Concrete Structural Integrity Assessment Form
Evaluate the condition and integrity of concrete structures using this comprehensive assessment form.
Structure Identification / Location
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Structure
*
Building
Bridge
Parking Structure
Retaining Wall
Other
Assessment of Key Structural Elements
*
Rows
No Issues
Minor Issues
Moderate Issues
Severe Issues
Beams
1
2
3
4
Columns
5
6
7
8
Slabs
9
10
11
12
Foundations
13
14
15
16
Visible Cracks (Severity)
*
None
1
2
3
4
Severe
5
1 is None, 5 is Severe
Corrosion of Reinforcement (Severity)
*
None
1
2
3
4
Severe
5
1 is None, 5 is Severe
Surface Spalling or Delamination (Severity)
*
None
1
2
3
4
Severe
5
1 is None, 5 is Severe
Evidence of Water Intrusion
*
None
Minor
Moderate
Severe
Previous Repairs Noted?
*
Yes
No
Overall Structural Integrity Rating
*
1
2
3
4
5
Submit Assessment
Should be Empty: