Dam Infrastructure Damage Assessment Form
Document and evaluate damage to dam infrastructure with this comprehensive assessment form.
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Dam Name or Location
*
Component(s) Assessed
*
Spillway
Embankment
Outlet Works
Intake Structure
Powerhouse
Other
Type of Damage Observed
*
Please Select
Cracks
Erosion
Leakage/Seepage
Deformation
Corrosion
Other
Severity of Damage
*
1
2
3
4
5
Damage Details by Component
Rows
Condition
Description
Spillway
No Damage
Minor
Moderate
Severe
Embankment
No Damage
Minor
Moderate
Severe
Outlet Works
No Damage
Minor
Moderate
Severe
Intake Structure
No Damage
Minor
Moderate
Severe
Powerhouse
No Damage
Minor
Moderate
Severe
Immediate Safety Risk?
*
Yes
No
Uncertain
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