检查日期：      年      月      日至       年      月     日

所在地区                                                   

所在河流                                                   

主管单位（或业主）                                         

原设计单位                                                 

原施工单位                                                 

坝    型                                                   

竣工日期                      首次蓄水日期                 

正常蓄水位               m    设计最高水位               m

运行期最高水位           m    运行期最低水位             m

检查时运行情况：

水库水位              m       水库蓄水量              万m³

检查人员：

安全辅助设施检查表

1 通讯设施

型式                                                       

存在问题                                                  

2 照明

型式                                                      

存在问题                                                  

3 交通设施

型式                                                       

存在问题                                                  

4 观测设施

外部                                                      

内部                                                       

观测仪器完好状况                                          

5 其它

坝体检查表

1 坝顶                                                     

2 防浪墙                                                  

3 迎水坡                                                   

4 背水坡                                                  

5 坝趾                                                    

6 排水系统                                                 

7 导渗降压设施                                            

8 其它                                                    

坝基及坝区检查表

1 坝基                                                    

2 两岸坝端                                                

3 坝趾近区                                                

4 坝端岸坡                                                

5 上游铺盖                                                

6 其它                                                    

坝内输水涵检查表

1 引水段                                                  

2 进水塔                                                  

3 洞（管）身                                              

4 出口                                                    

5 消能工                                                  

6 工作桥                                                  

7 闸（阀）门及启闭机                                      

8 其它                                                    

溢洪道检查表

1 进水段（引渠）                                           

2 堰顶或闸室                                              

3消能工                                                    

4 工作桥                                                   

5 闸（阀）门及启闭机                                      

6 其它                                                    

厂房检查表

1 厂房近区                                                

2 泄流槽                                                  

3防洪墙                                                   

4 厂房结构                                                

5 厂房内机电设备                                          

6 其它