Cistern Inspection Checklist Form
Complete this checklist to document the condition and inspection details of the cistern.
Inspector Name
*
First Name
Last Name
Inspection Date
*
-
Month
-
Day
Year
Date
Cistern Location/ID
*
Checklist - Mark all items that are satisfactory
*
Cistern is clean and free of debris
No visible cracks or structural damage
No signs of leaks or standing water outside cistern
Access hatch is secure and in good condition
Venting is clear and functional
No evidence of pest intrusion
Water level is within normal range
*
Yes
No
Not applicable
Cistern inlet and outlet are clear
*
Yes
No
Not applicable
General Comments / Observations
Submit Inspection
Should be Empty: