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Project |
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| Surveyed By | {Field1} | Certificate Number | {Field2} |
| Date / Time | {Field3} | Owner | {Field4} |
| Customer | {Field5} | Sheet Number | {Field6} |
| PO Number | {Field7} | Is Imperial | {Field8} |
| Purpose | {Field9} | Category | {Field10} |
| Comments | {Comments} | ||
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Manhole |
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| Inspection Status | {Field11} | Drainage Area | {Field12} |
| Manhole Number | {Field13} | Manhole Use | {Field14} |
| Weather (Ground Conditions) | {Field15} | Street | {Field16} |
| City | {Field17} | Location Details | {Field18} |
| Location Code | {Field19} | Additional Info | {Field20} |
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Manhole 2 |
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| Rim To Invert | {Field21} | Grade To Invert | {Field22} |
| Rim To Grade | {Field23} | Year Built | {Field24} |
| Year Renewed | {Field25} | Pre-Cleaning | {Field26} |
| Date Cleaned | {Field27} | Evidence of Surcharge | {Field28} |
| Additional Component Information | {Field29} | Media Label | {Field30} |
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Surface / Steps |
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| Surface Type Asphalt | {Field31} | Surface Type Concrete Pavement | {Field32} |
| Surface Type Concrete Collar | {Field33} | Surface Type Grass Dirt | {Field34} |
| Surface Type Gravel | {Field35} | Surface Type Other | {Field36} |
| Potential For Runoff | {Field37} | Access Type | {Field38} |
| Step Number | {Field39} | Step Material | {Field40} |
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Cover 1 |
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| Cover Shape | {Field41} | Cover Size | {Field42} |
| Cover Material | {Field43} | Cover Type Solid | {Field44} |
| Cover Type Vented | {Field45} | Cover Type Gasketed | {Field46} |
| Cover Type Bolted | {Field47} | Cover Type Inner Cover | {Field48} |
| Cover Type Locking | {Field49} | Cover Size Width | {Field50} |
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Cover 2 |
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| Cover Bearing Surface Diameter | {Field51} | Cover Frame Fit | {Field52} |
| Cover Condition Sound | {Field53} | Cover Condition Cracked | {Field54} |
| Cover Condition Broken | {Field55} | Cover Condition Corroded | {Field56} |
| Cover Condition Bolts Missing | {Field57} | Cover Condition Missing | {Field58} |
| Cover Insert Type | {Field59} | Cover Bearing Surface Diameter Width | {Field60} |
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Hole / Insert |
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| Hole Diameter | {Field61} | Hole Number | {Field62} |
| Insert Condition Sound | {Field63} | Insert Condition Poorly Fitting | {Field64} |
| Insert Condition Cracked | {Field65} | Insert Condition Leaking | {Field66} |
| Insert Condition Insert Fell | {Field67} | Insert Condition Corroded | {Field68} |
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Ring |
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| Adjustment Ring Type | {Field71} | Adjustment Ring Height | {Field72} |
| Ring Condition Sound | {Field73} | Ring Condition Cracked | {Field74} |
| Ring Condition Broken | {Field75} | Ring Condition Corroded | {Field76} |
| Ring Condition Leaking | {Field77} | Ring Condition Poor Install | {Field78} |
| Adjustment Ring Material | {Field79} | ||
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Frame |
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| Frame Material | {Field81} | Frame Bearing Surface Width | {Field82} |
| Frame Bearing Surface Depth | {Field83} | Frame Clear Open Diameter | {Field84} |
| Frame Condition Sound | {Field85} | Frame Condition Cracked | {Field86} |
| Frame Condition Broken | {Field87} | Frame Condition Missing | {Field88} |
| Frame Condition Corroded | {Field89} | Frame Condition Coated | {Field90} |
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Frame / Seal |
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| Frame Offset Distance | {Field91} | Frame Seal Inflow | {Field92} |
| Frame Depth | {Field93} | Seal Condition Sound | {Field94} |
| Seal Condition Cracked | {Field95} | Seal Condition Loose | {Field96} |
| Seal Condition Offset | {Field97} | Seal Condition Missing | {Field98} |
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Chimney |
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| Chimney Material 1 | {Field101} | Chimney Material 2 | {Field102} |
| Chimney Ini | {Field103} | Chimney Clear Opening | {Field104} |
| Chimney Depth | {Field105} | Chimney Lining Interior | {Field106} |
| Chimney Lining Exterior | {Field107} | ||
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Cone |
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| Cone Type | {Field111} | Cone Material | {Field112} |
| Cone Depth | {Field113} | Cone Lining Interior | {Field114} |
| Cone Lining Exterior | {Field115} | ||
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Wall |
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| Wall Diameter | {Field121} | Wall By Size | {Field122} |
| Wall Material | {Field123} | Wall Depth | {Field124} |
| Wall Lining Interior | {Field125} | Wall Lining Exterior | {Field126} |
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Bench / Channel |
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| Bench Present | {Field131} | Bench Material | {Field132} |
| Bench Lining | {Field133} | Channel Installed | {Field134} |
| Channel Material | {Field135} | Channel Type | {Field136} |
| Channel Exposure | {Field137} | Work Order | {Field138} |
| Project | {Field139} | PressureValue | {Field140} |
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Custom |
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| Custom 1 | {Field141} | Custom 2 | {Field142} |
| Custom 3 | {Field143} | Custom 4 | {Field144} |
| Custom 5 | {Field145} | Custom 6 | {Field146} |
| Custom 7 | {Field147} | Custom 8 | {Field148} |
| Custom 9 | {Field149} | Custom 10 | {Field150} |
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Cover 3 |
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| Cover Type Hatch Single | {Field151} | Cover Type Hatch Double | {Field152} |
| Cover Type Lamphole | {Field153} | ||
| Cover Condition Restraint Defective | {Field157} | Cover Condition Restraint Missing | {Field156} |
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GPS |
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| Manhole Start Latitude | {ManholeStartLatitude} | Manhole Start Longitude | {ManholeStartLongitude} |
| Manhole End Latitude | {ManholeEndLatitude} | Manhole End Longitude | {ManholeEndLongitude} |
| Start Manhole Height | {StartManholeHeight} | End Manhole Height | {EndManholeHeight} |
| Start Manhole Offset | {StartManholeOffset} | End Manhole Offset | {EndManholeOffset} |
| Manhole Start X | {ManholeStartX} | Manhole End X | {ManholeEndX} |
| Manhole Start Y | {ManholeStartY} | Manhole End Y | {ManholeEndY} |
| GPS Accuracy | {GPS_Accuracy} | Coordinate System | {Coordinate_System} |