Nebraska Department of Transportation

Scheduled Special Inspection – Bridge Report

Structure No.:	Special Inspection Requested By: (Print Name)	Date Original Report Submitted:	Date of Last Full Inspection:
General Location of Defect:	Deck Superstructure Substructure Piles Other
Specific Location of Defect or Condition:
Description of the condition or defect to be inspected and the purpose of the inspection: (Attach photos)
Requested Next Special Inspection (Month/Year):	Special Inspection Form shall be addressed at all full inspections as well.
Special Inspection Term: (Months)	24 Other
Date of Inspection	Inspector ID	Inspection Comments (Describe any changes observed in the condition or defect and attach photos.)
Reason for Termination of Special Inspections:
Termination of Special Inspections Approved By: (Print Name)	Date of Termination:
Special Instructions:

NDOT Form 7, July 17	Page ____ of ____