Manhole Vacuum Test Report Form
Complete this form to document the results and details of a manhole vacuum test inspection.
Report Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Site/Location
*
Manhole Identification
*
Test Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Test Equipment or Gauge ID
*
Pre-Test Condition / Observations
Vacuum Test Result
*
Passed
Failed
Measured Vacuum Value and Duration
*
Final Pass/Fail Outcome & Comments
Submit Report
Should be Empty: