Winter Road Maintenance Checklist Form
Document winter road inspections, equipment status, actions, and hazards during winter maintenance operations.
Date of Inspection
*
 -
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
Road Segment or Location
*
Current Weather Conditions
*
Clear
Snowing
Icy
Sleet/Freezing Rain
Windy
Other
Road Surface Condition
*
Dry
Wet
Snow Covered
Icy
Slushy
Other
Equipment Readiness Checklist
*
Plow Blades Inspected
Salt/De-icer Loaded
Lights/Signals Operational
Tires/Chains Checked
Other
Treatment Actions Performed
*
Plowing
Salting
Sanding
Brine Application
No Action Needed
Other
Hazards Observed
*
Fallen Branches
Blocked Drainage
Black Ice
Stalled Vehicles
No Hazards
Other
Additional Notes
Inspection Completion Status
*
Completed
Partially Completed
Not Completed
Submit Checklist
Should be Empty: