Utilities Inspection Quality Control Survey Form
Use this form to review the quality of a utilities inspection and record findings, issues, and follow-up actions.
Inspection Details
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
Utility Type
*
Water
Gas
Electric
Wastewater
Telecom
Other
Inspection Location / Site
*
Inspection Report ID
*
Quality Control Evaluation
Overall Quality Rating
*
1
2
3
4
5
Inspection Criteria Evaluation
*
Rows
Poor
Fair
Good
Very Good
Excellent
Completeness
1
2
3
4
5
Accuracy
6
7
8
9
10
Clarity of Notes
11
12
13
14
15
Photo/Documentation Quality
16
17
18
19
20
Compliance with Procedure
21
22
23
24
25
Timeliness
26
27
28
29
30
Issues Found During Review
Missing Photos
Incomplete Notes
Unclear Findings
Skipped Steps
Inconsistent Measurements
Safety Concern
Other Relevant Issue
Primary Defect or Concern Observed
Review Outcome
Final decision
*
Pass
Fail
Needs Review
Corrective actions or comments
Reinspection or follow-up required
*
Yes
No
Pending
Submit
Should be Empty: