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Run: Cathodic Protection Annual Pipe-to-Soil Survey

Annual pipe-to-soil survey template for documenting cathodic protection readings on steel gas and water mains, checking the -0.85 V CSE criterion, and tracki...

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Inspection Details

Survey date and time recorded critical (required)

Inspector name and company recorded critical (required)

Pipeline asset identified critical (required)

Include pipeline name, segment, stationing, or test station ID.

Asset type selected critical (required)

Note (optional)

Survey method documented critical (required)

Weather and soil conditions noted

Reference standard noted

Verify readings against the -0.85 V CSE criterion used for cathodic protection evaluation per NACE SP0169.

Reference Electrode and Test Setup

Reference electrode type confirmed critical (required)

Reference electrode condition acceptable critical (required)

Electrode is clean, intact, and suitable for field use.

Yes No N/A

Lead connections secure and free of damage critical (required)

Yes No N/A

Test equipment calibration current critical (required)

Record the most recent calibration or verification date for the voltmeter or data logger.

Measurement setup free of obvious interference critical (required)

Confirm no obvious electrical interference, poor contact, or unsafe access conditions affected the reading.

Yes No N/A

Pipe-to-Soil Potential Readings

Measurement point 1 location critical (required)

Identify the test station, milepost, valve box, or accessible point.

Measurement point 1 pipe-to-soil potential critical (required)

Enter the stabilized pipe-to-soil potential reading referenced to CSE.

Measurement point 1 meets -0.85 V CSE criterion critical (required)

Yes No N/A

Measurement point 2 location

Use additional points as needed for the survey route.

Measurement point 2 pipe-to-soil potential

Measurement point 2 meets -0.85 V CSE criterion

Yes No N/A

Additional readings documented

Record any additional pipe-to-soil readings, including location, value, and notable conditions.

Deficiencies and Corrective Actions

Deficiencies identified

Note (optional)

Corrective action required

Yes No N/A

Corrective action details

Describe repairs, retest requirements, or escalation to corrosion engineering or the AHJ.

Follow-up due date

Enter the target date/time for retest or corrective action completion.

Sign-Off

Survey record reviewed for completeness critical (required)

Yes No N/A

Inspector signature critical (required)

Supervisor or corrosion engineer review

Use when internal procedure requires technical review or approval.

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