RE 71-17 Annual Site Inspection Checklist



RE 71-17Rev. 5-2007DEPARTMENT OF TRANSPORTATIONANNUAL SITE INSPECTION CHECKLIST WITH PHOTOS SEQ CHAPTER \h \r 1ODOT Agreement No. FORMTEXT ?????County: FORMTEXT ????? FORMTEXT ?????Route: FORMTEXT ?????ODOT InspectorSection: FORMTEXT ????? FORMTEXT ?????Parcel(s): FORMTEXT ????? FORMTEXT ?????State Job No.: FORMTEXT ?????ODOT Inspector Address and Phone NumberPID: FORMTEXT ????? FORMTEXT ?????Begin Rental Date: FORMTEXT ????? FORMTEXT ?????Ending Rental Date: FORMTEXT ?????Tenant Name and Phone NumberAgreement Complied With FORMCHECKBOX Yes FORMCHECKBOX No (explain) FORMTEXT ?????Rental Amount: FORMTEXT ????? FORMTEXT ?????Pmt. Due Date: FORMTEXT ?????Tenant Notification AddressTenant: Site or P.M. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Location of State Owned PropertyNames of Individuals Present for InspectionPayment Cycle: Monthly FORMCHECKBOX Yearly FORMCHECKBOX Other FORMCHECKBOX Inspection Date: FORMTEXT ?????(Comment Section Below will expand as Needed) (Attach Photos, Especially Of Non-Compliance Conditions)General Comments: FORMTEXT ?????Describe Non-Compliance: FORMTEXT ?????Describe Plan To Bring Into Compliance With Dates: FORMTEXT ?????Describe Followup To Plan With Dates: FORMTEXT ?????Described Reinspection Results With Dates: FORMTEXT ?????If Not In Compliance Describe Followup Plan: FORMTEXT ????? ................
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