Water Utility Access Box Inspection Checklist
Complete this checklist to document the condition and accessibility of the water utility access box.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Access Box Location or ID
*
Physical Condition of Box
*
Good
Minor Damage
Major Damage
Requires Replacement
Cover Status
*
Secure and Intact
Loose
Missing
Obstructions Present?
*
No Obstructions
Vegetation
Debris
Other
Any Signs of Water Leakage?
*
No
Yes, Minor
Yes, Major
Signs of Tampering or Unauthorized Access?
*
No
Yes
Accessibility
*
Easily Accessible
Partially Obstructed
Not Accessible
Additional Notes or Observations
Submit Inspection
Should be Empty: