Dam Safety Survey Form
Complete this Dam Safety Survey Form to document inspection details, observed conditions, safety indicators, risk concerns, and follow-up actions.
Dam Name or Identification Number
*
Location of Dam (City, State, or Coordinates)
*
Date and Time of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Observed Overall Condition of the Dam
*
Excellent
Good
Fair
Poor
Rate the Following Safety Indicators
*
Rows
Excellent
Good
Fair
Poor
Structural Integrity
1
2
3
4
Seepage/Leakage
5
6
7
8
Spillway Condition
9
10
11
12
Vegetation Management
13
14
15
16
Instrumentation/Monitoring
17
18
19
20
Are there any visible signs of distress (cracks, erosion, settlement)?
*
Yes
No
Are any of the following risk concerns present?
Unusual seepage or wet areas
Obstructed spillway
Animal burrows
Unstable slopes
Other
Please rate the urgency of follow-up actions required
*
No Action Needed
1
2
3
4
Immediate Action Required
5
1 is No Action Needed, 5 is Immediate Action Required
Recommended follow-up actions or comments
Name of Inspector(s)
*
Submit Survey
Should be Empty: