Structure Repair Report (Non-State Structures)

Structure No.:	-	City/County:
Location:	Bridge Culvert
Initial Report Prepared By:	Date of Inspection:	Inspection Team Initials:
Final Report Prepared By:	Urgency:
Type of Damage:

Condition Rating and Load Rating:

Deck: Superstructure: Substructure: Abutments: Piers: Piling: Joints:
Bearings: Culvert Barrel: Culvert Ends: Load Rating (Type 3, 3S2, & 3-3): , , .

Description of Damage:

Cause of Damage:

This Bridge is Programmed for:

REPL REPR REHB REDK WIDN CURB OVLY W/REDK REMV
NOT PROGRAMMED UIP W/OVLY EXTND STUDY

Project No.:	C.N.	Letting Date:

Proposed Solution for Repair:

Estimated Cost:	Option:
Estimated Cost:	Option:	Date Sent to Owner:

Action Taken (to be completed by Owner):

Date Action Completed:	Returned Completed Report to Consultant On:

NDOT Form 321a, July 17