Checklist:

1. Description of structure

1.1. Name, location, type, and size

1.2. Owner, project engineer, contractor, date(s) of construction

1.3. Photographs

1.3.1. General view

1.3.2. Detailed close-up of condition of area

1.4. Sketch map-orientation indicating the sunny and shady areas and the well and poorly

drained regions

2. Nature of environmental and loading conditions

2.1. Exposure

2.1.1. Environment: arid, subtropical, marine, freshwater, industrial, etc.

2.1.2. Weather (July and January mean temperatures, mean annual rainfall, and

months in which 60% of rainfall occurs)

2.1.3. Freezing and thawing

2.1.4. Wetting and drying

2.1.5. Drying under dry atmosphere

2.1.6. Chemical corrosion and attack: sulfates, acids, bases, chloride, gases

2.1.7. Abrasion, erosion, cavitation, impact

2.1.8. Electric conductivity

2.1.9. Deicing chemicals that contain chloride ions

2.1.10. Heat from adjacent sources

2.2. Drainage

2.2.1. Flashing

2.2.2. Joint sealants

2.2.4. Contour

2.2.5. Elevation of drains

2.3. Loading conditions

2.3.1. Dead

2.3.2. Live

2.3.3. Impact

2.3.4. Vibration

2.3.5. Traffic

2.3.6. Seismic

2.3.7. Other

2.4. Soils (foundation conditions)

2.4.1. Expansive soil

2.4.2. Compressible soil (settlement)

2.4.3. Evidence of pumping

3. Distress indicators

3.1. Cracking

3.2. Staining

3.3. Surface deposits and exudations

3.4. Leaking

4. Present condition of structure

4.1. Overall apparent alignment of structure

4.1.1. Settlement

4.1.2. Deflection

4.1.3. Expansion
 4.1.4. Contraction

4.2. Surface condition of concrete

4.2.1. General conditions (good, satisfactory, poor)

4.2.2. Formed and finished surfaces

4.2.2.1. Smoothness

4.2.2.2. Bugholes (surface air voids)

4.2.2.3. Sand streaks

4.2.2.4. Honeycomb

4.2.2.5. Soft areas

4.2.2.6. Cold joints

4.2.2.7. Staining

4.2.3. Cracking

4.2.3.1. Location and frequency

4.2.3.2. Crack map

4.2.3.3. Width and pattern (see descriptions)

4.2.3.4. Leaching, stalactites

4.2.3.5. Working versus nonworking (dormant)

4.2.4. Scaling

4.2.4.1. Area, depth

4.2.4.2. Type (see definitions)

4.2.5. Spalls and popouts

4.2.5.1. Number, size, and depth

4.2.5.2. Type (see definitions)

4.2.6. Stains, efflorescence

4.2.7. Exposed reinforcement

4.2.8. Curling and warping

4.2.9. Erosion

4.2.9.1. Abrasion

4.2.9.2. Cavitation

4.2.10. Previous patching or other repair

4.2.11. Surface coatings/protective systems/linings/ toppings

4.2.11.1. Type and thickness

4.2.11.2. Bond to concrete

4.2.11.3. Condition

4.2.12. Penetrating sealers

4.2.12.1. Type

4.2.12.2. Effectiveness

4.2.12.3. Discoloration
VISUAL INSPECTION FORM

Report number

1. GENERAL Purpose of inspection

Inspector’s name(s)

Name

Location

Type
1A. DESCRIPTION
Size
OF THE
Owner
STRUCTURE
Project engineer

Contractor

Date(s) of construction

General view

Photographs Detailed close-up of

condition of area

Sketch map

orientation

indicating sunny

and shady areas

and well and

poorly drained

regions
 Normal weight

aggregate type

Aggregate size

Admixture type
1B. MATERIALS
Concrete Mixture proportion
USED (if known)
Compressive

strength

Modulus of

elasticity

2. NATURE OF Exposure Environment (arid,

ENVIRONMENTAL subtropical, marine,

AND LOADING freshwater,

CONDITIONS industrial, etc.)

Weather (July and

Jan. mean

temperatures, mean

annual rainfall, and

months in which

60% of rainfall

occurs)

Freezing and

thawing

Wetting and drying

Drying under dry

atmosphere
 Chemical corrosion

and attack (sulfates,

acids, bases,

chloride, gases)

Abrasion, erosion,

cavitation, impact

Electric

conductivity

Deicing chemicals

that contain chloride

ions

Heat from adjacent

sources

Flashing Joint

sealants

Weepholes Contour
Drainage
Elevation of drains

Contour

Elevation of drains

Loading Dead

conditions Live

Impact

Vibration

Traffic

Seismic Other
 Other

Expansive soil

Compressible soil
Soils (foundation
(settlement)
conditions)
Evidence of

pumping

Cracking

3. DISTRESS Staining

INDICATORS Surface deposits and exudations

Leaking

4. PRESENT Settlement
Overall apparent
CONDITION OF Deflection
alignment of
STRUCTURE Expansion
structure
Contraction

Surface condition Smoothness

of concrete Bugholes

(surface air

voids)
Formed and finished
Sand streaks
surfaces
Honeycomb

Soft areas

Cold joints

Staining

Cracking Location and

frequency
 Crack map

Width and

pattern

Leaching,

stalactites

Working

versus

nonworking

Area, depth
Scaling
Type

No., size,

Spalls and popouts and depth

Type

Stains, efflorescence

Exposed

reinforcement:

corrosion

Curling and warping

Abrasion
Erosion
Cavitation

Previous patching or

others repair

Surface coatings, Type and

protective systems, thickness

linings, toppings Bond to

Condition

Type

Effectiveness
Penetrating sealers
Discoloratio