Form FS1052C "Bridge Inspection Report" - British Columbia, Canada

Form FS1052C is a British Columbia Ministry of Forests, Lands, Natural Resource Operations and Rural Development form also known as the "Bridge Inspection Report". The latest edition of the form was released in March 1, 2008 and is available for digital filing.

Download a PDF version of the Form FS1052C down below or find it on British Columbia Ministry of Forests, Lands, Natural Resource Operations and Rural Development Forms website.

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Download Form FS1052C "Bridge Inspection Report" - British Columbia, Canada

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BRIDGE INSPECTION REPORT
STEEL / CONCRETE / GLULAM,
BRIDGE INSPECTION SUMMARY
km
STRUCTURE NO.
FSR
PAGE
N
CROSSING
DISTRICT
PROJECT NO.
DATE OF
YYYY - MM
BRIDGE CLASS
NUMBER OF SPANS
DATE OF
YYYY - MM
THIS
NEXT
Permanent Bridge
Semi-permanent Bridge
INSPECTION
INSPECTION
a) Spans, abutments and piers are numbered from the left bank, facing downstream; piles, posts, curbs and stringers are numbered
NOTE:
from upstream of bridge; use additional forms for multi-span bridge.
b) Use back of form or separate sheet to sketch and detail problem area and/or materials required for repairs.
c)
CONDITION:
1 - Very Good (new);
2 - Good;
3 - Fair;
4 - Poor;
5 - Very Poor;
6 - N/A (not applicable)
BRIDGE ELEMENT
CONDITION
REMARKS
Running Planks
Structural Decking
Concrete Deck
Gravel Surfacing
Ties (incl. Shims)
DECK
Nails
Curbs and Blocks
Hand Rails
Deck to Girder Bolts
Hardware
Delineators
Girders / Slabs
Diaphragms
SUPER-
STRUCTURE
Bracing
SPAN # ____
Trussing
Hardware
Caps
Piles or Posts
Concrete
Bracing or Sheathing
PIERS
Cribs
Hardware
Riprap
Overall
Cribs
Tie-backs
Bin Walls
Caps or Sills
Piles or Posts
Concrete
ABUTMENTS
Bulkhead Planks
Wing Wall Planks
Bracing
Hardware
Fill
Riprap
Overall
APPROACHES
HAZARD(S) DESCRIPTION
PRESENT
PRESENT
ESTIMATED
m
m
m
WATER
WATER
HIGH-WATER
LEVEL
CLEARANCE
LEVEL
HAZARDS:
rHigh water
Debris
Scour
Ice
None
REPAIR DESCRIPTION AND COST ESTIMATE
REPAIR
Yes
No
REQUIRED?
PROFESSIONAL
Yes
No
INSPECTION
REQUIRED?
AS-BUILT CHECKED?
NARROW STRUCTURE SIGNS?
PRESENT POSTED RATING
SUGGESTED REPLACEMENT DATE
NUMBER OF
PICTURES
tonnes
Yes
No
Yes
No
at new load rating:
at original
TAKEN
COMMENTS
INSPECTOR'S SIGNATURE
NEW LOAD RATING
REVIEWED AND NOTED BY (SIGNATURE)
DATE SIGNED
YYYY - MM - DD
YYYY - MM - DD
tonnes
P.Eng.
DISTRIBUTION:
WHITE — Region;
CANARY — District;
PINK — Inspector
FS 1052C HTH 2008/03
BRIDGE INSPECTION REPORT
STEEL / CONCRETE / GLULAM,
BRIDGE INSPECTION SUMMARY
km
STRUCTURE NO.
FSR
PAGE
N
CROSSING
DISTRICT
PROJECT NO.
DATE OF
YYYY - MM
BRIDGE CLASS
NUMBER OF SPANS
DATE OF
YYYY - MM
THIS
NEXT
Permanent Bridge
Semi-permanent Bridge
INSPECTION
INSPECTION
a) Spans, abutments and piers are numbered from the left bank, facing downstream; piles, posts, curbs and stringers are numbered
NOTE:
from upstream of bridge; use additional forms for multi-span bridge.
b) Use back of form or separate sheet to sketch and detail problem area and/or materials required for repairs.
c)
CONDITION:
1 - Very Good (new);
2 - Good;
3 - Fair;
4 - Poor;
5 - Very Poor;
6 - N/A (not applicable)
BRIDGE ELEMENT
CONDITION
REMARKS
Running Planks
Structural Decking
Concrete Deck
Gravel Surfacing
Ties (incl. Shims)
DECK
Nails
Curbs and Blocks
Hand Rails
Deck to Girder Bolts
Hardware
Delineators
Girders / Slabs
Diaphragms
SUPER-
STRUCTURE
Bracing
SPAN # ____
Trussing
Hardware
Caps
Piles or Posts
Concrete
Bracing or Sheathing
PIERS
Cribs
Hardware
Riprap
Overall
Cribs
Tie-backs
Bin Walls
Caps or Sills
Piles or Posts
Concrete
ABUTMENTS
Bulkhead Planks
Wing Wall Planks
Bracing
Hardware
Fill
Riprap
Overall
APPROACHES
HAZARD(S) DESCRIPTION
PRESENT
PRESENT
ESTIMATED
m
m
m
WATER
WATER
HIGH-WATER
LEVEL
CLEARANCE
LEVEL
HAZARDS:
rHigh water
Debris
Scour
Ice
None
REPAIR DESCRIPTION AND COST ESTIMATE
REPAIR
Yes
No
REQUIRED?
PROFESSIONAL
Yes
No
INSPECTION
REQUIRED?
AS-BUILT CHECKED?
NARROW STRUCTURE SIGNS?
PRESENT POSTED RATING
SUGGESTED REPLACEMENT DATE
NUMBER OF
PICTURES
tonnes
Yes
No
Yes
No
at new load rating:
at original
TAKEN
COMMENTS
INSPECTOR'S SIGNATURE
NEW LOAD RATING
REVIEWED AND NOTED BY (SIGNATURE)
DATE SIGNED
YYYY - MM - DD
YYYY - MM - DD
tonnes
P.Eng.
DISTRIBUTION:
WHITE — Region;
CANARY — District;
PINK — Inspector
FS 1052C HTH 2008/03
NOTES ON BRIDGE INSPECTION REPORTS
Some common problems to be noted under the "Remarks" heading:
i)
TIMBER PILES AND SAWN TIMBER: treated — checks, cracks, mechanical damage, rot; untreated — rot, checks,
mechanical damage, wear.
ii)
LOGS: rot, spiral grain, cracks, unpeeled (measure depth of rot and record).
iii) STEEL CONNECTORS (rods, bolts, nails, wire rope, etc.): corroded, loose, broken, missing.
iv) GLULAM: checks, cracks, rot.
v)
STEEL GIRDERS: cracks in welds, corrosion of painted surface, change in geometry or alignment.
vi) CONCRETE: cracks, spalling.
vii) DELINEATORS: broken, missing.
viii) LOG CRIBS: tilting, bulging, rot, scour.
ix) PILE OR POST ABUTMENTS: broken or twisted planks, broken tie-backs, leaning either parallel or perpendicular
to bridge centreline, rot at groundline, scour.
x)
PIERS: leaning, scour, ice damage, debris build-up.
xi) RIPRAP: missing, unstable, poorly-graded.
xii) FILL: sloughing, uneven or excessive settlement, poor drainage.
Mark all other problems or deficiencies as applicable.
Particular attention should be paid to rot in wood, especially at groundline, at connectors and at bearings, as well as at
or near midspan of log stringers.
Where individual problems are noted, they should be clearly identified as to location in bridge (e.g., abutment #1; pier #2
— pile #2; span #2 — stringer #4), complete with a sketch detailing the problem (length, width and depth of a crack).
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