Gooseneck Bend Inspection Checklist Form
Complete this checklist during each gooseneck bend inspection. Ensure all items are reviewed and findings are noted.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Visual Condition of Gooseneck Bend
*
Good
Minor Damage
Major Damage
Corrosion or Rust Present?
*
No
Minor
Severe
Bolts and Fasteners Secure?
*
All Secure
Some Loose
Missing/Damaged
Presence of Leaks or Fluid Residue
*
None
Minor
Significant
Overall Condition Rating
*
1
2
3
4
5
Notes or Observations
Recommended Follow-up Actions
Submit Inspection
Should be Empty: