Rating
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Follow-up Required?
*
Yes
No
Additional Comments or Observations
Inspector Signature
Submit Checklist
Submit Checklist
Should be Empty: