Condition Inspection Form (Cif) B01818LZ
Condition Inspection Form (Cif) B01818LZ
SUBMITTED BY:
Insert Name, Position, Signature and Date of Signing WILFREDO S. MALLARI
Initial all other pages District Engineer
Bridge Condition Inspection Form Page 1 of 11 Effective Date August 22, 2007
SUMMARY
Bridge Condition Inspection Form Page 2 of 11 Effective Date August 22, 2007
REPAIR RECORD
MAJOR MAINTENANCE
MAJOR MAINTENANCE IMPLEMENTATION INSPECTOR
DATE
TYPE SCOPE COST START COMPLETION DURATION STATUS COMMENTS
ROUTINE MAINTENANCE
ROUTINE MAINTENANCE IMPLEMENTATION INSPECTOR
DATE
TYPE SCOPE COST START COMPLETION DURATION STATUS COMMENTS
A Sweeping and cleaning of bridge deck 30,000.00
E Painting bridge components 60,000.00
Bridge Condition Inspection Form Page 3 of 11 Effective Date August 22, 2007
SPAN ELEMENT - CONDITION
SPAN No. 1 (one set of forms for each span) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Bridge Condition Inspection Form Page 4 of 11 Effective Date August 22, 2007
SPAN ELEMENT - CONDITION
SPAN No. 2 (one set of forms for each span) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Bridge Condition Inspection Form Page 4 of 11 Effective Date August 22, 2007
PIER ELEMENT - CONDITION
PIER No. 1 (one set of forms for each pier) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Scour/Erosion Check, bridges across waterways only Height, bridge deck to ground level, left, (m) 6.46
Height, bridge deck to ground level, right, (m) 6.48
Bridge Condition Inspection Form Page 5 of 11 Effective Date August 22, 2007
ABUTMENT ELEMENT - CONDITION (1/2)
ABUTMENT No. 1 (one set of froms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Scour/Erosion Check, bridges across waterways only Height, bridge deck to ground level, left, (m) 1.61
Height, bridge deck to ground level, right, (m) 1.61
Bridge Condition Inspection Form Page 6 of 11 Effective Date August 22, 2007
ABUTMENT ELEMENT - CONDITION (2/2)
ABUTMENT No. 1 (one set of forms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Bridge Condition Inspection Form Page 7 of 11 Effective Date August 22, 2007
ABUTMENT ELEMENT - CONDITION (1/2)
ABUTMENT No. 2 (one set of froms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Scour/Erosion Check, bridges across waterways only Height, bridge deck to ground level, left, (m) 1.59
Height, bridge deck to ground level, right, (m) 1.59
Bridge Condition Inspection Form Page 6 of 11 Effective Date August 22, 2007
ABUTMENT ELEMENT - CONDITION (2/2)
ABUTMENT No. 2 (one set of forms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Bridge Condition Inspection Form Page 7 of 11 Effective Date August 22, 2007
SPAN Element - Damage Rating
SPAN No. 1 (one set of forms for each span) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
DECK MAIN MEMBER
Timber Decay/Splitting/Cracking Concrete Cracking
Disconnection/Displace. RC Spalling/Scaling/Disinteg.
Steel Corrosion Girder Delamination
Cracking PC Rebar exposure/corrosion
Deformation/Buckling Girder Honeycomb
Loose connection Slab Water leakage
Cracking Steel Corrosion
Concrete Spalling/Scaling/Disinteg. Steel Cracking
Slab Rebar exposure/corrosion Girder Deformation/Buckling
Honeycomb Steel Abnormal vibration
Water leakage Truss Loose connection
SECONDARY MEMBER (SM) / OTHER MEMBER (OM) Cable S. Paint peel off
SMOM SM OM SM OM SM OM SM OM SM OM Corrosion
Cracking Demount. Loose connection
Concrete Spalling/Scaling/Disint. (Bailey) Deformation/Buckling
Delamination Fretting/Abrasion
Rebar exposure/corrn. Masonry Cracking
Honeycomb (Arch) Material displacement/loss
Water leakage Bulging
Corrosion Timber Decay/Splitting/Cracking
Steel Cracking Disconnection/Displace.
Deformation/Buckling LEFT RAILING (LR) / RIGHT RAILING (RR)
Abnormal vibration LR RR LR RR LR RR LR RR LR RR SM OM
Loose connection Cracking
Paint peel off Concrete Delamination/Disinteg.
Fretting/Abrasion Impact/Accident damage
Masonry Cracking Rebar exposure/corrosion
Material displace./loss Corrosion
Bulging Steel Loose connection
Decay//Cracking Aluminum Impact/Accident damage
Timber Disconnection/Displace. Paint peel off
Bridge Condtion Inspection Form Page 8 of 11 Effective Date August 22, 2007
SPAN Element - Damage Rating
SPAN No. 1 (one set of forms for each span) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
DECK MAIN MEMBER
Timber Decay/Splitting/Cracking Concrete Cracking
Disconnection/Displace. RC Spalling/Scaling/Disinteg.
Steel Corrosion Girder Delamination
Cracking PC Rebar exposure/corrosion
Deformation/Buckling Girder Honeycomb
Loose connection Slab Water leakage
Cracking Steel Corrosion
Concrete Spalling/Scaling/Disinteg. Steel Cracking
Slab Rebar exposure/corrosion Girder Deformation/Buckling
Honeycomb Steel Abnormal vibration
Water leakage Truss Loose connection
SECONDARY MEMBER (SM) / OTHER MEMBER (OM) Cable S. Paint peel off
SMOM SMOM SM OM SM OM SM OM SM OM Corrosion
Cracking Demount. Loose connection
Concrete Spalling/Scaling/Disint. (Bailey) Deformation/Buckling
Delamination Fretting/Abrasion
Rebar exposure/corrn. Masonry Cracking
Honeycomb (Arch) Material displacement/loss
Water leakage Bulging
Corrosion Timber Decay/Splitting/Cracking
Steel Cracking Disconnection/Displace.
Deformation/Buckling LEFT RAILING (LR) / RIGHT RAILING (RR)
Abnormal vibration LR RR LR RR LR RR LR RR LR RR SM OM
Loose connection Cracking
Paint peel off Concrete Delamination/Disinteg.
Fretting/Abrasion Impact/Accident damage
Masonry Cracking Rebar exposure/corrosion
Material displace./loss Corrosion
Bulging Steel Loose connection
Decay//Cracking Aluminum Impact/Accident damage
Timber Disconnection/Displace. Paint peel off
Bridge Condtion Inspection Form Page 8 of 11 Effective Date August 22, 2007
PIER Element - Damage Rating
PIER No. 1 (one set of forms for each pier) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
MAIN STRUCTURE EXPANSION JOINT
Cracking Seals Water leakage
Concrete Spalling/Scaling/Disinteg. Abnormal space/noise
Delamination Difference in elevation
Rebar exposure/corrosion Deteriorated Sealant
Honeycomb
Tilt/Settlement Steel Water leakage
Fretting/Abrasion Abnormal space/noise
Masonry Cracking Difference in elevation
Material loss/displace. Displacement
Bulging Cracking
Tilt/Settlement Rubber Water leakage
Decay/Splitting/Cracking Abnormal space/noise
Timber Disconnection/Displace. Difference in elevation
Tilt/Settlement Displacement
BEARING/RESTRAINT Rupture
Corrosion None
Steel Loose connection FOUNDATION
Abnormal displacement Cracking
Paint deterioration Concrete Spalling/Scaling/Disinteg.
Bed (support) damage Delamination
Bulging Rebar exposure/corrosion
Rubber Abnormal displacement Honecomb
Bed (support) damage Tilt/Settlement
None Steel Corrosion
SCOUR PROTECTION Cracking
Concret Cracking Deformation/Buckling
Masonry Material loss/disinteg. Tilt/Settlement
Riprap
Gabion Damage on containing wire
Mattress Material loss/disinteg.
None
Bridge Condition Inspection Form Page 9 of 11 Effective Date August 22, 2007
ABUTMENT Element - Damage Rating (1/2)
ABUTMENT No. 1 (one set of forms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
MAIN STRUCTURE EXPANSION JOINT
Cracking Seals Water leakage
Concrete Spalling/Scaling/Disinteg. Abnormal space/noise
Delamination Difference in elevation
Rebar exposure/corrosion Deteriorated Sealant
Honeycomb
Tilt/Settlement Steel Water leakage
Fretting/Abrasion Abnormal space/noise
Masonry Cracking Difference in elevation
Deterioration Displacement
Bulging Cracking
Tilt/Settlement Rubber Water leakage
Decay/Splitting/Cracking Abnormal space/noise
Timber Disconnection/Displace. Difference in elevation
Tilt/Settlement Displacement
SLOPE/BANK PROTECTION Rupture
Concret Cracking None
Masonry Bank erosion FOUNDATION
Grouted Slope erosion Cracking
Riprap Material loss/disinteg. Concrete Spalling/Scaling/Disinteg.
Gabion Damage on containing wire Delamination
Mattresses Material loss/disinteg. Rebar exposure/corrosion
Bank erosion Honecomb
Slope erosion Tilt/Settlement
Steel Corrosion Steel Corrosion
Sheet Pile Displacement/Deformation Cracking
Bank erosion Deformation/Buckling
Slope erosion Tilt/Settlement
None
Bridge Condition Inspection Form Page 10 of 11 Effective Date August 22, 2007
ABUTMENT Element - Damage Rating (2/2)
ABUTMENT No. 1 (one set of forms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
BEARING/RESTRAINT BRIDGE APPROACH
Corrosion Embank- Material loss
Steel Loose connection ment Depression
Abnormal displacement None
Paint deterioration Assessment of Bridge Approach will be limited to 6.0 meter length.
Bed (support) damage
Bulging
Rubber Abnormal displacement
Bed damage
None
LEFT WING WALL (LW) / RIGHT WING WALL (RW)
LWRW LWRW LW RW LW RW LW RW LW RW
Cracking
Concrete Delamination/Disinteg.
Rebar exposure/corrosion
Corrosion
Masonry Loose connection
Deformation/Buckling
Paint peel off
None
Bridge Condition Inspection Form Page 11 of 11 Effective Date August 22, 2007
ABUTMENT Element - Damage Rating (1/2)
ABUTMENT No. 2 (one set of forms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
MAIN STRUCTURE EXPANSION JOINT
Cracking Seals Water leakage
Concrete Spalling/Scaling/Disinteg. Abnormal space/noise
Delamination Difference in elevation
Rebar exposure/corrosion Deteriorated Sealant
Honeycomb
Tilt/Settlement Steel Water leakage
Fretting/Abrasion Abnormal space/noise
Masonry Cracking Difference in elevation
Deterioration Displacement
Bulging Cracking
Tilt/Settlement Rubber Water leakage
Decay/Splitting/Cracking Abnormal space/noise
Timber Disconnection/Displace. Difference in elevation
Tilt/Settlement Displacement
SLOPE/BANK PROTECTION Rupture
Concret Cracking None
Masonry Bank erosion FOUNDATION
Grouted Slope erosion Cracking
Riprap Material loss/disinteg. Concrete Spalling/Scaling/Disinteg.
Gabion Damage on containing wire Delamination
Mattresses Material loss/disinteg. Rebar exposure/corrosion
Bank erosion Honecomb
Slope erosion Tilt/Settlement
Steel Corrosion Steel Corrosion
Sheet Pile Displacement/Deformation Cracking
Bank erosion Deformation/Buckling
Slope erosion Tilt/Settlement
None
Bridge Condition Inspection Form Page 10 of 11 Effective Date August 22, 2007
ABUTMENT Element - Damage Rating (2/2)
ABUTMENT No. 2 (one set of forms for each abutment) Bridge ID B01818LZ Bridge Name Sucat Interchange (EB)
Unit
Unit
Material Defect Rating Material Defect Rating
State State
BEARING/RESTRAINT BRIDGE APPROACH
Corrosion Embank- Material loss
Steel Loose connection ment Depression
Abnormal displacement None
Paint deterioration Assessment of Bridge Approach will be limited to 6.0 meter length.
Bed (support) damage
Bulging
Rubber Abnormal displacement
Bed damage
None
LEFT WING WALL (LW) / RIGHT WING WALL (RW)
LWRW LWRW LW RW LW RW LW RW LW RW
Cracking
Concrete Delamination/Disinteg.
Rebar exposure/corrosion
Corrosion
Masonry Loose connection
Deformation/Buckling
Paint peel off
None
Bridge Condition Inspection Form Page 11 of 11 Effective Date August 22, 2007