Washington State
Department of Transportation

Bridge & Roadway
Preliminary Damage Report

{var IsExercise}
1. Date
2. Time
 Statusmof Bridge or Roadway
  {var Status}
 6. Region
 
7. County

8. Route
9. Milepost
10. Bridge Number (if applicable)
11. Location:

 12. Inspector's Name: 

13. Remarks
 {var Remarks}


Emergency Bridge Inspection
Check box that corresponds with any problems below: Note: Only check a box if you are going to close the bridge.

If Bridge is SAFE to stay OPEN, apply GREEN tape with the date, time, and inspector's initials to right hand side of the bridge on the approaching corner.

If Bridge is UNSAFE and to be CLOSED, apply RED tape with date. time, and inspector's initials to right hand side of the bridge on the approaching corner.

14. Bridge Approaches 21. Hinge or Expansion Joints Check for:
General alignment of roadways and rails, and damaged utilities
Raised or lowered approaches
Cracks or buckling in the deck or roadway Raised or protruding joints or utility covers Cracking, crushing, spalling, or misalignment in columns, bent caps, abutments, beams, girders or wing walls Settlement around abutments, columns or walls
Missing bolts or rivets and/or fractured, broken, missing, or damaged anchorage connections. Dislocation or movement of bearings
Changes in water flow or debris accumulations
Loss of soils around footings,walls and roadway embankments due to erosion or scour
15. Wing Walls 22. Railings, Parapet, and Curb
16. Bridge Abutments 23. Utilities and Surrounding Areas
17. Bent Caps, and Columns 24. Seismic Restraint Devices
18. Bearings 25. Debris Accumulation in Channel
19. Beams or Girders 26. Undermined Footings
20. Deck (top and underside)  
Roadway
Geo-technical Issues
27. Cracking
34. Shoulder settlement
28. Buckling
35. Sags in roadway safety features (guardrail)
29. Heaving or rolling
36. Movement above or below tilted trees
30. Pavement separation
37. Debris on roadway
31. Change in configuration- striping or lane shift
38. Sloughing slopes
32. Change in roadway surface
39. Unstable road blocks above roadway
33. Signs, VMS and sign bridges
40. Sinkhole
Communications Log
Sending Station
Receiving Station
Radio frequency MHZ
Sent/Recieved (local)

DOT Form DOT Form 580-020 revised 02/2024
 Version 2.0