U.S. Department of Transportation
Federal Highway Administration
1200 New Jersey Avenue, SE
Washington, DC 20590
202-366-4000


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Bridges & Structures

Guidelines for the Installation, Inspection, Maintenance and Repair of Structural Supports for Highway Signs, Luminaries, and Traffic Signals

Appendix C Sample Inspection Report

Sample inspection form: Cover page from the NJDOT sign structure survey report.

Sample inspection form: Table of Contents

Sample inspection form: Inspection Information

Sample inspection form: Summary data including location and structure information

Sample inspection form: Comments and comprehensive report of deficiencies. Page 1 of 4

Sample inspection form: Comments and comprehensive report of deficiencies. Page 2 of 4

Sample inspection form: Comments and comprehensive report of deficiencies. Page 3 of 4

Sample inspection form: Comments and comprehensive report of deficiencies. Page 4 of 4

Sample inspection form: plan drawing of front elevation

Sample inspection form: plan drawing of tower elevation

Sample inspection form: plan drawing of foundation and truss section

Sample inspection form: completed ultrasonic anchor bolt inspection report

Sample inspection form: photos from the inspection - front and back of sign

Sample inspection form: photos from the inspection - right and left towers

Sample inspection form: photos from the inspection - tower to truss connection and tower to foundation connection

Sample inspection form: - left median/foundation damage and abandoned electrical system.

Sample inspection form: weld pool crack and lower chord splice with one bolt head deteriorated

Sample inspection form: - middle chord splice with two bolt ends exhibiting similar fracturing and right foundation partially exposed for ultrasonic testing of the anchor bolts

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Updated: 07/30/2013
Federal Highway Administration | 1200 New Jersey Avenue, SE | Washington, DC 20590 | 202-366-4000