Irrigation Access Box Inspection Checklist Form
Complete this checklist to document the inspection of an irrigation access box.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
Box Location or ID
*
Condition of Access Box
*
Good
Fair
Poor
Is the box free of debris?
*
Yes
No
Are all components functional?
*
Yes
No
Partially
Any visible damage?
Cracks
Missing Cover
Water Accumulation
Other
Overall Condition Rating
*
1
2
3
4
5
Action Required?
*
Yes
No
Additional Notes
Submit
Should be Empty: