Road Skid Resistance Inspection Form
Comprehensive form for recording roadway skid resistance and pavement surface conditions.
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Inspector Contact (Email)
*
example@example.com
Roadway Name or Number
*
Location Details (e.g., segment, mile marker, coordinates)
*
Surface Type
*
Asphalt
Concrete
Chip Seal
Gravel
Other
Lane Number or Type
*
Please Select
Lane 1
Lane 2
Lane 3
Shoulder
Ramp
Other
Weather Conditions at Time of Inspection
*
Clear/Dry
Wet
Rain
Snow
Icy
Foggy
Other
Road Surface Condition
*
Good
Fair
Poor
Under Maintenance
Other
Measurement Method/Instrument Used
*
Please Select
British Pendulum Tester
Dynamic Friction Tester
Locked Wheel Tester
Grip Tester
Other
Skid Resistance Reading (Value/Unit)
*
Observed Defects or Hazards
*
Cracking
Rutting
Polished Surface
Potholes
Debris
Standing Water
None Observed
Other
Is Corrective Action Needed?
*
Yes
No
Follow-up Notes or Recommendations
Submit Inspection
Should be Empty: