Date of Inspection: _______________________ Name of Inspector: ______________________

Pot Bearing Inspection Form

Location of Bearing: _______________________

Type of Bearing: Fixed Guided Transversely Guided Longitudinally Non-Guided

Box Girder/Pier:
Are these cracks radial to bearing?
Orientation:_______________
Length:___________________
Orientation:_______________
Length:___________________
(Drawn on plan view)
Yes No
Location:_______________
Width:_________________
Location:_______________
Width:_________________
FIXED BEARING

Concrete Plinth
Are these cracks greater than 0.01 inches? Yes No
Orientation:_______________ Location:_______________
Length:___________________ Width:_________________
Spall developing in corner of block? Yes No
(Report immediately if Yes) SLIDING GUIDED BEARING
Sole Plate
Is the Sole Plate Rusted? Yes No
Is the Sole Plate Bent? Yes No
Is the Stainless Steel Layer Rusted? Yes No
Is the Stainless Steel Layer Rippled? Yes No
Is the Stainless Steel Layer Delaminated? Yes No
FREE SLIDING BEARING
Distance from Piston to Edge of Sole Plate: ______________________________
Is the sole plate touching or nearly touching the Base Pot (Riser Plate)? Yes, Touching Yes, within 1/8” No
Location: N NE E SE W SW W NW
Guide Bar
Is the Guide Bar Rusted? Yes No
Is the Guide Bar Securely Attached? Yes No
Is the Guide Bar Rubbing? Yes No
Is there Teflon Extrusion? Yes No If Yes. 0-1/4” Minor Moderate 0-1/4” Severe
Piston
Is the Piston Surface Rusted? Yes No
Is there Teflon Extrusion? Yes No If Yes. 0-1/4” Minor Moderate 0-1/4” Severe
Is the Piston Flange touching or nearly touching the Base Pot (Riser Plate)? Yes, Touching Yes, within 1/8” No
Location: N NE E SE W SW W NW
Base Pot (Riser Plate)
Is the Base Pot Rusted? Yes No
Is the Base Pot Bent? Yes No
Is the Base Pot Level? Yes No
Is there Neoprene Extrusion? Yes No If Yes. Minor – Oily Stains Flakes Moderate Marble Size Severe Marble Size
Riser Pad
Rate Condition of Riser Pad. Good-No cracks to minor hairline cracks Fair- Poor-Large wide cracks and spalls
Is the riser pad spalling under the bearing? Yes No

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