Catch Basin Maintenance Checklist Form
Document all inspection and maintenance work for catch basins using this checklist.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Catch Basin Location
*
Inspector Name
*
Weather Conditions
Please Select
Clear
Cloudy
Rainy
Snowy
Other
Catch Basin Condition
*
Please Select
Good
Fair
Poor
Debris or Sediment Level
*
Please Select
None
Low
Moderate
High
Standing Water Present?
*
Yes
No
Maintenance Actions Performed
*
Removed debris
Cleaned grate
Repaired structure
Inspected outflow
Other
Additional Notes
Upload Photo (if applicable)
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of
Submit Inspection
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