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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 qualifications 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)

Upload certificate of training for FHWA-NHI-130055:

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)

Upload certificate of training for FHWA-NHI-130056:

Bridge Inspector Refresher Training, course number FHWA-NHI-130053: (three-day course):

Yes
No

Date:

(e.g. MM/DD/YYYY)

Upload certificate of training for FHWA-NHI-130053:

Bridge Inspection Techniques for Nonredundant Steel Tension Members (NSTM), course number FHWA-NHI-130078:(three-day course):

Yes
No

Date:

(e.g. MM/DD/YYYY)

Upload certificate of training for FHWA-NHI-130078:

Bridge Inspection Experience

Number of years inspecting bridges:

Total number of bridges inspected in the presence of an NBIS qualified bridge inspector::

Questions/comments:

Captcha Image (Security Code):*

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