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}


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}

Manhole 2

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}

Surface / Steps

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}

Cover 1

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}

Cover 2

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}

Hole / Insert

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}


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}    


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}

Frame / Seal

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}


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}    


Cone Type {Field111} Cone Material {Field112}
Cone Depth {Field113} Cone Lining Interior {Field114}
Cone Lining Exterior {Field115}    


Wall Diameter {Field121} Wall By Size {Field122}
Wall Material {Field123} Wall Depth {Field124}
Wall Lining Interior {Field125} Wall Lining Exterior {Field126}

Bench / Channel

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}


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}

Cover 3

Cover Type Hatch Single {Field151} Cover Type Hatch Double {Field152}
Cover Type Lamphole {Field153}    
 Cover Condition Restraint Defective {Field157} Cover Condition Restraint Missing {Field156}


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}