Water System Assessment Checklist
Use this checklist to assess the condition, water quality, operations, maintenance needs, and overall performance of a water system.
Inspection Details
Inspector Name
*
Organization / Department
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site / Facility Name
*
Site Location / Address or GPS Reference
*
Water System Type
*
Please Select
Municipal
Well
Surface Water
Rural Distribution
Storage Tank
Treatment Plant
Other
Water Source and Infrastructure Assessment
Water source type
*
Groundwater
Surface water
Rainwater
Purchased/Imported water
Mixed source
Other
Source condition
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Intake/source protection condition
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Treatment components present
*
Filtration
Chlorination
Sedimentation
UV disinfection
None
Other
Treatment component condition
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Storage tank/reservoir condition
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Distribution network condition
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Visible leaks, corrosion, or damage
*
None observed
Minor issues
Moderate issues
Severe issues
Access and security of critical assets
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Water Quality and Operational Performance
Water Clarity / Turbidity Observation
*
Clear
Slightly Cloudy
Cloudy
Very Cloudy
Not Observed
Odor
*
No Odor
Mild Odor
Strong Odor
Not Observed
Color
*
Colorless
Slightly Colored
Noticeably Colored
Not Observed
Taste Issue Observed
None
Slight Taste Issue
Pronounced Taste Issue
Not Tested
Pressure Status
*
Very Low
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Very Low, 10 is Excellent
Flow Consistency
*
Very Inconsistent
1
2
3
4
5
6
7
8
9
Highly Consistent
10
1 is Very Inconsistent, 10 is Highly Consistent
Recent Interruptions / Service Reliability
*
No Recent Interruptions
Minor Interruptions
Frequent Interruptions
Service Unreliable
Unknown
Basic Water Quality Testing Results
Rows
Result
Units
Pass / Fail / Unknown
pH
1
Turbidity
2
Chlorine Residual
3
Temperature
4
Bacteriological Indicator
5
Notes on Abnormal Readings or Operational Concerns
Overall Water Quality / Operational Performance
*
1
2
3
4
5
Maintenance, Risk, and Overall Findings
Recent maintenance performed
Outstanding maintenance issues
Priority risk level for the system
*
Low
Medium
High
Critical
Immediate corrective actions needed
Overall system condition rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Assessor recommendations
Final assessment comments
Submit Assessment
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