The state's railways require critical changes, while state and local roads also rate poorly in the report, published on Tuesday.
But airports and national roads are both rated as "good".
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Ports, stormwater provisions, electricity, irrigation, telecommunications, gas and wastewater provisions are all rated "adequate" in the report.
More than three quarters of the sectors require major or critical changes, it says.
"The state's infrastructure is under stress in many areas and needs major changes to rise above its generally average to poor condition," Ian Pedersen, chair of the Engineers Australia NSW infrastructure report card committee said in a statement.
"There remains a lack of strategic planning, coordination and integration and a commitment to existing plans.
"With population growth driving further demands the public and private sectors will need to invest a significant amount of money to bring NSW's infrastructure up to a reasonable standard."
