Pavement Maintenance Effectiveness Survey Form
Use this form to evaluate the outcomes of pavement maintenance activities. Please answer all questions based on your direct observations and experience.
Your role or relationship to the pavement maintenance project
*
Please Select
Project Manager
Maintenance Crew
Inspector
Resident/Community Member
Other
Pavement location or segment
*
Type of maintenance performed
*
Please Select
Pothole Repair
Crack Sealing
Overlay/Resurfacing
Reconstruction
Preventive Maintenance
Other
Pavement condition before maintenance
*
Excellent
Good
Fair
Poor
Very Poor
Pavement condition after maintenance
*
Excellent
Good
Fair
Poor
Very Poor
How effective was the maintenance overall?
*
1
2
3
4
5
Please rate the following aspects of the maintenance
*
Rows
Very Effective
Effective
Neutral
Ineffective
Very Ineffective
Durability
1
2
3
4
5
Surface Smoothness
6
7
8
9
10
Safety Improvement
11
12
13
14
15
Timeliness of Completion
16
17
18
19
20
Were any visible issues present after maintenance?
*
No visible issues
Cracking
Potholes
Surface Irregularities
Drainage Problems
Other
What is the priority for future maintenance at this location?
*
High Priority
Medium Priority
Low Priority
No Further Maintenance Needed
Additional comments or observations
Submit Survey
Should be Empty: