Butterfly Valve Inspection Form
Complete this form to assess the condition and operation of a butterfly valve during inspection.
Valve Identification or Location
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Valve Type
*
Please Select
Wafer
Lug
Double Flanged
Other
Valve Size (inches or mm)
*
Inspection Status
*
Passed
Requires Attention
Failed
Checklist of Findings
*
No visible leaks
Handle/actuator operates smoothly
Seat and disc condition acceptable
Bolts and fasteners secure
No signs of corrosion or damage
Other
Operational Test Results
*
Defects or Observations
Urgency or Follow-up Needed
*
Immediate Action Required
Schedule for Maintenance
Monitor Only
No Further Action
Submit Inspection
Should be Empty: