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STATE HIGHWAY ADMINISTRATION

WORK ZONE INSPECTION FORM: SURVEY OF CURRENT STATE PRACTICES

SUMMARY OF FINDINGS

Allison R. Hardt Wenxin Qiao

Office of Policy and Research

June 2012

Martin O’Malley, Governor Anthony G. Brown, Lt. Governor

Beverley K. Swaim-Staley, Secretary Melinda B. Peters, Administrator

Abstract: In an effort to identify best practices, the Maryland State Highway Administration’s Office of Policy and Research, sent an e-mail to AASHTO’s Research Advisory Committee requesting examples of work zone inspection forms currently in use by the other states. 25 responses were received including 24 State Departments of Transportation and one Canadian Province. This document contains all of the information received from the respondents with a focus on three areas:

1. Information received regarding current practices and the forms used. 2. A list of contacts that can be used to obtain additional information. 3. Inspection forms currently being used and/or proposed for use.

Given the large response and interest in this survey, an electronic copy of the summary report will be sent to the states and individuals that responded.

State NoteArkansas Inspection form is included in the forms section.

Caltrans

For Caltrans, workzone inspection involves a couple of different items. Caltrans inspects workzones for both contract and Cal OSHA Title 8 compliance. To that end, a Safety Checklist has now been adopted Statewide that covers a variety of potential workzone issues. The premise behind these checklists is that the Assistant Resident Engineer (ARE) can pull the checklists they need for that day's ongoing activity and ensure compliance with items that are primarily visual for the ARE. Additionally, each project is required to do a weekly safety diary and these checklists streamline that process. Secondarily, Caltrans wanted additional focus in North Region Construction on daily traffic control compliance. At issue is reducing the potential for tort liability for taking a traffic control non‐compliance issue out of context with overall performance on the project. Using their Standard Plans for traffic control, a series of ARE diary forms were developed for use by field staff. Copies of the forms are provided in the Forms section.

Florida

The Florida DOT requires the contractor to certify the work zone quantities for payment. The contractor selects the pay item from the drop down on the setup tab (located at the bottom of the excel worksheet), and these get transferred to the main sheet. Some of these forms take you to a different site for you to download the form, by number. Below is a link to the forms. http://www.dot.state.fl.us/construction/forms/Site%20Source/SiteSource.shtm

Idaho

Idaho provided three documents. One is a four‐page checklist being used for work zone traffic control. One is (Work Zone Traffic Control Reviews) a proposed form to be used in the future. The third document (WZ Check List) contains suggested additions to the proposed form. The proposed form is still a work in progress and there is a joint ITD/FHWA team working on the form.

Illinois

Report” (located at http://www.dot.il.gov/const/conforms.html and attached). This form is required per Section 700 of IDOT’s Construction Manual (http://www.dot.il.gov/constructionmanual/current/section_700.pdf), and can be used for District Traffic Control Supervisor’s inspections as well . As a related inspection form, when field conditions dictate per Article 701.10 of IDOT’s Standard Specifications for Road and Bridge Construction (http://www.dot.il.gov/desenv/stdspecs12.html, excerpted below), the “Traffic Control Surveillance Report”, Form BC 2240 (http://www.dot.il.gov/const/conforms.html and attached), is to be used by the Contractor to document surveillance as required. Lastly, regarding work zone safety and inspection related forms, Form OPER 725, the IDOT’s Bureau of Operations’ “Traffic Control Authorization Request” (located at http://www.dot.il.gov/oper/operforms.html and attached), is typically submitted at the preconstruction conference and is used primarily as an emergency ‘contact list’ should conditions warrant on a specific contract. This use of this form is discussed in the Bureau of Safety Engineering’s “Work Zone Safety and Mobility Rule: Safety 3‐07” (http://www.dot.il.gov/illinoisSHSP/WorkZoneSafetyMobility/03092009_Policy_Safety_307.pdf).

Indiana

INDOT developed a checklist for Work Zone Traffic Control quality assurance audits. They also require the contractor to complete and turn in either the attached sign and barricade report or something similar in look and feel on a weekly basis. This is the quality control side. The checklist is used in the office while viewing a video recording taken during the audit. Comments are made on various things camera while inspectors drive through the project. Both positive and negative findings are noted and then written in a report. The checklists are used to assemble an annual report that lists targets for improvement. If a category exists on the project, say drums are used, then the category is circled. If there are deficiencies anywhere on the project for a sub category, it is marked once for the entire project. For example, if there are 100 dirty drums or only 1, the drums are deficient.

IowaThe Iowa DOT has a daily traffic control diary boiler plate that is required to be completed each day by Contractors. A copy of this form is included in the Forms section.

Survey Response Information

* A total of 25 responses were received; 24 from State DOTs and one from a Canadian Province.

MaineMaine has not used a specific form. In general they do drive through with the Resident, take pictures and notes. The focus is on positive guidance and compliance with the MUTCD and specifications.

Maryland SHA initiated the survey to update the current form which is included in the forms section.Michigan Michigan's form is included in the Forms section.

MinnesotaTwo versions of the Work Zone Inspection forms used by some of the Districts at the Minnesota DOT are included in the Forms section.

Mississippi Mississippi's form is in the Forms section.

Missouri

MoDOT uses three different surveys to rate work zones. All three differ in the amount of information obtained.1. Work Zone Customer Survey: Information obtained from traveling public (form provided). 2. Work Zone Inspection Form: Technical MoDOT personnel complete these forms to compare work zone customer surveys with the inspection forms.http://www.modot.org/workzones/documents/WorkZone‐Inspection‐Form.pdf 3. Temporary Traffic Control Inspection Work Sheet: This form has greater detail that MoDOT uses for a in‐depth work zone review.(file: MoDOT TTC Inspection WS with Grade Description.docx provided)

Montana Montana's form is included in the Forms section.

New HampshireNH is using a new form that was recently implemented. As a result, they still consider it to be a work in progress.

New Jersey

The NJDOT forms used for Work Zone Inspections are included in the forms section. OCPH‐1 is used by Construction Group for evaluation of contractors. The Work Zone Inspection file is used for in‐house Maintenance forces.

Ohio

Ohio provided links to their forms. The form for long‐term work zones (zone is in place 24/7) can be found at: http://www.dot.state.oh.us/Divisions/ConstructionMgt/Admin/Inspection%20Forms/PDF%20Files/CA‐D‐8.pdfthe form used for short‐term work zones (zone is setup and removed daily) can be found at:http://www.dot.state.oh.us/Divisions/ConstructionMgt/Admin/Inspection%20Forms/PDF%20Files/CA‐D‐7.pdf

Oregon

ODOT's Traffic Control Inspection Report can be found on their Construction Forms page along with instructions and a example.http://www.oregon.gov/ODOT/HWY/CONSTRUCTION/HwyConstForms1.shtml#S_T

Pennsylvania

PennDOT's forms for work zone traffic control quality assurance are included in the Forms section. Form M‐7002 is used by the maintenance quality assurance staff on the in‐house department maintenance crews. The other form is used primarily on non‐departmental crews such as utility workers.

Saskatchewan Canada

The Saskatchewan Ministry of Highways & Infrastructure uses 2 forms (included in the Forms section) for work zone traffic accommodation inspections. The “Traffic Accommodation Checklist” form is more of an informal day‐to‐day form used by project staff and the “Work Zone Sign Audit” form is more for formal inspections by an external inspector with a points rating system included; although it can also be used as an informal tool.

South Carolina South Carolina's form is included in the Forms section.

Utah Utah will have a new form effective July 1st. The one currently in use is included in the Forms section.

Vermont

The Vermont Agency of Transportation's form is included in the Forms section. It is only used for formal inspections, but may be referenced by inspectors for less formal site visits. It is thorough but has been found to be cumbersome and somewhat repetitive.

Washington Washington State's form is included in the Forms section.Wisconsin Wisconsin's form is included in the Forms section.

Work Zone Inspection Form Contacts

Arkansas: Kassie D. Bornds Planning And Research Policy Analysis 501‐569‐2465 [email protected] California: Ed Yarbrough Caltrans North Region Construction Construction Safety Engineer Yuba City Construction Office 379 Colusa Highway Yuba City, CA 95991 530-822-5182 [email protected] Florida: Stefanie D. Maxwell, P.E. Specialty Engineer FDOT, Office of Construction 605 Suwannee Street, MS 31 Tallahassee, FL 32399 (850-412-8021 [email protected] Idaho: Greg M. Laragan, P.E. Highways Operations Engineer Idaho DOT P.O. Box 7129 Boise, ID 83707-1129 208-334-8535 [email protected] Illinois: Mark Neale, P.E. Documentation Engineer - Bureau of Construction Illinois DOT 2300 South Dirksen Parkway Springfield, IL 62764 217-785-4610 [email protected]

Indiana: Pat McCarty, P.E. Senior Engineer, Work Zone Safety Indianapolis Traffic Management Center 8620 East 21st Street Indianapolis, IN 46219 Office 317-899-8626 Cell 317-758-7587 Fax 317-898-0897 [email protected]] Iowa: Mark R. Bortle, P.E. Traffic Safety Engineer Office of Construction Iowa DOT 800 Lincoln Way Ames, IA 50010 515 239-1587 [email protected] Louisiana DOT: Barry L. Lacy, P.E. Claims/Work Zone/Audit Engineer 1201 Capitol Access Road Room 510K Baton Rouge, LA 70802 225-379-1584 Maine: Dana Hanks Maine DOT [email protected] Michigan: Chris Brookes Work Zone Delivery Engineer Michigan DOT [email protected] 517-373-6281

Minnesota: Ted Ulven Work Zone Standards Specialist Office of Traffic, Safety and Technology MD DOT 1500 West County Road B-2 Roseville, MN 55113 651-234-7058 [email protected] Mississippi: Richard Chisolm, P. E. State Construction Engineer Mississippi DOT 601-359-7301 [email protected] Missouri: Daniel J. Smith, P.E. Traffic Management and Operations Engineer MoDOT - Traffic Division 1320 Creek Trail Drive P.O. Box 270 Jefferson City, MO 65102 Office: (573) 526-4329 Fax: (573) 526-4868 [email protected] Montana: Jim Wingerter, P.E. Construction Traffic Control Engineer Montana DOT [email protected] 406-454-5897 New Hampshire: Dean H. Wilson, P.E. Process Review Engineer NH DOT Bureau of Construction 603-271-2571 [email protected] Lee Simpson [email protected]

New Jersey: Tony Pellegrino Manager, Bureau of Employee Safety NJ DOT 609-530-5472 [email protected] Ohio: Reynaldo A. Stargell, P.E. Ohio DOT Office of Traffic Engineering 614‐644‐8177 Oregon: Justin King, Oregon DOT TCP Quality Assurance Engineer TCP Phone: 503-986-3584 [email protected] Pennsylvania: Mark Grabusnik Roadway Programs Manager PennDOT Bureau of Maintenance and Operations/QA Section 400 North Street Harrisburg, PA 17105 717-787-6987 [email protected] Saskatchewan Ministry of Highways & Infrastructure: Paul Rachar, Senior Road Construction Engineer Technical Standards Branch 240 Henderson Drive Regina, SK S4N 5P7 306-787-4953 [email protected] South Carolina: Joe Sease SC DOT Utah: Keith Bladen Safety/Loss Control Coordinator Utah DOT 4501 South 2700 West Box 148430 Salt Lake City, UT 84114-8430 801-965-4267 [email protected]

Vermont: Amy L. Gamble, PE Traffic Operations Engineer Vermont Agency of Transportation 802-828-1055 [email protected] Washington State: Doug Brodin Washington State DOT [email protected] Wisconsin: Randall J. Hoyt, PE Work Zone Program Manager Lakeside Engineers on-site at Wisconsin DOT Bureau of Traffic Operations 433 W. St. Paul Ave, Suite 300 Milwaukee, WI 53203 414-227-4671 [email protected]

State DOT Work Zone Inspection Forms

Traffic Control DevicesInspection Checklist

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Date and Time of Inspection:

List of Deficiencies

Inspection of traffic control devices shall be performed by the Prime Contractorat a minimum frequency of once per day. One inspection per week must beperformed at night. Daily inspection forms must be submitted to the ResidentEngineer weekly.

Project:Contractor:

Reason for Deficiency Action(s) Taken

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I certify that I have been properly trained in the inspection of traffic control devices and I certify that all traffic control devices have been installed and maintained in good condition and in compliance with the plans and Standard Specifications. Any deficiences at the time of inspection were noted and corrective actions were taken as shown above.

Contractor Responsible Person Signature

Phone Numbers: D1 Dispatch (707) 441-5747 D2 Dispatch (530) 225-3273 D3 TMC (916) 859-7900

Job Stamp Report No. DEPARTMENT OF TRANSPORTATION Date �� M T W T F S S Shift Hours Start Stop

ASSISTANT RESIDENT ENGINEER’S DAILY TRAFFIC CONTROL REPORT

Location & Description of Operation ��

CLOSURE ID#_________________ LOG# ___________ 1097 TIME:______________ 1098 TIME:_____________ DAYTIME CLOSURE / NIGHT CLOSURE (circle one) DAYTIME CLOSURE: Do all signs have 2 flags/cone beside them/ properly ballasted (to prevent blowing over), as necessary? YES / NO (circle one) NIGHT CLOSURE: Does W20-1 have 12 inch diameter flashing beacon installed and operating? YES / NO (circle one) TYPE OF CLOSURE: T-10 DIRECTION: NB / SB / WB / EB (circle one)

FAS (EITHER/OR) PM:__________ PM:__________ PM:__________ PM:_________ PM:__________ PM:__________ PM:__________ NOTE: The C20 (CA) and W4-2 are interchangeable for the first two positions after the W20-1 sign. The W4-2 is mandatory after the FAS.

PM:__________ PM:__________ PM:__________ PM:_________ On ramp, ACS OK In lane closure gore In lane closure before on-ramp after on-ramp AT EXIT RAMP (If no ramp, NA this block) AT ENTRANCE RAMP (If no ramp, NA these blocks) NOTE: Cones at ramp locations are to be set at a maximum of 50 foot spacing PCMS MESSAGES: PCMS 1st Flash ___________________ 2d Flash ________________ 3rd Flash ____________________ MONITORING: TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ NARRATIVE:

Inspectors Hours: ___________ to ___________

Full time inspection YES / NO Name: Title: Date:

PCMS





CLOSURE ID#_________________ LOG# ___________ 1097 TIME:______________ 1098 TIME:_____________ DAYTIME CLOSURE / NIGHT CLOSURE (circle one) DAYTIME CLOSURE: Do all signs have 2 flags/cone beside them/ properly ballasted (to prevent blowing over), as necessary? YES / NO (circle one) NIGHT CLOSURE: Are flaggers provided proper lighting (10 foot/candles) and are they clearly visible to the public? YES / NO (circle one) NIGHT CLOSURE: Does W20-1 have 12 inch diameter flashing beacon installed and operating? YES / NO (circle one) TYPE OF CLOSURE: T-13 DIRECTION: NB / EB (circle one)

PM:__________ PM:__________ PM:__________ PM:_________ PM:__________ PM:__________ DIRECTION: SB / WB (circle one)

PM:__________ PM:__________ PM:__________ PM:_________ PM:__________ PM:__________ NOTE: If Advance Flaggers are required, they are placed after the C9A (CA) and before the W3-4. Add additional spacing between these signs. PCMS MESSAGES: PCMS #1 1st Flash ___________________ 2d Flash _____________________ 3rd Flash ____________________ PCMS #2 1st Flash ___________________ 2d Flash _____________________ 3rd Flash ____________________ MONITORING: TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ NARRATIVE:



PCMS #1

PCMS #2





CLOSURE ID#_________________ LOG# ___________ 1097 TIME:______________ 1098 TIME:_____________ DAYTIME CLOSURE / NIGHT CLOSURE (circle one) DAYTIME CLOSURE: Do all signs have 2 flags/cone beside them/ properly ballasted (to prevent blowing over), as necessary? YES / NO (circle one) DETOUR: Is a detour in place? YES / NO (circle one and discuss the detour in the narrative section) Is EXIT sign in gore area covered? YES / NO (circle one) TYPE OF CLOSURE: T-14 DIRECTION: NB / EB / WB / SB (circle one)

PM:__________ PM:__________ PM:_________ PM:_________ PM:__________ NOTES: C30 (CA) only required if connector/additional lane at ramp, refer to SP T14. If not required, NA the PM block. Ensure cones are extended through the gore area past the point where drivers may try to go thru the grass area of the gore. Cones at ramp locations are to be set at a maximum of 50 foot spacing

Are Entrance Ramps set per SP T14?

YES / NO (circle one)

Entrance Ramps (Example, refer to SP T14 to ensure entrance ramp signs/barricades are configured appropriately for entrance ramp conditions) NOTE: Cone spacing at Entrance ramps to be a maximum of 25 feet. PCMS MESSAGES: PCMS 1st Flash ___________________ 2d Flash ________________ 3rd Flash ____________________ MONITORING: TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ TIME:___________ Are all devices in place and functioning? YES / NO if no note deficiency_______________________________________ NARRATIVE:



PCMS

Minimum 3 per lane

Minimum 3 per lane

Page 1 of 4 WORK ZONE SAFETY CHECKLISTTRAFFIC ENGINEERING

URGENT -CORRECT IMMEDIATELY [ ]5-WORKING DAYS TO CORRECT [ ]

WHEN URGENT IS MARKED, DENOTE ITEM

PROJECT NO. KEY NO. LOCATION DISTRICT

RESIDENT ENGINEER DATE

IN COMPANY WITH

A. DRIVE THRU:ARE MANEUVERS DIFFICULT OR UNEXPECTED [ ] YES [ ] NO [ ] ADEQUATE [ ] INADEQUATE

ADEQUATE WARNING OF HAZARDS [ ] YES [ ] NOAPPLICATION DOES NOT MEET GUIDELINES [ ]

IS SIGNING CLEAR / UNCLUTTERED AND PROPERLY SPACED [ ] YES [ ] NO INAPPROPRIATE MESSAGE [ ]

ARE TRAFFIC CONTROL DEVICES SUFFICIENTLY VISIBLE [ ] YES [ ] NO INAPPROPRIATE PLACEMENT [ ]

UNNECESSARY LANE CLOSURES [ ] YES [ ] NO TO MUCH INFORMATION ON PCMS [ ]COMMENTS:

NOT DELINEATED, NO CONES / BARRELS [ ]COMMENTS:

B. SIGNS:[ ] ADEQUATE [ ] INADEQUATE

D. ARROW PANEL:NEED TO BE REMOVED / REPOSITIONED / COVERED [ ] [ ] ADEQUATE [ ] INADEQUATE

NEED CLEANING / REPLACEMENT [ ] MALFUNCTION (BULB OUT, ETC.) [ ]

NEED ADDITIONAL SIGNS [ ] INCORRECT PLACEMENT [ ]

CONFLICTING (PERMANENT / TEMPORARY SIGNING) [ ] MISALIGNED BULBS [ ]

NON-APPROVED SIGN SUPPORT [ ] NOT DIMMED AT NIGHT [ ]COMMENTS:

BLOCKED BY VEGETATION [ ]

IMPROPER LOCATION / HEIGHT [ ]COMMENTS:

C. PORTABLE CHANGEABLE MESSAGE SIGN:

WEATHER CONDITIONS

DAY OR NIGHT WORK (IN / NOT IN) PROGRESS

CONSTRUCTION / MAINTENANCE / UTILITY / PERMIT

INSPECTION MADE BY

NAME OF CONTRACTOR

POSTED SPEED ______ MPH


E. DRUMS = D / CONES = C: D / C G. (Continued)[ ] ADEQUATE [ ] INADEQUATE ARE FLAG PERSONS:

CERTIFIED [ ] YES [ ] NOINAPPROPRIATE TAPER LENGTH [ ] / [ ] POSITIONED CORRECTLY [ ] YES [ ] NO

HIGHLY VISIBLE [ ] YES [ ] NOSPACING INADEQUATE (TO LONG / TO SHORT) [ ] / [ ] PROPERLY CLOTHED [ ] YES [ ] NO

FLAGGING CORRECTLY [ ] YES [ ] NOREPAIR / CLEAN / REPLACEMENT [ ] / [ ] COMMENTS:

REFLECTIVE BANDS DAMAGED / MISSING ON CONES / TUBULAR MARKERS [ ] / [ ]

ADDITIONAL DEVICES NEEDED [ ] / [ ] H. PAVEMENT MARKING:[ ] PERMANENT [ ] CONSTRUCTION

MISALIGNED [ ] / [ ] [ ] ADEQUATE [ ] INADEQUATECOMMENTS:

REMOVE [ ]

REPAIR [ ]F. TRAFFIC BARRIER:

[ ] ADEQUATE [ ] INADEQUATE NEED ADDITIONAL [ ]

IMPROPER BARRIER FLARE [ ] DIRTY OR OBSCURED [ ]

IMPROPER TERMINAL TREATMENT [ ]UNNECESSARY (MARKINGS / NOT ERADICATED COMPLETELY) [ ]

COMMENTS:BARRIER NEEDS TO BE REALIGNED / REMOVED [ ]

WARNING LIGHT (SERVICE / CLEAN) [ ]I. PAVEMENT MARKERS:

DELINEATORS (CLEAN / ADDITIONAL) [ ] [ ] PERMANENT [ ] CONSTRUCTION[ ] ADEQUATE [ ] INADEQUATE

ATTENUATOR (REPAIR / REPLACE) [ ]COMMENTS: REPLACE MISSING [ ]

REMOVE [ ]NEED ADDITIONAL [ ]

G. WORKSITE TRAFFIC CONTROL SUPERVISOR & FLAGGING OPERATION: COMMENTS:

[ ] ADEQUATE [ ] INADEQUATE

NEED ADDITIONAL ADVANCE SIGNING [ ] YES [ ] NOJ. TRUCK MOUNTED ATTENUATOR:

IS WORKSITE TRAFFIC CONTROL SUPERVISOR: PROPERLY POSITIONED [ ] YES [ ] NO

PROVIDED BY CONTRACTOR [ ] YES [ ] NOCERTIFIED [ ] YES [ ] NO PROPERLY MAINTAINED / DELINEATED [ ] YES [ ] NO

COMMENTS:REVIEWED BY DISTRICTS [ ] YES [ ] NO


K. STRUCTURES/CRUSHING/ STOCKPILE/PLANT OPERATIONS:

K. (Continued)

MSHA GIVEN ADVANCE NOTICE OF APPROXIMATE DATE CRUSHING OPERATION WILL COMMENCE [ ] YES [ ] NO

MOBILE EQUIPMENT RUNNING OVER POWER CONDUCTORS OR LOADS DRAGGED OVER POWER CONDUCTORS [ ] YES [ ] NO

EQUIPMENT

POWER WIRES AND CABLES INSULATED ADEQUATELY WHERE THEY PASS INTO OR OUT OF ELECTRICAL COMPARTMENTS [ ] YES [ ] NO

BACKUP ALARMS [ ] YES [ ] NOPARKED OUT OF HAZARDOUS LOCATIONS

[ ] YES [ ] NO CABLES THAT ENTER METAL FRAMES OF MOTORS, SPLICE BOXES AND ELECTRICAL COMPONENTS ONLY THROUGH PROPER FITTINGS [ ] YES [ ] NO

FUEL TRUCKS PLACARDED [ ] YES [ ] NO

ADEQUATE FIRE EXTINGUISHERS MAINTAINED ON SITE AND CHECKED MONTHLY AND ANNUALLY [ ] YES [ ] NO

PERMANENT SPLICES AND REPAIRS MADE IN POWER CABLES, INCLUDING THE GROUND CONDUCTOR WHERE PROVIDED [ ] YES [ ] NO

ALL GUARDS IN PLACE ON MOVING MACHINERY [ ] YES [ ] NO

ELECTRICALLY POWERED EQUIPMENT DE-ENERGIZED BEFORE MECHANICAL WORK IS DONE ON SUCH EQUIPMENT [ ] YES [ ] NO

TOE BOARDS/RAILINGS [ ] YES [ ] NO

FIRST-AID SUPPLIES, INCLUDING BLANKET AND STRETCHER, MAINTAINED ON SITE [ ] YES [ ] NO

POWER SWITCHES LOCKED OUT OR OTHER MEASURES TAKEN T0 PREVENT EQUIPMENT FROM BEING ENERGIZED WITHOUT KNOWLEDGE OF PERSONS WORKING ON IT [ ] YES [ ] NO

PROPER PROTECTIVE GEAR WORN BY ALL PERSONNEL [ ] YES [ ] NO

SUITABLE WARNING NOTICES POSTED AT POWER SWITCH AND SIGNED BY INDIVIDUALS WHO ARE TO DO THE WORK [ ] YES [ ] NO

HARD HATS, RESPIRATORS, BOOTS,HEARING PROTECTION, HIGH VISIBILITY CLOTHING, FALL PROTECTION

SUITABLE DANGER SIGNS POSTED AT ALL MAJOR ELECTRICAL INSTALLATIONS

[ ] YES [ ] NO

ON-SITE PERSON PERFORMING AND DOCUMENTING DAILY INSPECTIONS [ ] YES [ ] NO

ALL METAL ENCLOSING OR ENCASING ELECTRICAL CIRCUITS GROUNDED OR PROVIDED WITH EQUIVALENT PROTECTION [ ] YES [ ] NO

SUITABLE COMMUNICATION SYSTEM AVAILABLE IN THE EVENT OF AN EMERGENCY [ ] YES [ ] NO

METAL FENCING AND METAL BUILDINGS ENCLOSING TRANSFORMERS AND SWITCHGEAR GROUNDED [ ] YES [ ] NO

TOILET FACILITIES AVAILABLE ON SITE OR READILY ACCESSIBLE FROM THE SITE [ ] YES [ ] NO

FRAME GROUNDING OR EQUIVALENT PROTECTION PROVIDED FOR MOBILE EQUIPMENT POWERED THROUGH TRAVELING CABLES [ ] YES [ ] NO

CONTINUITY AND RESISTANCE OF GROUNDING SYSTEMS TESTED AFTER INSTALLATION, REPAIR AND MODIFICATION, AND ANNUALLY THEREAFTER [ ] YES [ ] NO

COMMENTS:


L. MISCELLANEOUS: ACCIDENTS: [ ] YES [ ] NO

OPERATIONS IN ROADWAY WITHOUT WARNING / PROTECTION [ ] YES [ ] NO EVIDENCE OF AN ACCIDENT [ ] YES [ ] NO

ADEQUATE WORKER / PUBLIC SAFETY [ ] YES [ ] NO DAMAGED TRAFFIC CONTROL DEVICES [ ]

ADEQUATE BUFFER SPACE [ ] YES [ ] NO SKID MARKS [ ] DEBRIS [ ]

APPROPRIATE OPERATION / INSTALLATION OF TEMPORARY TRAFFIC SIGNAL [ ] YES [ ] NO

IS THE WORK AREA PROTECTED [ ] YES [ ] NOTRENCHING SLOPES/SPOILSLADDERS SUPPORTEDBARRIERS/OPENINGS

MATERIALS PROPERLY STORED [ ] YES [ ] NO

EQUIPMENT PROPERLY STORED [ ] YES [ ] NOCYLINDERS SECURED/CAPPEDFLAMMABLES

ARE LANE CLOSURES IN ACCORD WITH ALLOWED HOURS [ ] YES [ ] NO

CRANES/AERIAL EQUIPMENTGUARDED [ ] YES [ ] NOPOSTED/ANGLES [ ] YES [ ] NOINSPECTIONS [ ] YES [ ] NO

COMMENTS / RECOMMENDATIONS:

REVIEWED BY: REVIEWED WITH:

DISTRIBUTION:

DE-ADE-REGIONAL/RESIDENT ENGR-OTHER

SIGN & DATE SIGN & DATE

Joint FHWA/ITD Spot Check Review Sheet (DRAFT) Work Zone Traffic Control

PROJECT INFORMATION District: 1, 2, 3, 4, 5, 6, LHTAC, ACHD – Circle One Project Name: Project Key Number: Resident Engineer: Full Oversight / Non-Full Oversight – Circle One REVIEW INFORMATION Date of Review: Review Participants: Project Close Out Completed – Yes / No – Circle One Project Close Out Participants: WORK ZONE TRAFFIC CONTROL CHECK LIST QUESTIONS

a. Are drums, tubular markers and signs clean and in generally good condition?

b. Do all drums, tubular markers and signs have adequate reflective material?

c. Does the distance between traffic control devices and signs meet spacing requirements?

d. Have conflicting pavement markings been completely removed?

e. Are temporary pavement markings performing adequately? (Taper, Skip, Retroreflectivity, Location, and Use)

f. Are all flaggers and traffic control maintenance personnel wearing high visibility vests, including Class 2 or 3 retro-reflectivity?

g. Has pedestrian, handicapped and bicycle traffic been accommodated?

h. Have conflicting speed limit signs been covered or taken down?

i. Are night time reviews of WZTC being completed? How Often?

j. Are workers and traffic separated appropriately per ITD’s Work Zone Safety and

Mobility Program?

k. Is the work zone laid out in accordance with the traffic control plan?

l. Who is the traffic control manager or project inspector? FINDINGS &RECOMMENDATIONS

Work Zone Safety and Mobility Check List All Projects

• Safety of workers and the public are addressed (pg 3*) • Non-motorized traffic addressed and included in traffic control plan (pg 3*) • Separate traffic from work zone (pg 3-4*) • Comply with lateral separation and speed limit reductions in accordance with Table 1 (pg 4*) • If speed limit is reduced, supplemental strategies are included in traffic control plan (pg 4*) • Include strategies in accordance with Table 2 (pg 5*) • Provisions indicate that all traffic control devices shall be installed, maintained, removed or covered to

reflect actual field conditions (pg 6*) • Provisions indicate that all traffic control devices shall be maintained in no less than marginal condition.

Condition criteria are based on ATSSA’s Quality Guidelines for Work Zone Traffic Control Development (pg 6*)

• Traffic control plan indicates maximum length, locations, and circumstances where speed limit reductions will be allowed (pg 6*)

• Optional provision for use of law enforcement. If used, pay item included in contact (pg 6*) • Transportation management plan is complete and includes traffic control plan and consideration given to

a transportation operation a public information component (pg 12*)

Additional Requirements for Projects Classified as Significant** • Project identified in STIP as significant (pg 2*) • Existing and expected LOS determined (pg 9*) • Pre-work zone crash rate determined within the project limits (pg 9*) • Transportation management plan includes (pg 12*):

o traffic control plan o transportation operations plan o public information plan

*References are based on ITD’s Work Zone Safety and Mobility Program, dated December 2008 **Significant projects are defined as those projects on the Interstate system within the boundaries of a designated Transportation Management Area (TMA) that occupy a location for more than three days with either intermittent or continuous lane closures. ITD may request an exception for Interstate “Significant Project” status based on the ability to show that the specific Interstate system project or categories of Interstate projects do not have sustained work zone impacts (pg 2).

Printed 6/14/2012 BC 726 (3/06)

Traffic Control Inspection Report

Date Time Weather County Contract Report No.

OPER 725 on File Est. Completion Date Section Marked Route

Type of Work Location

RE / RT Contractor

Evaluate: (G) Good, (F) Fair, (D) Deficient, (X) Does Not Apply

Traffic Control Condition

Location / Placement

Night Visibility

Overall Effectiveness

Description, Comments or Corrective Measures Recommended

Signs

Sign Flashers

Drums or Barricade Lights

Drums, Barricades or Cones

Pavement Markings

Vertical Panels

Arrow Board(s)

Comments on other items:

Do any previously reported discrepancies still exist ? Yes No If yes, describe:

cc: File RE or RT Subcontractor Field Engineer Submitted by:

Contractor: Field Office Reviewed by:

Traffic Control Surveillance Report

Contractor

Contract No.

Date

Time of Inspection

Signature

Weather

Comments and/or Corrective Action

Midnight

1 A.M.

2 A.M.

3 A.M.

4 A.M.

5 A.M.

6 A.M.

7 A.M.

8 A.M.

9 A.M.

10 A.M.

11 A.M.

Noon

1 P.M.

2 P.M.

3 P.M.

4 P.M.

5 P.M.

6 P.M.

7 P.M.

8 P.M.

9 P.M.

10 P.M.

11 P.M.

Distribution: Contractor Resident

Completed forms must be turned in to the Resident the next working day.

BC 2240 (Rev. 9/97)

Traffic Control Authorization Request

District:

County

Project

Contract Number

Marked Route

Section

Location

Inclusive Dates of Work to Work Hours AM PM to AM PM

Work Type Maintenance Construction Traffic Other Describe Work

Contractor or Agency Doing Work

Responsible Engineer: (Construction Foreman/Superintendent, Maintenance/Traffic Field Engineer)

Name Telephone No. ( ) ( )

Office Home

(If traffic control is to be employed between 5:00 p.m. and 8:30 a.m. or on Saturday, Sunday or holidays give addition numbers)




Controls: (Describe specific controls to be used, including reference to appropriate Highway Standards or sections of manuals, and set forth any special controls proposed).

Distribution District Operations/Traffic Engineer Submitted by:

Project Implementation Engineer Field Engineer Approved by:

Resident Engineer (District Operations/Traffic Engineer)

ISP District

Printed 6/14/12 OPER 725 (Rev. 10/02) (BT 725)

CONTRACT: PROJECT: THRU

T F S

DATE:

DATE:

WEEKLY TRAFFIC CONTROL DEVICE REPORT

REMARKS

DATE

PLACED S M

DATES:

DESCRIPTIONLOCATION T W

PE/PS SIGNATURE:

*If device is not O.K., describe deficiency under Remarks.

USE √ IF O.K.

Date of Corrective Action Taken: Report Prepared By:

Title:

Contract Number:____−_________

Date Reviewed:___/____/____

WORK ZONE INSPECTION CHECKLIST

Route:__________

Reviewer:__________________________

g

Constructability

Poor / Lack Of Mot Plans

Tubular Markers

Knocked Down/not ProvidedEncroachment Of Workers / Equipment Into Travel Lanes Washed-Out / Not Visible At Night

Lack Of Access / Good Access Point Wrong Type / SizeWork Area Too Restricted Marginal / Unacceptable Condition

Utility Coordination Lacking Other

Motorist Behavior

Heavy Motorist Traffic On Closed Road

Temporary Pavement Markings

Not ProvidedDebris On Pavement Tape Not Staying Down

Speeding Wrong TypeSevere Grade Changes Not Visible / Poor Condition

Slowing Due To Work / Work Vehicles / Police Permanent Markings Not Adequately RemovedDifficult Merge / Shift Movement Not Correctly Placed

Rumble Strips / Unusually Rough Pavement

Construction Signing

Sign Message Missing / Not Standard / CrookedPassing Inside A Queue Sign Missing / Knocked Down / Leaning / Twisted

Reckless Driving / Road Rage Incorrect SignUnprotected Drop-Off Near Roadway Incorrect Placement / Spacing

Motorists Driving Thru Drums To Access Drives Non-Standard Color / Design

Queue / Delay Queue / Delay Not Reflective / Poor ConditionOther No Oa For Regulatory Sign

Nighttime

Significant Glare Problem Incorrect / Non-Breakaway SupportModerate Glare Problem Insufficient Mounting Height

Work Area Levels Warning Lights Not Provided / Obscured / Burnt OutWorkers Not Wearing Appropriate Nighttime Attire Sign Obscured

Permanent Highway Lighting Not Working Conflict With Permanent Sign

CrossoversSubstandard Geometrics

Arrow Boards

Not ProvidedPoor Pavement Condition / Ride Quality Intensity / Too Dim

Not Properly Protected Improperly Placed / Not Necessary / Confusing

Lane WidthsNarrow At Work Area Bulbs Burned Out

Narrow Through Entire Work Zone Not Used And Not In Caution ModeNot Delineated / Defined

Work Site Speed Limit Assemblies

Assemblies Not Provided

Merge Tapers

Not Provided Advanced Assemblies Not Provided / Positioned CorrectlyToo Short Or No Tangent Length Between Tapers Uncovered / Placed Away From Permanent Speed Limit Sign

Placed At An Awkward / Inappropriate Location Insufficient Mounting HeightSign Missing / Misplaced / Wrong Placed Too Far In Advance Of Work Area

Drums Missing / Inadequate In Taper Flashers Not Activated While Working

Shift TapersToo Short Assembly Activaled Where There Was No Work

Placed At An Awkward / Inappropriate Location Speeds IncorrectSign Missing / Misplaced / Wrong Incorrect / Wrong Signage

Turn Lanes

Not Provided Bulbs Burned OutAwkward Alignment

Portable Changeable

Message Signs

Not ProvidedToo Short Intensity / Too Dim / Not Legible

Confusing To Motorists Poorly Placed

Temporary Barrier Wall

Ends Not Properly Protectedp y Poor ConditionNot Provided Too Many Frames / Display Rate Too Quick

Wrong Type / Improperly Used Poor Message ContentInsufficient Taper Rate / Delineation Not Used And Not In Standby Mode

Not Properly Delineated

Detour Routes

Poor Selection Of RouteLittle / No Shy Distance To Traffic Poor / Incomplete Plan Detail

Not Placed Correctly Missing Rma / Misleading Signing

Barricades

Not Provided / Out Of Place Sign BlockedOriented Incorrectly Route Not Identified

Wrong Type

Temporary Traffic Signals

Temp Video Detection Not Working / In PlaceMarginal / Unacceptable Condition / Faded Heads Not Aligned Correctly

Steady Burn Lights Not Provided / Not Working Timing Not AdequateNot Staggered Correctly Plan Detaillacking / Incorrect

Drums

Knocked Down / Not Provided OtherImproper Spacing / Placement

Flagging Operations

Not Wearing Proper / Retroreflective AttireWrong Type Flagger Ahead Sign Not In Place

Marginal / Unacceptable Condition Flagger Ahead Sign In Place With No FlaggerSteady Burn Lights Not Provided / Not Working Flagger Not Properly Positioned

Dirty / Dusty Flagger Not Using Proper Device

Vertical Panels

Knocked Down / Out Of Position / Not Provided Flagger Not Using PaddleOriented Incorrectly Paddle / Flag In Poor Condition

Improper Spacing

Worksite Added Penalty Signs

Not ProvidedMarginal / Unacceptable Condition Incorrect Placement / Spacing

Orange Stripes Fading Incorrect Type / DesignSteady Burn Lights Not Provided / Not Working Not At Start Of Job

Other Sign Damaged

Cones

Knocked Down / Not ProvidedEquipment And

Materials Storage And Placement

Dumped Concrete Near Side Of Road

Improper SpacingPersonal

Protective Equipment (PPE)

Inappropriate Work / Safety Apparal

No Retro-reflective Striping Pedestrian Facilities

No Pedestrian FacilitiesMarginal / Unacceptable Condition Pedestrian Walking In Roadway

Dirty / Dusty

Circle if there are additional notes on the back of the page ‐‐>

Date: Day:

Prime Contractor:

Lane:

Sta. or MP:

Review of Traffic Control and Traffic Operations:Yes No

All signs & devices installed correctly:

All signs & devices in acceptable condition:

All signs & devices reflective at night:

All warning lights working (day & night):

Are arrow displays working / aimed properly?

