Project Name*

Inspector*

Inspection Date*

Structure Name*

Member ID*

Unique identifier for this steel member

Member Type*

Steel Section Designation

Span / Bay Location

Member Length (ft)

Fracture Critical Member (FCM)Fracture Critical Member (FCM)

Corrosion Grade (SSPC VIS 2)*

Measurable Section Loss PresentMeasurable Section Loss Present

Ultrasonic Thickness (UT) Testing PerformedUltrasonic Thickness (UT) Testing Performed

Corrosion Description

Coating System Type

Lead-Based Paint SuspectedLead-Based Paint Suspected

Coating Condition*

Measured Dry Film Thickness (mils)

Average DFT from spot readings

Estimated Remaining Coating Life (years)

Recoating RecommendedRecoating Recommended

Coating Notes

Connection Condition

Loose / Missing Fasteners PresentLoose / Missing Fasteners Present

Weld Defects PresentWeld Defects Present

Connection Notes

Repair Priority*

Repair Recommendations

Free Fillable Steel Corrosion Survey

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