Monument Condition Assessment Form
Please complete this form to assess and report the current condition of the monument.
Monument Name or ID
*
Location of Monument
*
Inspector Name
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Structural Condition
*
1
2
3
4
5
Condition by Component
*
Rows
Excellent
Good
Fair
Poor
Foundation
1
2
3
4
Walls
5
6
7
8
Roof
9
10
11
12
Surface Finish
13
14
15
16
Observed Deterioration Indicators
*
Cracks
Staining
Biological Growth
Surface Erosion
Displacement
Other
Urgency of Intervention
*
Immediate
Within 3 Months
Within 1 Year
Routine Monitoring
Recommended Next Action
*
Please Select
No Action Required
Detailed Investigation
Preventive Maintenance
Repair/Restoration
Other
Additional Comments or Observations
Submit Assessment
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