All temporary luminaires working?

If checked "no" above, when were corrections completed:

Any changes or modifications to the project's traffic control?

Start Time Hours

01/13/12 Appendix 5-11

Subcontractor:

County:

Time Observed:

EB/WB SB/NB

Shift Number: Contractor's Designated Work Shift in Hours:

ROAD WORK AHEAD sign END ROAD WORK sign

Rt. / Lt.Traffic Control Standard Used:

Daily Traffic Control Diary

Project Number:

Note: The listing of flaggers may be submitted daily as a separate form.

End Time

PrintedSignature

Flagger Name

1 or 2 or 3

Direction:

AM / PM

Sta. or MP:

TRAFFIC CONTROL DEFICIENCIES

Points Description: 2 Points - Major Deficiency, 1 Point - Minor Deficiency

(SIGNS)No. Points Description1 2 Signs are not clipped into the moveable stands correctly.2 2 Wrong application of signs, not telling the truth or left overnight.3 2 Obstruction blocking the view of the sign.4 2 Signs need to be added such as LOOSE GRAVEL, UNEVEN CENTERLINE, BUMP, ETC.5 1 Signs are not spaced correctly from the work area or flagger.6 1 Signs need to be cleaned, straightened, or replaced if necessary.7 1 Sign has the wrong sheeting for the application.8 1 Sign post splices are not to specification.9 1 Add post to sign, 2 post 10 to 20 sq ft and 3 post over 20 sq ft.10 1 Sign is the wrong size for the application.11 1 Mesh signs are prohibited.12 1 Signs are not covered completely with an opaque material.13 1 Sign heights are 7’ in urban areas, 5’ in rural areas and 1’ on portable stands.14 1 Signs are required on both sides of the road on a 4 lane divided highway.15 1 Two bolts per post are required through signs.16 1 Other than a speed plaque, only 1 sign per set of post shall be used.17 1 Jobs within 1 mile of each other shall be signed as 1 job.g j

(BARRICADES)No. Points Description1 2 Barricades are not crashworthy.2 1 Chevrons pointing in the wrong direction.3 1 Barricades need to be cleaned or replaced if necessary.4 1 Barricades shall be sheeted on both sides.

(FLAGGING OPERATIONS)No. Points Description1 2 Flaggers not qualified.2 2 Flagger stationed in the wrong location.3 2 Flagger standing in the shade, next to equipment, or does not have an escape route.4 2 A pilot car shall be used or channelizing devices shall be down centerline.5 2 Flaggers shall have ANSI Class II lime green vest.6 1 Flagger using STOP/SLOW paddle less than 6’ length and less than 18” sign.7 1 Flaggers using flags in non-emergency operations.8 1 Flagger station shall have a 100’ taper.

TRAFFIC CONTROL DEFICIENCIES

Points Description: 2 Points - Major Deficiency, 1 Point - Minor Deficiency

(CMS/ARROWBOARDS)No. Points Description1 2 Wrong message on CMS.2 2 Blank CMS/Arrow board in clear zone.3 2 Arrow board in the wrong application such as shifting tapers or flagging one lane road operation.4 1 CMS/Arrow boards shall be delineated.5 1 Not enough CMS’s in use.6 1 Arrow boards need to be at the beginning of the taper.

(MISCELLANEOUS)No. Points Description1 2 Ballast tied to moveable sign stands.2 2 Moveable sign stands not crashworthy.3 2 Striping in poor condition or may need to be ground or blasted better.4 2 Equipment parked in clear zone or on opposite shoulder from an operation.5 2 Need to utilize shoulder drop-off detail.6 2 Correct connecting rods shall be used on every joint of concrete barrier.7 2 Use correct flare rate on concrete barriers7 2 Use correct flare rate on concrete barriers.8 2 Concrete barriers shall be flared outside clear zone or crash cushion shall be used.9 2 Tapers for lane closures are too short.10 1 Posted speed limit is wrong.11 1 Lights need to be serviced.12 1 Wrong lights for the application.13 1 Lights not from the QPL List.14 1 Caution tape is prohibited within the clear zone.15 1 Reflectors are required every 15’ on concrete barriers.16 1 Roadway needs to be swept to make striping more visible

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Page 1 of 3 11/25/09

Mn/DOT Work Zone Inspection Long Form

MAINTENANCE CONSTRUCTION BRIDGE UTILITY OTHER DISTRICT: SUBAREA: SP / PERMIT / TH: DATE: TIME: WEATHER: REVIEWED BY:

ROADWAY:

UNDIVIDED 2L2W FREEWAY EXPRESSWAY OTHER OPERATION:

DAY NIGHT WORK ( IN NOT IN) PROGRESS MOBILE/MOVING STATIONARY : SHORT INTERMEDIATE LONG (LAYOUT )

LANE CLOSURE SHOULDER CLOSURE PILOT CAR BYPASS 2L2W DETOUR FLAGGING OPER PORTABLE SIGNALS OTHER

PAVING MILLING GRADING SWEEPING/FLUSHING SHOULDERING PATCHING STRIPING CRACK SEALING GUARDRAIL CULVERTS JOINT REPAIR BRIDGE INSPECTION DECK REPAIR UTILITY OTHER

SPEED LIMIT: POSTED: MPH ADVISORY: MPH WZ: MPH

1. SEE FIELD MANUAL 6K-4 TO 6K-6 FOR DROP OFF DELINEATION STANDARDS 2. SEE FIELD MANUAL 6K-83 TO 6K-97 FOR QUALITY STANDARDS

DRIVE THROUGH: YES NO COMMENTS FOLLOW UP N/A MANEUVERABLE TRAFFIC SHIFTS ADEQUATE ADVANCE WARNING ADEQUATE WORK AREA PROTECTION

ADEQUATE EQUIPMENT AND MATERIAL STORAGE

APPROPRIATE DROP OFF DELINEATION

APPROPRIATE FIELD MANUAL LAYOUT OR TTC

NO ACTION REQUIRED ACTION OBSERVED ONSITE

FOLLOW UP REQUIRED BY

FLAGGING: YES NO COMMENTS FOLLOW UP N/A ADEQUATE ADVANCE SIGNING ADEQUATE PROCEDURE ADEQUATE POSITION/VISIBILITY APPROPRIATE HI-VIS CLOTHING APPROPRIATE COMMUNICATION ADEQUATE ATTENTION/FOCUS ESCAPE ROUTE CERTIFICATION



Page 2 of 3 11/25/09

SAFETY/PERSONAL PROTECTIVE EQUIPMENT:

YES NO COMMENTS FOLLOW UP N/A

APPROPRIATE PPE - MNDOT APPROPRIATE PPE - CONTRACTOR ADEQUATE WORKER VISIBILITY ACCEPTABLE VEHICLE BEACONS ADEQUATE FALL PROTECTION FOLLOWING SAFETY GUIDELINES



SIGNS: YES NO COMMENTS FOLLOW UP N/A ADEQUATE SIGN VISIBILITY AND LEGIBILITY

APPROPRIATE SIGN SEQUENCE APPROPRIATE NUMBER OF SIGNS APPROPRIATE SIGN SPACING CONFLICTING SIGNS COVERED APPROPRIATE SIGN SHEETING APPROPRIATE BALLAST SIGN CONDITION (A=ACCEPTABLE, M=MARGINAL, U=UNACCEPTABLE)

A M

U



ARROW BOARD: YES NO COMMENTS FOLLOW UP N/A APPROPRIATE PLACEMENT APPROPRIATE MODE ADEQUATE VISIBILITY AND ALIGNMENT (BULBS)



PORTABLE CHANGEABLE MESSAGE SIGN:


ADEQUATE VISIBILITY APPROPRIATE MESSAGE/CYCLE LATERAL CLEARANCE ADEQUATE DELINEATION



CHANNELIZERS: BARRELS

CONES TUBES BARRICADES OTHER


APPROPRIATE TYPE APPROPRIATE PLACEMENT APPROPRIATE SPACING APPROPRIATE TAPER LENGTH APPROPRIATE NUMBER CHANNELIZER CONDITION (A=ACCEPTABLE, M=MARGINAL, U=UNACCEPTABLE)2

A M

U



Page 3 of 3 11/25/09

PAVEMENT MARKINGS: PERMANENT TEMPORARY


APPROPRIATE PAVEMENT MARKINGS

ADEQUATE VISIBILITY CONFLICTION MARKING REMOVED



PORTABLE SIGNALS: YES NO COMMENTS FOLLOW UP N/A APPROPRIATE TIMING



MOBILE OPERATION: YES NO COMMENTS FOLLOW UP N/A APPROPRIATE NUMBER OF VEH APPROPRIATE SPACING OF VEH PROTECTION VEHICLE



11/25/09

Mn/DOT Maintenance Work Zone Inspection Short Form DISTRICT: SUBAREA: SP / PERMIT / TH: DATE: TIME: WEATHER: REVIEWED BY:

ROADWAY:

UNDIVIDED 2L2W FREEWAY EXPRESSWAY OTHER OPERATION:

DAY NIGHT WORK ( IN NOT IN) PROGRESS MOBILE/MOVING STATIONARY : SHORT INTERMEDIATE LONG (LAYOUT )

LANE CLOSURE SHOULDER CLOSURE PILOT CAR BYPASS 2L2W DETOUR FLAGGING OPER PORTABLE SIGNALS OTHER

PAVING MILLING GRADING SWEEPING/FLUSHING SHOULDERING PATCHING STRIPING CRACK SEALING GUARDRAIL CULVERTS JOINT REPAIR BRIDGE INSPECTION DECK REPAIR UTILITY OTHER

SPEED LIMIT: POSTED: MPH ADVISORY: MPH WZ: MPH

1. SEE FIELD MANUAL 6K-4 TO 6K-6 FOR DROP OFF DELINEATION STANDARDS 2. SEE FIELD MANUAL 6K-83 TO 6K-97 FOR QUALITY STANDARDS

DRIVE THROUGH: YES NO COMMENTS FOLLOW UP N/A MANEUVERABLE TRAFFIC SHIFTS ADEQUATE ADVANCE WARNING APPROPRIATE SIGN SEQUENCE/SPACING APPROPRIATE CHANNELIZER PLACEMENT APPROPRIATE ARROW BOARD PLACEMENT AND MODE

ADEQUATE WORK AREA PROTECTION APPROPRIATE WORKER PPE ADEQUATE EQUIP/MATERIAL STORAGE APPROPRIATE DROP OFF DELINEATION1 APPROPRIATE FIELD MANUAL LAYOUT SIGN CONDITION (A=ACCEPTABLE, M=MARGINAL, U=UNACCEPTABLE)

A M

U

CHANNELIZER CONDITION (A=ACCEPTABLE, M=MARGINAL, U=UNACCEPTABLE)2

A M

U



FLAGGING: YES NO COMMENTS FOLLOW UP N/A ADEQUATE ADVANCE SIGNING ADEQUATE FLAGGING PROCEDURE ADEQUATE POSITION AND VISIBILITY APPROPRIATE HI-VIS CLOTHING APPROPRIATE COMMUNICATION ADEQUATE ATTENTION/FOCUS ESCAPE ROUTE CERTIFICATION



Rating - A= Excellent, B = Good, C = Fair, D = Poor, F = Unacceptable Page 1 of 7

MoDOT Temporary Traffic Control

Inspection Worksheet

PROJECT INFORMATION District: __________ County: _________________________________ Route: ______________________ Project No.: ___________________ Location: _________________________________________________ Date/Time: ___________________ Weather: ___________________ Inspector: ___________________ PROJECT SUMMARY RATINGS A B C D F N/A

Signs Channelizing Devices Barricades Traffic Barrier Crash Cushions CMS/Flashing Arrow Panels/Traffic Signals Lighting Flagger Operations Paint/Tape/Pavement Markers Tapers/Transition Areas/Lane Widths/Crossovers Roadway Conditions/Temporary & Uneven Pavement/Unprotected Hazards Entrance & Exit Ramps Truck & Equipment Crossings/Access Traffic Management Overall

COMMENTS


PROJECT SPECIFICS SIGNS Types Metal Signs Roll-Up Signs Wood Signs Plastic Signs w/ Lights w/ Flags w/ Cones w/ AWRS on Portable Stand on Temporary Stand on Barrier Mount on PSST Post on U-Channel Post on Wood Post on Truck Discrepancies Legibility Need Conflicting Faded/Dirty Advance Warning Splicing Reflectivity Lights Bracing Fluorescent Mounting Height Support Lettering Legend/Symbol Leaning Visibility Encroaching Twisted Location Distance Misleading NCHRP 350 Covering Missing Signs Condition

Rating A B C D F N/A

Comments

CHANNELIZING DEVICES Types Trim-Line Drum-Like Cones Direction Indicator Barricades Tubular Markers Vertical Panel w/ Lights Discrepancies Alignment Reflectivity Use Condition Size Location Spacing Missing Devices Ballasting NCHRP 350


Comments


BARRICADES Types Type I Type III w/ Lights w/ Signs Discrepancies Alignment Signing/Marking Reflectivity Condition Size Location Quantity Lighting Ballasting NCHRP 350


Comments

TRAFFIC BARRIER

Types Concrete Type F Water-Filled Plastic Other w/ Tabs w/ Glare Screen w/ End Treatment Discrepancies Alignment Taper Marking Condition Delineation Offset Blunt End NCHRP 350 Connection Anchoring


Comments

CRASH CUSHIONS

Types TMA Impact Attenuator Other Discrepancies Alignment Delineation Marking Condition Wrong Quantity Location Ballasting NCHRP 350



Comments

CMS / FLASHING ARROW PANELS / TRAFFIC SIGNALS Types CMS Flashing Arrow Panel Portable Traffic Signal Temporary Traffic Signal w/ Lighting Discrepancies Alignment Level Location Height Visibility Delineation Timing Operation Need Message Display


Comments

LIGHTING

Types Fleet Work Area Overhead Discrepancies Color Usage Visibility Glare Hot Spots Output


Comments

FLAGGER OPERATIONS

Types Flagger Pilot Vehicle AFAD Portable Flagger Device Discrepancies Certification Communications Procedures Location Attire Signing



Comments

PAINT / TAPE / PAVEMENT MARKERS

Types Paint Removable Tape Short-Term Tape Type 1 Marker Type 2 Marker ‘No Center Stripe’ Signing Discrepancies Quality Installation Reflectivity Placement Quantity Color Dimension Removal Scarring Conflict


Comments

TAPERS / TRANSITION AREAS / LANE WIDTHS / CROSSOVERS

Types Shoulder Taper Shifting Taper Merging Taper One-Lane/Two-Way Taper Median Crossover Head-to-Head Traffic Discrepancies Alignment Location Length Width Delineation Signing Hazards Design


Comments

ROADWAY CONDITIONS / TEMPORARY &UNEVEN PAVEMENT / UNPROTECTED

HAZARDS

Discrepancies Ruts Dips Pot Holes Stability Wedges Dirt/Debris Plates Joints Drainage Drop-Offs Equipment Material Open Excavations Blunt Ends NCHRP 350



Comments

ENTRANCE & EXIT RAMPS

Discrepancies Alignment Location Length Width Delineation Signing Merge Area Diverge Area


Comments

TRUCK & EQUIPMENT CROSSING / ACCESS

Discrepancies Location Length Width Delineation Signing Design


Comments

TRAFFIC MANAGEMENT

Discrepancies Speed Reduction Speed Limit Traffic Queue Detour Road Closure


Comments


Grade Description When reviewing work zones on the statewide tour, the MoDOT Temporary Traffic Control Inspection Worksheet is used for determining the safety and mobility performance of all types of work zones, per example, federal & state funded contract projects, state maintenance projects, and permit projects. The work zone review consists of several FHWA & MoDOT personnel from many different divisions and districts reviewing work zones in a three district cycle every year. The review consists of the group in a van rating all types of work zones from Monday to Wednesday with a presentation to upper management on Thursday. When reviewing, the MoDOT Temporary Traffic Control Inspection Worksheet rating system is based on an A, B, C, D, & F scoring system. The ratings are based on the following: A – Above and beyond the standards and specifications of the project. B – Meeting the standards and specifications of the project. C – A couple of deficiencies meeting the Category 3 severity level of the Standard Section 616.

D – Several deficiencies meeting the Category 3 severity level of the Standard Section 616 or a couple of deficiencies meeting the Category 2 severity level of the Standard Section 616. F - Several deficiencies meeting the Category 2 severity level of the Standard Section 616 or one or more deficiencies meeting the Category 1 severity level of the Standard Section 616.

The category severity levels are the following: Category 1 – Presents an immediate danger to the traveling public or workers and needs to be addressed immediately. A Category 1 deficiency shall be corrected within one hour. Category 2 – The situation doesn’t pose an immediate threat to either the public or the workers, but can impact the proper functioning of the work zone. A Category 2 deficiency shall be corrected within 24 hours. Category 3 – The situation doesn’t impact the functioning of the work zone but is more of a maintenance or aesthetic issue. A Category 3 deficiency shall be corrected within 96 hours. Contact the Engineer, Documentation, Re-inspection, and Follow-up Action Plans Normally with the District Work Zone Review, the group is with the appropriate personnel to correct any deficiencies on site or able to contact the contractor to start fixing the deficiencies in the appropriate time period, depending on the category level. If you are reviewing work zones on your own and there is a category1 severity level, you should stay at site until you have contacted the appropriate personnel of the deficiency. For category 2 & 3, you should contact the appropriate personnel as soon as possible. As always, if you have a concern or see a deficiency, the district Work Zone Coordinator is a great resource and contact. Document the deficiency on the worksheet when it was fixed or the time/date that you contacted the appropriate personnel to initiate the correction process. The work zone should be re-inspected to ensure the deficiencies were corrected by the district personnel. If the District Work Zone Review finds a consistent concern of work zone deficiencies, follow-up plans may be required for the districts to implement a policy to correct and prevent future occurrences.

CSD-761 MISSISSIPPI DEPARTMENT OF TRANSPORTATION TRAFFIC CONTROL PLAN REPORT

DATE PROJECT INSPECTOR TIME COUNTY OPERATING CHARACTERISTICS

Location Location

1. Queues

2. Speed

3. Gawking

4. Accidents

5. Congestion

6. Jay Walking

7. Erratic Maneuvers

8. Brake lighting

9. Skid marks

10. Other

COMMENTS/ACTION RECOMMENDED

(ADDITIONAL COMMENTS ON BACK)

Contractor Notified (DATE)

Action Taken

Action Deferred Signed:

ADVANCED WARNING ZONE

APPROACH ZONE WORK ZONE DETOUR

( ) CHECK BLOCK IF APPLICABLE

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SIGNS

BARRICADES

PAVEMENT MARKINGS

OTHER DEVICES

FLAGMEN

1

2012 Traffic Control Review Reports Points of Emphasis

Device Quality – use of guidelines Proper Use of Signs – Begin/End Work Zone, Speed Limits Alternative Devices – LED W20-7a, Rumble Strips, Flagger Illumination . Increased Relations with MHP – include in TC Review Type III Barricades – proper stripe direct, sign mounting height and crashworthy mounting of signs. Effective use of Changeable Message Signs. Restrict use of the “Motorcycles Use Extreme Caution” signs. Separate crossover and exit ramp decision point by a minimum of 1,000 feet. Use of flashers with Yield signs at entrance ramp merge points. Proper blunt end protection. Safe use of rock trucks on project to include separation from the travelling public. Nighttime inspections.

2

MDT Construction Zone Traffic Control Review

Date: ____________ Project Name: _____________________________ Project Designation: _________________________ Route/Location: ____________________________ Time of Review: ____________________________ Type of work in progress: ____________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Initial Drive Through:

• Are maneuvers difficult or unexpected ____________________________________________________ • Adequate warning of conditions _________________________________________________________ • Signing clear and uncluttered ___________________________________________________________ • Traffic control devices sufficiently visible _________________________________________________ • Any points of delay or congestion _______________________________________________________ • Conflicting Pavement Markings _________________________________________________________ • Overall impression of traffic control ______________________________________________________ • Weather ____________________________________________________________________________

Advanced Warning Area:

• Proper signs in place __________________________________________________________________ • Proper sign spacing ___________________________________________________________________ • Appropriate speed limit ________________________________________________________________ • Step down signs appropriate ____________________________________________________________

Transition Area:

• Correct taper length ___________________________________________________________________ • Proper devices and spacing _____________________________________________________________

Activity Area:

• Begin/End Work Zone signs within 500 feet ________________________________________________ • Appropriate speed limit ________________________________________________________________ • Signs/Speed Limit Corresponds with Work Activity _________________________________________ • End of WZ speed limit signs ____________________________________________________________ • Step down signs appropriate ____________________________________________________________ • Shoulder delineation __________________________________________________________________ • Centerline delineation _________________________________________________________________ • Flagging location

1. Appropriate warning signs _______________________________________________________ 2. Flaggers properly equipped _______________________________________________________ 3. Flaggers flagging properly ________________________________________________________ 4. Excessive delay ________________________________________________________________ 5. Adequate nighttime illumination ___________________________________________________

3

• Pilot Car zone 1. Vehicle properly signed __________________________________________________________ 2. Proper speed limit ______________________________________________________________ 3. Proper pilot car driver behavior ____________________________________________________

• Temporary Signals: 1. Appropriate Advanced Warning ___________________________________________________ 2. Operating properly ______________________________________________________________

• Other pertinent information in active work zone ____________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________ Termination Area:

• Proper sign spacing ___________________________________________________________________ • End of CZ speed limit sign _____________________________________________________________

Devices and Signs:

• Signs 1. Need to be removed, repositioned, covered ___________________________________________ 2. Need cleaning or replacement (reflectivity) __________________________________________ 3. Additional signs needed __________________________________________________________ 4. Conflicting signs – temp/perm _____________________________________________________ 5. Approved sign supports ______________________________________________________ 6. Posts too long __________________________________________________________________ 7. View blocked __________________________________________________________________

• Drums, Flexible Guide Posts, Ultra Panels, Type 2 OM 1. Spacing appropriate _____________________________________________________________ 2. Additional/excessive devices ______________________________________________________ 3. Proper alignment _______________________________________________________________ 4. Condition acceptable, marginal, unacceptable _________________________________________ 5. Need cleaning or replacement (reflectivity) _________________________________________

• Barricades 1. Proper use _____________________________________________________________________ 2. Approved structure ______________________________________________________________ 3. Correct direction of stripes ________________________________________________________ 4. Proper order in detours (Arrow - Road Closed) ________________________________________ 5. Signs mounted at proper height (5’) ____________________________________________ 6. Crashworthy sign mounting _______________________________________________________ 7. Need cleaning or replacement (reflectivity) __________________________________________

• Barriers 1. Correct flare rate in clear zone _____________________________________________________ 2. End treatment appropriate ________________________________________________________ 3. Proper alignment _______________________________________________________________ 4. Reflectors clean or needed ________________________________________________________

• Arrow Panel

4

1. Correct use (lane closure only) ____________________________________________________ 2. Correct placement ______________________________________________________________ 3. Functioning properly (25 – 40 flashes/minute) ________________________________________ 4. Bulbs all working _______________________________________________________________

• Changeable Message Signs 1. Correct placement ______________________________________________________________ 2. Correct use (max 2 phases, 3 lines, 8 characters/line) ___________________________________ 3. Correct message ________________________________________________________________

Traffic Control Plan

• Copy of plan onsite ___________________________________________________________________ • Plan being followed __________________________________________________________________

Additional Comments: _______________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Discussion with Project Manager or field crew member: ____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Report Information:

• MDT District ________________________________________________________________________ • EPM _______________________________________________________________________________ • Control Number ______________________________________________________________________ • Letting date _________________________________________________________________________ • Project description ____________________________________________________________________ • Contractor __________________________________________________________________________ • Contract amount _____________________________________________________________________ • Contract time/completion date __________________________________________________________

Reviewer: _________________________________________________________________________________ Accompanied by: ___________________________________________________________________________

Page 1 of 3 5-excellent, 4-good, 3- marginally acceptable, 2-not acceptable, 1-poor, 0-no WZTC, NA- Not applicable

N:\OPR\AASHTO\surveys sent to other states\Work Zone Inspection Forms_June 2012\NH WZ Traffic Control Inspecton Form.doc

NH WORK ZONE TRAFFIC CONTROL INSPECTION FORM

Date:____________ Time: __________AM/PM Direction: N S E W Type of Work: Construction Maintenance Contractor________________________________ Project #: ________________________________ Contract Administrator__________________________ Project Location: ________________________________________Mile Marker______________________ Project Description: _________________________________________________________________________ Project Duration: Mobile Short Duration Short-term Intermediate-term Long-term Work Zone Traffic Control: Work outside of Shoulder Shoulder Closure Lane closure

Lane Shift Flagging Operation Road Closure Active Work Zone Non-Active Work Zone

Advance Warning Area

PCMS ______ 1 .Message has no more than two phases and three lines per phase. ______ 2. Each message phase is shown for a minimum of 2 seconds (longer is better for longer ______ messages; no more than 8 seconds for all phases) ______ 3. Message is center justified on board. ______ 4. 18” font is used, and no more than 8 characters per line (no narrow fonts). ______ 5. Message is as brief as possible conveying: Problem or situation, locations or distance ______ to situation, recommended driver action (no generic or vague messages). ______ 6. Message makes sense regardless of which phase is read first. ______ 7. All pixels on sign are working and have similar brightness in all viewing angels. ______ 8. Message display does not flash, scroll nor is it otherwise animated. ______ 9. PCMS is situated and angled for maximum visibility and message can be read twice ______ through at prevailing speeds. Signs ______ Quantity ______ Too Many Signs Missing Signs _____________________________________ Condition ______ ____________________________________________________________________ Location ______ ____________________________________________________________________ Height ______ ____________________________________________________________________ Orientation (Tilt) ______ ____________________________________________________________________ Real Time signing ______ Signs reflect WZ activity: Y/N Unneeded Signs Covered or folded down: Y/N Sign Supports ______ Tubular Steel Wood Sign post Windmaster ______________________ Shoulder Taper ______ ____________________________________________________________________ ____________________________________________________________________ Arrow Panel ______ Visible at 1 mile: Y/N Legible at ½ mile: Y/N _____________________________

Transition Area:

Channelization: Cones Drums Vertical Panels Tubular Markers Barricades Device Condition ______ ____________________________________________________________________ Spacing ______ ____________________________________________________________________ Taper Length ______ ____________________________________________________________________ Taper Location ______ ____________________________________________________________________

Activity Area:

Buffer space ______ ____________________________________________________________________ Shadow / Barrier Vehicle ______ TMA (Truck Mounted Attenuator) ___________________________________ Placement Distance ______ ____________________________________________________________________ Channelization Cones Drums Vertical Panels Tubular Markers Barricades Device Condition ______ ____________________________________________________________________ Spacing at workers ______ ____________________________________________________________________ Transverse devices ______ ____________________________________________________________________ Drvwys/Intsctns/ramps ______ ____________________________________________________________________ Concrete Barrier ____________________________________________________________________ Condition ______ ____________________________________________________________________ Delineation ______ ____________________________________________________________________ End Treatment ______ ____________________________________________________________________



Activity Area (Cont.): Pavement Markings Temporary markings Interim markings Final markings Condition ______ ____________________________________________________________________ Remove/ cover ______ ____________________________________________________________________ Hazards ____________________________________________________________________ Advanced warning ______ ____________________________________________________________________ Marked w/ TC device ______ ____________________________________________________________________ Clear Zone ______ ____________________________________________________________________ Worker Attire ______ ____________________________________________________________________ Parked Vehicles / Equip. ______ ____________________________________________________________________ Pavement Condition ______ ____________________________________________________________________ Drop-off Treatment ______ ____________________________________________________________________

Special Conditions:

Flagging

Sign Locations ______ ____________________________________________________________________ Sign Credibility ______ Sign and Flagger Present Sign w/ No Flagger Flagger w/ No Sign Flag Tree ______ ____________________________________________________________________ Air Horn ______ ____________________________________________________________________ Pilot Car ______ ____________________________________________________________________ Flagger Location ______ Is flagger visible to approaching traffic? Yes No Flagger Communication ______ Visual Contact Two-way Radio Contact Flagger Attire ______ ____________________________________________________________________ Flagging Device ______ Stop/Slow Paddle Red Flag _______________________________________ Flagging Procedure ______ Good Fair Poor ____________________________________________

Officers Function ______ 1. Directing traffic through complex intersection, especially where signals are being overridden. ______ 2. Assisting construction vehicles in and out of work areas on high speed, high volume facilities. ______ 3. Rolling roadblock operations on interstate and turnpike facilities and other multi- lane highways. ______ 4. Enforcement. ______ 5. Presence

Road Closure

Signs and Barricades (at closure points) ______ ____________________________________________________________________ Detour Sign Locations ______ ____________________________________________________________________ Adequate Detour Signing ______ ____________________________________________________________________

Night Operations

Worker Attire ______ ____________________________________________________________________

Uniformed Officers w/Vehicle

1st Device in Taper Lit ______ ____________________________________________________________________ Taper Illuminated ______ ____________________________________________________________________ Work Area Illuminated ______ ____________________________________________________________________ Flagger Sta. Illuminated ______ ____________________________________________________________________ Glare from Lights ______ ____________________________________________________________________ Vehicles /Equipment ______ lights reflective tape ____________________________________________



Maintaining Pedestrians within the Work Zone

Signing _____ ____________________________________________________________________ Continuous Path _____ ____________________________________________________________________ Protection from Hazards _____ ____________________________________________________________________ Detours _____ ____________________________________________________________________ ADA Compliance _____ ____________________________________________________________________ Motorcycle Safety Hazard _____ Milled Surface Gravel Surface Low Shoulder Other _____ ____________________________________________________________________ Signing _____ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Maintaining Bicycles within the Work Zone

Signing _____ ____________________________________________________________________ Continuous Path _____ ____________________________________________________________________ Protection from Hazards _____ ____________________________________________________________________ Detours _____ ____________________________________________________________________

Speed Control Efforts

Advisory speeds _____ ____________________________________________________________________ Regulatory Reductions _____ Reduced limit = _____MPH _____________________________________________ Signing _____ ____________________________________________________________________ Speed Display Trailers _____ ____________________________________________________________________ Police Enforcement _____ ____________________________________________________________________ Comments:

Form OCPH-1 11/97 STATE OF NEW JERSEY

HIGHWAY CONSTRUCTION SAFETY IMPROVEMENT REPORT

ROUTE:

SECTION:

LOCATION OF WORK ZONE:

JOB NO:

MILE POST: FROM TO

WEATHER CONDITIONS:

ROAD SURFACE CONDITION:

DATE:

RESIDENT ENGINEER:

CONTRACTOR:

TYPE OF WORK

SHOULDER CLOSURE LANE CLOSURE RAMP CLOSURE DETOUR INTERSECTION OTHER

OBSERVED BY TOTAL HOURS

OBSERVATION TIME

WORK or ACCESS SUSPENSION (If Applicable) NUMBER OF

PEOPLE EFFECTED STATE POLICE N.J.D.O.T. BEGIN END STOP RESUME

CONDITIONS OBSERVED: (Place and X through the numbered box (es) where improvement is recommended)

1 CONSTRUCTION EQUIPMENT 8 CONSTRUCTION SIGNS 15 SIGNS 2 BREAKAWAY BARRICADES 9 DRUMS 16 CONES 3 HIGH INTENSITY FLASHING LIGHT 10 FLASHING ARROW BOARD 17 REFLECTORS ON CONCRETE BARRIER 4 PRECAST CONCRETE BARRIER 11 IMPACT ATTENUATORS 18 TRUCK MOUNTED ATTENUATOR (TMA) 5 TRAFFIC CONTROL TRUCK 12 TRAFFIC DIRECTORS 19 EXISTING TRAFFIC STRIPES 6 TEMPORARY TRAFFIC STRIPE 13 BUFFER ZONE 20 SAFETY VESTS, HARDHATS AND SHOES 7 CLEAR ZONE 14 RAISED PAVEMENT MARKERS 21 WORKSITE (PUBLIC, OSHA ETC.) REMARKS: (List Conditions, or/and Work Activities effected by the Safety Improvement Inspection or State “No Activities” need Improvement)

WAS THE SAFETY IMPROVEMENT IMPLEMENTED YES NO

EXPLAIN: (YES or NO)

Name of person notified Title Signature Date

Observer Name Title Signature Date

COPY to RESIDENT ENGINEER at SITE — COPY to STATE POLICE — COPY to N.J.D.O.T. REGIONAL OFFICE

Work Zone Inspection Inspected By Type of Inspection Date

' '

Time Weather Region

' '

Crew # Crew Name Crew Supervisor

Route # Roadway Type Mile Post From

'

Mile Post To Nearest Cross St. Direction

'

Township County # Of Lanes

' '

# Of Lanes Used Any Shoulder Posted Speed Limit

' ' '

Type Of Operation Corresponding Flip Chart

' '

Were They Followed Were They On Site Advanced Warning Signs

' ' '

Cones/Drums Cones/Drum Spacing Correct TMA Provided

' ' '

Arrow Panel/Board Arrow Panel/Board Correct Buffer Space Provided

' ' '

VMS Used Any Need for Traffic Directors If So Which One

' ' '

Was Crew Removed From Road All PPE Worn

' '

PPE List (Check All That Apply)

Vest Eye Protection Hard Hat

Respirator Hearing Gloves

Chaps Other

Comments:

Page 1 of 6

REPORT # _______________________________

DURATION OF REVIEW (Hrs.) _____ TYPE OF REVIEW: LONG TERM __ SHORT TERM __ PATA# ______________

EVAL (NAME/ORG): CO (NAME/#): DATE:

ASSEMBLY (DESC/#): SR: (SEG.-OFF. to SEG.-OFF.): - to -

FMN. (NAME/#): POSTED SPEED LIMIT: SCHEDULED ON CURRENT WEEK’S M-6146? YES � NO �

ARE ALL CATEGORY II TRAFFIC CONTROL DEVICES NCHRP 350/MASH COMPLIANT***? YES � NO � [REF. BULLETIN 15]

ACTING FMN. � FOREMAN ATTENDED FOREMAN’S ACADEMY: YES � NO � COMPLETED ACTING FOREMAN’S TRAINING: YES � NO �

ACMM (NAME/NUMBER): ATTENDED ACMM ACADEMY: YES � NO �

CLOSEOUT INFORMATION

FIELD COUNTY OFFICE

CLOSE OUT CONDUCTED: YES � NO � CLOSEOUT DATE:

DATE: FMN’S INITIALS: SIGNATURE/TITLE:

PHOTOS AVAILABLE: YES � NO � PRINT NAME:

OPERATIONAL REVIEW COMPLETED ON THIS ASSEMBLY? YES � NO � BEST PRACTICES IDENTIFIED**: YES � NO �

EVALUATION SUMMARYSUMMARY OF SCORING bY CATEGORY AND OVERALL RATING

SCORINGSUMMARY

CATEGORY A

TOTAL SCORE

_____________

NUMBER OFITEMS RATED

_____________

AVG. SCORETHIS SECTION_____________

WEIGHTEDFACTOR

0.50

WEIGHTED SCORETHIS SECTION_____________

SCORINGSUMMARY

CATEGORY B

TOTAL SCORE

_____________


_____________


WEIGHTEDFACTOR

0.30


SCORINGSUMMARY

CATEGORY C

TOTAL SCORE

_____________


_____________


WEIGHTEDFACTOR

0.20


FINAL NUMERIC SCORE (TOTAL OF ALL WEIGHTED SCORES) ______________

OVERALL ACTIVITY RATING*

* If any Category “A” Element has Scored Less than a “3.0” the Overall Rating is

Automatically Identified as “UNSATISFACTORY”

See Attached Detail Sheets for Individual Element Scoring by Category.

** See Attached Detail Sheets for Observations Relative to “BEST PRACTICES”.

***AASHTO Manual for Assessing Safety Hardware (MASH)

SUMMARY OF ObSERVATIONS

M-7002 (6-11)

QUALITY ASSURANCE EVALUATIONWORK ZONE TRAFFIC CONTROLPLEASE TYPE OR PRINT ALL INFORMATION IN bLUE OR bLACK INK www.dot.state.pa.us

4.75 - 5.00 Exceeds Expectations __________

4.50 - 4.74 Commendable __________

4.25 - 4.49 Satisfactory __________

3.25 - 4.24 Needs Improvement __________

< 3.25 Unsatisfactory __________

Automatic Unsatisfactory __________

Page 2 of 6

CAT ELEMENT SCORE COMMENTS

A. 1. Traffic Setup ____ ________________________________________________________

2. Sign Spacing ____ ________________________________________________________

3. Sign Visibility ____ ________________________________________________________

4. Sign Maintenance ____ ________________________________________________________

5. Sign Distance / Height ____ ________________________________________________________

6. Flagger Visibility ____ ________________________________________________________

7. Flagger(s) Controlling Traffic ____ ________________________________________________________

8. Shadow Vehicle ____ ________________________________________________________

INNOVATION AND TECHNOLOGY APPLICATION

Category A: Apparent “best Practice(s)“ Observed: __________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

SCORINGSUMMARY

CATEGORY A

TOTAL SCORE

_____________


_____________


WEIGHTEDFACTOR

0.50


SCORINGSUMMARY

CATEGORY B

TOTAL SCORE

_____________


_____________


WEIGHTEDFACTOR

0.30



b. 1. Publication 213 or TTCP ____ ________________________________________________________

2. Signaling Devices ____ ________________________________________________________

3. Flagging Attire ____ ________________________________________________________

4. Channelization ____ ________________________________________________________

5. Sight Distance ____ ________________________________________________________

6. Ramps / Intersections ____ ________________________________________________________

7. Reduced Speed ____ ________________________________________________________

8. Figure Identification (Pub. 213) ____ ________________________________________________________


Category b: Apparent “best Practice(s)“ Observed: __________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Page 3 of 6

SCORINGSUMMARY

CATEGORY C

TOTAL SCORE

_____________


_____________


WEIGHTEDFACTOR

0.20


FINAL NUMERIC SCORE (TOTAL OF ALL WEIGHTED SCORES) ______________

OVERALL ACTIVITY RATING*

* If any Category “A” Element has scored less than a 3.0, the Overall Activity Rating is automatically identified as “Unsatisfactory”.


