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Bridge status change Form 107
Contacts
Resources and information
Training information
FAQs
siims
Team Leader Bridge Inspector Form
*
Required information
I. Inspector contact information
First name of bridge inspector:
*
Last name of bridge inspector:
*
Enterprise A&A user name:
*
(e.g. first.last@iowaid)
Email address:
*
Phone number:
*
(e.g. 555-123-4567)
Cell phone number:
(e.g. 555-123-4567)
Organization / agency / company:
*
Address 1:
*
Address 2:
City:
*
State:
*
ZIP code:
*
II. License Information
Professional Engineer
Yes
No
License number:
State:
Expiration Date:
Engineer-in-training (EIT)
Yes
No
EIT certificate number:
Technician
Yes
No
III. Bridge Inspection Training
Safety Inspection of In-Service Bridges, course number FHWA-NHI-130055:
(two-week course)
yes
no
Date:
(e.g. MM/DD/YYYY)
Safety Inspection of In-Service Bridges for Professional Engineers, course number FHWA-NHI-130056:
(five-day course)
Yes
No
Date:
(e.g. MM/DD/YYYY)
Bridge Inspector Refresher Training, course number FHWA-NHI-130053:
(three-day course)
Yes
No
Date:
(e.g. MM/DD/YYYY)
Fracture Critical Inspection Techniques for Steel Bridges, course number FHWA-NHI-130078:
(four-day course)
Yes
No
Date:
(e.g. MM/DD/YYYY)
IV. Bridge Inspection Experience (required for non-professional engineers only)
Number of years inspecting bridges:
Number of bridges inspected annually in the presence of an NBIS qualified bridge inspector:
Total number of bridges inspected:
Question/comments:
Captcha Image (Security Code):