Maintenance Hole Cover Inspection Form
Maintenance Hole Cover Inspection Form
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Cover ID / Number
*
Visual Condition
*
Good
Fair
Poor
Other
Are there any visible hazards?
*
No
Yes
Structural Integrity
*
Intact
Cracked
Damaged
Is cover properly seated and secure?
*
Yes
No
Additional Notes / Observations
Follow-up Action Required
*
None
Repair
Replace
Further Inspection
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