Farm Effluent Storage Checklist Form
Use this form to inspect farm effluent storage conditions, record checklist items, note issues, and assign follow-up actions.
Site and Inspection Details
Farm/Site Name
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Middle Name
Last Name
Inspector Role/Position
Storage Location / Tank or Pond ID
*
Inspection Type
*
Routine
Follow-up
Incident
Weather / Ground Conditions
Dry
Wet
Damp
Frozen
Mud / Soft Ground
Other
Storage Condition Checklist
Visible leaks present?
*
No
Yes
Cracks visible?
*
No
Yes
Seepage observed?
*
No
Yes
Evidence of overflow?
*
No
Yes
Freeboard status
*
Please Select
Compliant
Borderline
Below required level
Unable to determine
Inlet and outlet integrity satisfactory?
*
Yes
No
N/A
Fencing and security adequate?
Yes
No
N/A
Signage in place and legible?
Yes
No
N/A
Bund or containment condition satisfactory?
*
Yes
No
N/A
Storage components condition check
Rows
Good
Fair
Poor
N/A
Tank or pond wall
1
2
3
4
Liner or base
5
6
7
8
Inlet
9
10
11
12
Outlet
13
14
15
16
Bund or containment
17
18
19
20
Fence or barrier
21
22
23
24
Signage
25
26
27
28
Overall storage condition
*
1
2
3
4
5
Estimated storage level / fill status
*
Please Select
Empty
Low
Moderate
High
Near full
Overflowing
Unable to determine
Odor, vegetation, or algae indicators observed
Strong odor
Unusual odor
Excess vegetation
Algae growth
None observed
Other
Actions, Maintenance, and Follow-up
Issues found
*
Corrective actions required
*
Immediate action taken
Priority / urgency
*
Low
Medium
High
Critical
Maintenance work needed
Responsible person or team
*
Target completion date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Follow-up inspection required
*
Yes
No
Notes / comments
Submit Checklist
Should be Empty: