Structure Design Verification Form

A3-2

Structure ID Name
           

Superstructure details

Span Groups Structure Type: Bridge

completed

Span Span
Mod Type Span Span Pier Span BGL Span Span Type No. of Protection Coating
Year

Material Construction Initials

(Table 1) From To Length Length (Table 3) Girders (Table 5)
(Table 2) (Table 4)

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

Structures Inspection Manual, Transport and Main Roads, September 2016 1

Structure Design Verification Form
A3-2

Superstructure details
Span Groups Structure Type: Culvert
completed

Span Span Span Protection

Modification Span Span Cell Shape Span Cell Cell Cell Cell Liner
Year

Material Type Construction Coating Initials

(Table 1) From To (Table 32) Length Height Length Area (Table 33)
(Table 2) (Table 3) (Table 4) (Table 5)

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

                                                                                         

Structures Inspection Manual, Transport and Main Roads, September 2016 2

Structure Design Verification Form
A3-2

Superstructure details
Deck
completed

Modification Construction Type Depth of

Span Span Deck Material Surfacing Type Thickness Thickness Drainage Type
Year

Type Fill Initials

From To (Table 2) (Table 7) (Min) (Max) (Table 8)
(Table 1) (Table 6) (Culverts)

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

                                                                       

Structures Inspection Manual, Transport and Main Roads, September 2016 3

Structure Design Verification Form
A3-2

Substructure details
Substructure 1
Substructure Group Foundation Group
completed

Modification Abutment/Bed
Group
Year

Type From To Material Type Material Type Protection Initials

(Table 10)
(Table 1) (Table 12) (Table 9) (Table 12) (Table 11) (Table 13)

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

Structures Inspection Manual, Transport and Main Roads, September 2016 4

Structure Design Verification Form
A3-2

Substructure details
Substructure 2
Bearing Joint
completed

Modification
Group Deck Articulation
Year

Type From To Type Fixity Type Initials

(Table 10) No (Table 17)
(Table 1) (Table 14) (Table 15) (Table 16)

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

Structures Inspection Manual, Transport and Main Roads, September 2016 5

Structure Design Verification Form
A3-2

Structure Barrier

Span Span Location Type Containment Class

Height Comments Initials
From To (Table 18) (Table 19) (Table 20)

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

                                               

Structures Inspection Manual, Transport and Main Roads, September 2016 6

Structure Design Verification Form
A3-2

Approach Guardrail

Approach Location Type

Comments Initials
(AP1 or AP2) (Table 21) (Table 22)

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

                             

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Utility Services

Utility Service Type

Quantity Units Locations and Attachment Details Comments Initials
(Table 30)

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

                                   

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Structural Geometry - General

Road Design Speed Initials

     

     

     

     

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