Well Casing Inspection Log Form
Log well casing inspection details, condition findings, and follow-up actions for accurate recordkeeping.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Well Identification Number or Name
*
Well Location (Address or GPS Coordinates)
*
Casing Type
*
Please Select
Steel
PVC
Concrete
Other
Casing Diameter (inches)
General Condition of Casing
*
Excellent
Good
Fair
Poor
Issues or Defects Observed
Corrosion
Cracks
Leaks
Obstructions
None
Other
Actions Taken During Inspection
Follow-up Recommendations or Comments
Submit Inspection Log
Should be Empty: