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Bridge status change Form 107
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Change Inspector Role Form

* Required information

To maintain your SIIMS account, complete this form if your qualification for bridge inspector have changed.

First name:*

Last name:*

Email address:*

Organization / agency / company :*

New Role:

Program Manager
Team Leader
Load Rater

License Information

License Number:

State:

Expiration date:

(e.g. MM/DD/YYYY)

Engineer-in-training (EIT)

Yes
No

EIT Certificate number:

TECHNICIAN

Yes
No

Bridge Inspection Training

Enter the relevant information if you recently completed 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)

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:

Questions/comments:

Captcha Image (Security Code):

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