DAM INSPECTION CHECKLIST
Department of Environmental Protection
Bureau of Waterways Engineering
Division of Dam Safety
NAME OF DAM:
LOCATION:
_______________________________
Municipality:
_______________________
DEP CLASSIFICATION DATA: Size:
PHYSICAL DATA:
Type of Dam: ____________
DEP DAM NO.: D____-______
County:
__________________
Hazard:
Height of Dam:
_______________
Normal Pool Storage Capacity:
________
ELEVATIONS:
Normal Pool:
Pool at Inspection:
DAM OWNER:
ADDRESS:
_______________________
____________________________
Tailwater at Inspection:
OPERATOR: ________________________
_____________________________
(___)-___-____
FAX NO.: (___)-___-____
E-MAIL ADDRESS: _______________________
A completed and signed Dam Owners Notice Checklist is to accompany this Inspection Checklist.
PERSONS PRESENT AT INSPECTION:
Name
Title/Position
Representing
______________________
_______________________
______________________
______________________
_______________________
______________________
______________________
_______________________
______________________
______________________
_______________________
______________________
PHONE:
DATE OF INSPECTION:
____/______/______
WEATHER:
_________________
TEMPERATURE:
_________________
This is to certify that the above dam has been inspected and the
following are the results of this inspection.
Signature of Registered Professional Engineer
(P.E. Seal Required)
Date Revised: 1/2009
Date
COMMENTS
EMBANKMENT: CREST
1
2
3
4
5
6
7
8
9
Surface Cracking
Sinkhole, Animal Burrow
Low Area(s)
Horizontal Alignment
Ruts and/or Puddles
Vegetation Condition
Warning Signs
Additional Comments (Refer to item number if applicable):
EMBANKMENT: UPSTREAM FACE
10
11
12
13
14
15
16
17
Slide, Slough, Scarp
Slope Protection
Sinkhole, Animal Burrow
Emb.-Abut. Contact
Erosion
Vegetation Condition
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 2 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
COMMENTS
EMBANKMENT: DOWNSTREAM FACE
18
19
20
21
22
23
24
25
26
27
Wet Area(s) (No Flow)
Seepage
Slide, Slough, Scarp
Emb. - Abut. Contact
Sinkhole, Animal Burrow
Erosion
Unusual Movement
Vegetation Control
Additional Comments (Refer to item number if applicable):
EMBANKMENT: INSTRUMENTATION
28
29
30
31
32
33
34
35
36
37
Piezometers/Observ. Wells
Staff Gauge and Recorder
Weirs
Survey Monuments
Drains
Low Flow Release
Frequency of Readings
Location of Records
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 3 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
COMMENTS
DOWNSTREAM AREA
38
39
40
41
42
43
44
45
46
47
Abutment Leakage
Foundation Seepage
Slide, Slough, Scarp
Drainage System
Boils
Wet Areas
Reservoir Slopes
Access Roads
Security Devices
Act 91 Run-of-the-River
Signs or Bouys
48
49
Additional Comments (Refer to item number if applicable):
SPILLWAYS: ERODABLE CHANNEL
50
51
52
53
54
55
Slide, Slough, Scarp
Erosion
Vegetation Condition
Debris
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 4 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
COMMENTS
SPILLWAYS: NON-ERODABLE CHANNEL
56
57
58
59
60
61
62
63
64
Sidewalls
Channel Floor
Unusual Movement
Approach Area
Weir or Control
Discharge Channel
Boils
Additional Comments (Refer to item number if applicable):
SPILLWAYS: DROP INLET
65
66
67
68
69
Intake Structure
Trashrack
Stilling Basin
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 5 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
COMMENTS
OUTLET WORKS
70
71
72
73
74
75
76
77
78
79
80
81
82
Intake Structure
Trashrack
Stilling Basin
Primary Closure
Secondary Closure
Control Mechanism
Outlet Pipe
Outlet Tower
Outlet Structure
Seepage
Unusual Movement
Additional Comments (Refer to item number if applicable):
CONCRETE/MASONRY DAMS: UPSTREAM FACE
83
84
85
86
87
88
Surface Conditions
Condition of Joints
Unusual Movement
Abutment-Dam Contacts
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 6 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
COMMENTS
CONCRETE/MASONRY DAMS: DOWNSTREAM FACE
89
90
91
92
93
94
Surface Conditions
Condition of Joints
Unusual Movement
Abutment-Dam Contacts
Drains
Leakage
95
96
Additional Comments (Refer to item number if applicable):
CONCRETE/MASONRY DAMS: CREST
97
98
99
100
101
102
103
Surface Conditions
Horizontal Alignment
Vertical Alignment
Condition of Joints
Unusual Movements
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 7 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
COMMENTS
RESERVOIR AREA
Sedimentation
Slope Stability
Sinkholes
Fractures
Unwanted Growth
109 Storage Gage
104
105
106
107
108
110
111
Additional Comments (Refer to item number if applicable):
Final Comments:
Dam Safety High Hazard Dam Inspection Checklist
Page 8 of 10
Date Revised: 1/09
REPAIR
CONDITION
DATE:
IVESTIGATE
DEP DAM NO.:
MONITOR
ITEM
NAME OF DAM:
DAM OWNERS NOTICE CHECKLIST
Department of Environmental Protection
Bureau of Waterways Engineering
Division of Dam Safety
NAME OF DAM:
DEP DAM NO.:
This is to certify that both the Downstream Hazard Description is accurate and the Posted Notice
locations listed below have been inspected and the following are the results of these inspections.
Name of Dam Owner
Signature of Dam Owner
Date
This Dam Owners Notice Checklist is to accompany the Inspection Checklist filed by the Engineer.
EMERGENCY ACTION PLAN
Date of Last Update of Emergency Plan:
Downstream Hazard Description (Refer to sections II.C and II.D in the EAP), additionally, specify any new
developments, structures, etc. downstream within the inundation area:
COMMENTS
1
2
3
4
5
6
7
8
9
10
11
12
Additional Comments (Refer to item number if applicable):
Dam Safety High Hazard Dam Inspection Checklist
Page 9 of 10
Date Revised: 1/09
REPLACED
LOCATION
MISSIING
DATE
INSPECTED
EXISTING
ITEM
POSTED NOTICES (Refer to section V.A in the EAP)
Dam Safety High Hazard Dam Inspection Checklist
Page 10 of 10
Date Revised: 1/09