C. 1. Sign ballasted ____ ________________________________________________________

2. Supervision ____ ________________________________________________________

3. Arrow Panels ____ ________________________________________________________

4. barricades ____ ________________________________________________________

5. Warning Lights ____ ________________________________________________________


Category C: Apparent “best Practice(s)“ Observed: __________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

4.75 - 5.00 Exceeds Expectations __________

4.50 - 4.74 Commendable __________

4.25 - 4.49 Satisfactory __________

3.25 - 4.24 Needs Improvement __________

< 3.25 Unsatisfactory __________

Automatic Unsatisfactory __________

Page 4 of 6

QUALITY ASSURANCE EVALUATION INDICATORS

A. 1. Traffic Setup****

Traffic setup in accordance with appropriate PUB 213 figure or TTCP?

1. Major deviation. Not in compliance with PUB 213 figure or TTCP.

3. Minor deviations from PUB 213 figure or TTCP.

5. Set up in accordance with PUB 213 figure or TTCP.

A. 2. Sign Spacing

Advanced warning signs placed at proper distances? (Ref. PUB 213 or TTCP)

1. More than two signs improperly positioned.

3. One or two signs improperly positioned.

5. All signs properly positioned.

A. 3. Sign Visibility

Traffic Control Signs visible to approaching traffic?

1. More than one sign obstructed.

3. One sign obstructed.

5. All signs visible.

A. 4. Sign Maintenance

Signs and Pins properly maintained?

1 – More than one sign and/or sign hardware not properly maintained, not clean, not legible, or not in good state of repair.

3 – One sign and/or sign hardware not properly maintained, not clean, not legible, or not in good state of repair.

5 – All signs and/or sign hardware properly maintained, clean, legible, and in good state of repair.

A. 5. Sign Distance / Height (Ref. PUB 213, Sign Layout and General Notes)

Signs located at proper lateral distance & mounting height?

1. More than one sign not properly located or mounted.

3. One sign not properly located or mounted.

5. All signs properly located and mounted.

A. 6. Flagger Visibility (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Score one point for each condition satisfied (For maximum of 5 Points Allowed) (Ref. PUB 234 Flagger Handbook)

A. Flagger(s) visible to oncoming traffic for a minimum distance of “E” as shown in applicable Pub. 213 figure.

B. Flagger(s) properly positioned along the edge of the roadway on the shoulder.

C. Flagger(s) positioned at a distance not exceeding the maximum allowed spacing from the “Flagger Ahead” or

“Be prepared to Stop” sign for the figure in use.

D. Flagger(s) have an open avenue of escape from their position in the event of vehicle encroachment.

E. Flagger(s) attention is focused on oncoming traffic.

A. 7. Flagger(s) Controlling Traffic (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Flagger(s) adequately controlling traffic? (Ref. PUB 234 Flagger Handbook)

1. Significant incident, which could clearly endanger the safety of workers or the public.

3. Minor, isolated incident to traffic movement which does not endanger the safety of the workers or the public.

5. Traffic moves smoothly and safely through the work zone at all times and flaggers are in communication with each

other at all times.

A. 8. Shadow Vehicle (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Shadow vehicle used as required, (Ref. PUB 213)

1. Shadow vehicle required but not used; or operator positioned inside stationary vehicle.

3. Shadow vehicle used but placed at improper distance or improperly positioned.

5. Shadow vehicle used as required.

Page 5 of 6

b. 1. Publication 213 or TTCP

Publication 213 or TTCP at worksite?

1. Publication 213 or TTCP not at worksite.

5. Publication 213 or TTCP at worksite.

b. 2. Signaling Devices (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Flagger(s) using proper hand signaling device? (Ref. PUB 234 and PUB 212)

1. Correct hand signaling device not being used over an extended period of time.

3. Isolated misuse of proper hand signaling device.

5. Proper hand signaling device used, stop/slow paddle w/72” shaft or red flag measuring 24” x 24” used where permitted.

b. 3. Flagging Attire (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Flagger(s) appropriately attired? (Ref. PUB 445 Safety Manual and PUB 234 Flagger Handbook)

1. Flagger(s) not wearing protective helmet and/or high visibility multi-colored vest or rain gear; not meeting ANSI

Class II requirements.

5. Flagger(s) wearing protective helmet and high visibility multi-colored vest or rain gear; meeting ANSI Class II

requirements.

b. 4. Channelization (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Taper and longitudinal sections properly installed? (One point to be awarded for each item correctly addressed)

(Ref. PUB 212, PUB 213)

a – Channelizing devices forming the taper and longitudinal sections are all of the same type in each section.

b – Correct number of devices used.

c – Taper and longitudinal section lengths are sufficient and correct.

d – Beginning of taper visible to oncoming traffic.

e – Spacing between devices uniform and correct within +/- 10% of designated distance and alignment of devices is

true and non-erratic.

b. 5. Sight Distance (Ref. PUB 212)

Sight distance from intersecting roadways or driveways not obstructed by work zone warning signs?

1. Obstruction of commercial driveway or significant intersection (> 200 ADT) or an incident or problem observed.

3. Obstruction of private driveway or minor intersection….no incident or problem observed.

5. No sight distance obstructions.

b. 6. Ramps / Intersections (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Advance warning signs erected on ramp(s) or intersecting highways? (Ref. PUB 213 “General Notes”)

1. Ramps and intersecting roadways within the work zone requiring signing are not signed.

3. Ramps and intersecting roadways within the work zone requiring signing are signed but devices are improperly placed.

5. All ramps and intersecting roadways within the work zone requiring signing are properly signed.

b. 7. Reduced Speed (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Reduced regulatory speed limits correctly posted. (One point awarded for each item correctly addressed.)

a – Reduced work zone speed limit a maximum of 10 mph below the normal posted regulatory speed limit.

b – Reduced work zone speed limit is at least 25 mph or has been reduced to less than 25 mph or reduced greater than

10 mph below the posted speed limit with an engineering and traffic study.

c – Work area speed limit signs (R2-2-2), placed at a maximum spacing of ½ mile.

d – “End Road Work” signs correctly positioned.

e – Conflicting regulatory or warning signs removed, covered, folded or turned so that they are not readable to

oncoming traffic.

b. 8. Figure Identification ( Pub.213 )

Foreman able to identify appropriate Pub. 213 figure being used on job site?

1. Not able to identify.

3. Able to identify with some assistance from evaluator.

5. Able to identify without assistance from evaluator.

Page 6 of 6

C. 1. Signs ballasted

Work zone signs properly ballasted?

1. Any sign(s) repeatedly blown over or unballasted or improper material or method used to ballast sign(s).

5. No signs blown over and no improper material or method used to ballast signs.

C. 2. Supervision/Monitoring

Personnel available to maintain traffic control devices?

1. Integrity of setup is not maintained.

5. Integrity of setup is maintained.

C. 3. Arrow Panels (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Arrow Panels of proper size?

1. Incorrect size or more than 75% of bulbs inoperable.

3. Correct size with more than 25% but less than 75% of bulbs inoperable.

5. Correct size with no more than 25% of the bulbs inoperable.

C. 4. barricades (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

Stripes sloping downward toward the side of the barricade on which traffic is designated to pass?

1. No, stripes are not sloping downward toward the side of the barricade on which traffic is designated to pass.

5. Striping appropriate.

C. 5. Warning Lights (N/A – Not Applicable … Score This Element “N/A” When the Function is Not Warranted)

The appropriate light(s) are attached to each device.

1. No.

5. Yes.

**** “Minor deviation” is the absence of a downstream taper where required by the figure. “Major deviation” is the absence of an

upstream taper and/or channelization where required by the figure or the selection and application of the figure inappropriate

for the work being performed or the environment in which it is being performed.

WORK ZONE SAFETY QA FORM QA Number ________

Constr. Operation

Maint. Operation Short Term Setup Date Daytime Night

Permit / Utility Operation Long Term Setup __________ District ____ County ______________________ Inspected By _____________________________________

SR ______ Section _______ Seg. _____ Off. _____ Project Manager /

PennDOT Foreman ___________________________

Contractor __________________________________

What Part of Project was QA’ed Northbound Southbound Eastbound Westbound

Entire Project including intersecting roadways

What Figure(s) was being used? ______________ or TCP Stage and/or Phase _____________

1. Are traffic control signs visible to approaching traffic?

N/A (5) All are visible (4) One obstructed (3) Two obstructed (1) Three or more obstructed.

Comments:

2. Are warning signs obstructing sight distance from driveways or side roads? N/A (5) No sight distance obstructions. (3) Minor Obstruction. No incident/problem observed.

(1) Obstructing or an incident/problem observed.

Comments:

3. Are conflicting signs removed or properly covered?

N/A (5) All signs removed or covered.

(3) Most signs are removed or covered.

(1) Conflicting signs cause confusion to the motoring public.

Comments: _________________________________________________________________________________

______________________________________________________________________________________________

4. Is the taper (including arrow panel when applicable) properly installed? * are channelizing devices all the same type * correct number of devices used

* is taper length correct * can taper be seen safely (not placed on horizontal or vertical curve)

(note: taper length is based on normal posted speed limit prior to construction)

TAPER ARROW PANEL N/A N/A

(5) All four items are correct (5) Visible for (XX) FT (XX = 20 times speed limit)

(4) Three items are correct (3) Minor deviation

(3) Two items are correct (1) Poorly

(2) One items are correct

(0) No items are correct Comments:

5. Are Act 229 Signs setup properly? N/A (3) Yes (0) No

(more)

6. Is White Light on Active Work Sign working properly?

Active Work Area (workers present) - N/A (3) Flashing (0) Not Flashing

Non-Active Work Area (no workers or construction activities) N/A (3) Not Flashing (0) Flashing

Comments _________________________________________________________________________________

______________________________________________________________________________________________

7. Are temporary pavement markings installed properly?

N/A (5) Yes (3) Minor deviations (1) NO Major deviations

Comments ___________________________________________________________________________________

______________________________________________________________________________________________

8. Are conflicting Pavement markings removed properly?

N/A (5) Yes (3) Minor deviations (1) Major deviations

Comments___________________________________________________________________________________

______________________________________________________________________________________________

9. Is the Flagger properly positioned and visible to approaching traffic?

N/A (5) Yes (3) Minor deviations (1) NO, Flagger is improperly positioned or not visible to traffic

Comments___________________________________________________________________________________

______________________________________________________________________________________________

10. Is the flagger appropriately attired?

N/A

(5) Flagger is wearing a hard hat and high visibility vest (leggings if PennDOT employee) at all times.

(3) Flagger is missing a hard hat or high visibility vest or (leggings if PennDOT employee).

(1) Flagger is not wearing a hard hat and high visibility vest and (leggings if PennDOT employee).

11. Is the traffic control setup installed in accordance with the appropriate Figure(s) or TCP?

N/A (5) Yes (3) Minor deviation (1) Not in compliance

Comments: ____________________________________________________________________________________

______________________________________________________________________________________________

12. Is the traffic control properly maintained (including visibility and proper spacing)?.

SIGNS CHANNELIZING DEVICES DELINEATION (rpm’s / delineators)

N/A N/A N/A

(5) Yes (5) Yes (5) Yes

(3) Minor deviation (3) Minor deviation (3) Acceptable

(1) Poor, needs work (1) Poor, needs work (clean or replace) (1) Needs work (cleaned and/or replace)

Comments

13. Are there any other deficiencies that need to be addressed (CMS, Signing, ITS etc)?

N/A (5) No (4) Minor deviation (2) Poor (0) Immediate Attention

Comments

(more)

14. Are crash reports collected by the construction unit and sent to the Traffic Unit?

N/A (4) Yes (2) Sometimes (0) No

Comments

15. Are crash reports reviewed by the Construction and Traffic Units to determine if changes or revisions are

needed in the traffic control?

