Templates
Well Inspection Report Template

Well Inspection Report Template

Well inspection reports have never been easier than with a checklist template where you can keep track of tasks you already performed and tasks you need to do still.

Use this template
or download pdf
Well Inspection Report Template

Well inspection reports have never been easier than with a checklist template where you can keep track of tasks you already performed and tasks you need to do still.

Use this template
or download pdf

About the Well Inspection Report Template

A well inspection report is an important document that allows you to keep track of the maintenance of your well so that you can make sure everything is in working order and that water is not contaminated.

Water, as one of the most basic human needs, contributes greatly to our health and well-being. If a water source is polluted it can endanger people’s safety. Therefore a well inspection is not only a preventive measure to keep people healthy, but also an important risk assessment tool that you can employ.

Related categories

Preview of the template
General Information
Well Site
Date
Inspection performed by
Is it a routine inspection?
Condition & Location
Condition
Well Type
Is the well up to current standards?
How deep is the well?
Are well records available?
How old is the well?
How often has the well been inspected?
How often were water tests performed?
Location
Where is the well located on the property?
Is the soil around the well burmed?
Are there any voids in the soil or on top of wellhead?
Is the wellhead visible and above ground?
Are there any permanent structures within 3m of the wellhead?
Does the well meet the minimum distance requirement from contamination sources?
Are there any abandoned wells on the property?
Well Components
Is the casing 30 or more cm above land surface?
Are there holes or crack in casing?
Does casing depth meet codes?
Is the cap watertight?
Is the cap securely attached to casing?
Is there any corrosion visible at plumbing fittings and storage tank?
Pressure Tank
What is the pump cut-in pressure?
What is the pump cut-out pressure?
What is the pressure differential?
How long does it take for pump to go from cut-in to cut-out with no water running?
Have water treatment systems been regularly maintained?
Water Testing
Is a water sample needed?
Well Yield
Well Flow Test Results: _______ GPM
Is a more extensive test needed?
Sign Off
Additional Comments
Signature
This template was downloaded 36 times
This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.