Lumiform Mobile audits & inspections
Get App Get App

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.

Downloaded 33 times

Rated 5/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates

Digitalize this paper form now

Register for free on and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 5/5 stars on Capterra

Well Inspection Report Template

General Information

Well Site
Inspection performed by
Is it a routine inspection?

Condition & Location


(check name not set)
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?


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
Share this template:

Similar templates