N/A (4) Yes (2) Sometimes (0) No

Comments

Were deficiencies and / or changes reported to the Project Manager / PennDOT Foreman? _ Yes No

Have deficiencies been corrected? Yes No Reviewed by _____________________________

Comments:

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

WORK ZONE TRAFFIC CONTROL REVIEW FORM DISTRICT NO. FILE NO.: DATE: COUNTY: ROUTE: WEATHER: TIME: CONTRACTOR: 1. SIGNS

YES NO N/A 1. Is Advance Signing Adequate 2. Are Signs Proper Sizes 3. Are Sign Legends Proper 4. Are Signs Properly Spaced 5. Are Signs Reflectorized with the Correct Retroreflective Sheeting 6. Are Sign Messages Confusing 7. Have Signs Been Covered or Removed When Not Applicable 8. Are Any Signs Obstructed by Trees, Vehicles, Other Signs, Etc. 9. Are Any Signs in Need of Replacement 10. Are Signs Mounted on Correct U-Channel Posts 11. Are Signs Mounted on Correct Square Tube Posts 12. Are Break-Away Assemblies Correct 13. Are Signs Mounted at Correct Height 14. Are Portable Sign Supports on the Approved Products List 15. Are Approved Sign Sub-Stratums Used on Portable Sign Supports 16. Are Roll Up Signs Fabricated From Approved Reflectorized Material 2. CHANNELIZING DEVICES

YES NO N/A 1. Are the Correct Type of Devices Being Used 2. Is the Number of Devices in Place Adequate

1

3. Are Devices Properly Spaced 4. Are Devices Proper Sizes 5. Are Devices Reflectorized with Correct Retroreflective Sheeting 6. Are All Devices on the Approved Products List 7. Does All Barricade Striping Point in Direction Traffic is to Pass 3. PAVEMENT MARKINGS

YES NO N/A 1. Are Pavement Markings Confusing 2. Have All Unnecessary Pavement Markings Been Removed 3. Do Pavement Markings Need Replacing 4. Are Lines Correct Width 5. Do Lines Reflect Correct Width at Night 6. Are Temporary Raised Pavement Markers in Place 7. Do Temporary Raised Pavement Markers Require Replacement 4. LIGHTING DEVICES

YES NO N/A 1. Are Warning Lights Present 2. When Present, Are Warning Lights Properly Installed 3. When Present, Do Warning Lights Need Replacing 4. Do Warning Lights Meet NCHRP Report 350 Weight Requirements 5. ADVANCE WARNING ARROW PANELS

1. Are Arrow Panels in Use YES NO N/A

2. Are Arrow Panels Placed as Directed by Standard Drawings 3. Are Correct Number of Arrow Panel In Use 4. Are Arrow Panels Placed to Ensure Adequate Sight Distance 5. Are Arrow Panels Operating at Correct Intensity for Daytime Visibility 6. Are Arrow Panels Dimmed at Night 7. Do Arrow Panels Have Any “Burnt Out” Lights

2

3

6. CHANGEABLE MESSAGE SIGNS YES NO N/A

1. Are Changeable Message Signs in Use 2. Are Message Signs Present When Not Needed 3. Are Message Signs Placed to Ensure Adequate Sight Distance 4. Are Message Signs Operating at Correct Intensity for Daytime

Visibility

5. Are Message Signs Dimmed at Night 6. Do Messages Pertain to Actual Roadway Conditions 7. Do Messages Duplicate the Permanent Construction Signs 8. Do Messages Flash at a Rate That Permits All Messages Be Read at

Least Once

7. FLAGGING OPERATIONS

YES NO N/A 1. Are Flagging Operations in Use 2. Are Nighttime Flagging Operations in Use 3. Are "Flagger Ahead" Signs Present When Not Needed 4. Are All Required Advance Signs Present and Installed Correctly 5. Do Flagger Locations Provide Sufficient Sight Distance 6. Are Flaggers Using Proper Devices (Stop/Slow Paddles) 7. Are Flaggers Using Proper Signaling Motions and Conducting

Themselves According to the MUTCD and Flaggers Handbook

8. Are Flaggers Attentive to the Surrounding Conditions 9. Are Flaggers Properly Dressed (Clean Vest or Jacket) 10. Are Flaggers Wearing Proper Class 3 Vest with Sleeves or Class 2

Vest and Pants During Nighttime Flagging Operations

11. Are Changeable Message Signs Present During Nighttime Flagging

Operations

8. TRUCK MOUNTED ATTENUATORS

YES NO N/A 1. Are Truck Mounted Attenuators in Use 2. Are the TMA's NCHRP Report 350 Approved 3. Do the TMA's Meet Specified Design Speed Requirements 4. Are TMA's Truck Mounted Type

5. Are TMA's Trailer Type 6. Are the TMA's Properly Located 7. Do Any TMA's Exhibit Evidence of a Previous Impact 8. Are the Trucks Proper Weight, Including Proper Ballast When Used 9. PORTABLE TERMINAL IMPACT ATTENUATORS

YES NO N/A 1. Are Portable Terminal Impact Attenuators in Use 2. Are the Attenuators NCHRP Report 350 Approved 3. Do the Attenuators Meet Specified Design Speed Requirements 4. Are the Attenuators Properly Located 5. When Present, Are the Cartridges in Need of Replacement 5. When Present, Are the Cartridges in Correct Locations 6. Are the Attenuators Properly Anchored 7. Are the Transition Panels Installed Correctly 8. Is the Nose of the Attenuator Properly Delineated 9. Do Any Attenuators Exhibit Evidence of a Previous Impact 10. TEMPORARY CONCRETE BARRIER WALL YES NO N/A 1. Does Barrier Wall Meet NCHRP Report 350 Requirements 2. Does Barrier Wall Require Painting 3. Is NCHRP Report 350 Barrier Wall Properly Stamped 4. Are Approach Ends of Barrier Wall Protected Correctly 5. Are Approach Tapers of Barrier Wall Installed Correctly 6. When Necessary, Are Sections of Barrier Wall Correctly Anchored 7. When Necessary, Are Sections of Barrier Wall Correctly Attached to

Adjacent Guardrail, Permanent Barrier Wall or Bridge Parapets

8. Are Reflective Discs Installed Properly 9. Does Color of Reflective Discs Match Adjacent Edge Line 10. Do Reflective Discs Require Replacement 11. Are Delineators Installed Properly 12. Does Color of Delineators Match Adjacent Edge Line 13. Do Delineators Require Replacement

4

14. Does Barrier Wall Exhibit Evidence of Being Hit 15. Do Sections of Barrier Wall Require Replacement COMMENTS: INSPECTED BY:

5

Contractor Work Zone Traffic Audit

Summary of Project Audit

SectionPoints

AwardedPoints

Available

1a Traffic Accom Supervisor

1b Traffic Plan

2 Signs (Total)

3 Flagpersons

4 Barricades

5 Light/Message Boards

6 Pilot Vehicles

7 Lane Tapers

8 Lane Channelization

9 Temp Pvt Marking

10 Special Conditions

C.S. km-km:

Level 0 - correct immediately: eg untrained flaggers; no PPE.

Contract #

Safety Manual 1100-300 OHS Violations Summary

Ministry Personnel:

Work Type:

Contractor

Audit Team Personnel: CB Wilson, L Schafer, A Goldstone, R Michayluk, Lyle Jacobsen

Date:

AADT:

Audit #

Weather

Level 2: - correct in max. 10 days: eg substandard reflectivity.

Contractor Personnel:

Level 1 - correct in max. 4 days: eg no back up alarm; missing signs.

10 Special Conditions

Totals =

Rating % =

1a: Traffic Accommodation Supervisor

Rating Points: Acceptable = 2; Marginal = 1; Unacceptable = 01 TAS certificate available?2 TAS certificate valid? Expiry date =3 On-Site Coverage - Full time / Part time?4 Maintains Sign Log

Total Points Awarded / Available = 1b: Traffic Plan #

1 Appropriate Plan?2 Appropriate Location for Approach Signs?3 Proper Sequencing?4 Appropriate Modifications?

Revised 28July2008 Total Points Awarded / Available =

CommentsPoints Awarded: 2 / 1 / 0

Name: _________________________________Certif # ______________Certif Valid Until _________________

CommentsPoints Awarded: 2 / 1 / 0

Comments:

Traffic Accommodation Checklist Contractor Contract Number Project Description: From Control Section To Type of Work Date T.A. Plan Yes No Time Direction of Travel G F P M N/A Comments/Activities Core Signage Construction Ahead End Construction Work Zone 1 – Signs

Men Working (every 3km) Rough Road Fresh Oil No Passing Flagperson Ahead

Yield to Oncoming Traffic Road Narrows (Lt/Rt) Barricade Ahead Barricade

Delineators/Cones End Work Area Pass With Care Truck Entrance Work Zone 2 – Signs

Men Working (every 3km) Rough Road Fresh Oil No Passing Flagperson Ahead

Yield to Oncoming Traffic Road Narrows (Lt/Rt) Barricade Ahead Barricade

Delineators/Cones End Work Area Pass With Care Truck Entrance

Flagpersons: Certificate

Attire and Equipment Flagging Station Flagging Procedures

Alert Pavement Markings Roadway Condition

Defined Travel Way Travel at 50 km/hr.

Pilot Vehicles Flashing Light and sign Proper Vehicle & Operation

______________________________________ ___________________________________ MHI Signature Contractor Signature

Instructions

Traffic Accommodation Rating How to rate individual signs, barricades, and delineators: • Refer to the Traffic Accommodation Manual for Work Zones to determine which signs may be applicable for each work

zone. Once the Traffic Accommodation Plan is approved this plan should be used to determine which signs should be used and where.

• You can refer to the booklet “Quality Standards for Work Zone Traffic Control Devices” published by ATSSA to help you rate signs, barricade, delineators etc. Pictures showing examples of good, fair and poor signs will be available shortly. Until then you can use the description below to help you rate signage.

• If either the sign condition or installation of a sign is deemed to be fair or poor, the sign should be graded as fair or poor. Sign condition: • Good – There may be several abrasions on the surface but very little loss of lettering or reflective sheeting. There has

been no touch-up of the lettering or stripes. Panels are not deformed to an extent so as to decrease the panels target value. There are no residue, asphalt or cement splatters on the surface. The message is legible and clear.

• Fair – Of the many surface abrasions throughout the surface, many are within individual letters of the message. The surface is free of any residue, asphalt or cement. Some color fading may be evident but the background color and reflectivity are still apparent at night. The message is legible and clear.

• Poor – Some letters or stripes have lost or are covered by more than 50 percent. The loss may be from scratches, abrasions, asphalt or cement. Reflective material is gone or covered on some letters or stripes. There may also be noticeable color fading.

Sign Installation: • Signs or barricades should not be leaning more the 15 degrees from vertical. The bottom of the sign should be between

1.0 m and 2.5 m above the subgrade shoulder line. If the sign is below the hood level of a standard sedan, it should be considered unacceptable. Signs should be facing the traffic, turned slightly in towards the oncoming traffic. They should not be more than 20 degrees turned in either direction.

• Covered signs that should be uncovered should be rated as if they are missing. Signs that should be covered but are not are also not acceptable.

• Most signs should be spaced 30 to 150 m apart depending on the speed of traffic. Spacing of signs should be reasonable considering the specified spacing in the standard plans and the current conditions in which they are being used. If motorist have ample time to read the signs at the average operating speed the spacing is adequate. If signs are more than 150 m apart, they should be rated as poor. Signs less than 30 m apart should also be rated as poor, unless conditions make this spacing impossible.

Flagperson • Flagpersons should be dressed in white or orange coveralls (other high visibility dress may also be acceptable if

approved by the project manager). They should also wear a high visibility vest; hard hat and steel toed boots. Any violation of the dress code should result in a poor rating.

• Flagpersons should be located away from obstacles like vehicles. They must have a clear escape route. They should be standing on the shoulder or just off the traffic lane about 50 to 150 m away from the work crews. They must be visible to oncoming traffic for at least 125 m and not obscured by signs or equipment. Flagging station should be rated as good or poor. If any of these conditions are violated, the station is considered poor.

• The flagperson should be using hand signals to direct traffic as needed. They should not hold the paddle in front of their face or wave the paddle at motorists. They should be informing motorists of conditions ahead as directed in a friendly manner.

• The flagperson should have the following equipment: • Paddle, • Horn, • Light,. • Radio.

• The flagperson must be alert at all times. If they are lying in the ditch, sitting in a vehicle or just not paying attention to oncoming traffic they should be rated poor for alertness.

Scoring Overall Traffic Accommodation • The contractor gets 5 demerit points for any individual poor or missing rating and 1 demerit point for a fair rating. • Twenty points wilol be assessed if the Traffic Accommodation Supervisor(s) caanot produce the appropriate training

certificate. • Twenty points will be assessed if the traveled way is not clearly marked, routinely difficult to maneuver or confusing to

negotiate. • Bonus situation for an overall good rating. A good overall rating is where 9 or less demerit points were charged. Only

one poor rating is allowed. • No bonus or penalty is to be applied if the overall rating is acceptable. An acceptable rating occurs if the contractor has

less than 20 demerit points but more than 9. It should be noted that an unsafe condition should be corrected as soon as possible after detection. If it is not, the contractor should be rated as unacceptable regardless of the number of demerit points.

• An unacceptable overall rating should be given if the contractor has 20 or more demerit points.

Work Zone Inspection

Page 1 of 1

Score:Speed Limit: Case Nbr:

Engineer: Date:

Contractor: Location: Project Nbr:

Courtesy?

District:

Comments:

Comments:

Name Title

A.B.C.D.E.F.

Flaggers certified?Dressed properly?Proper control of traffic?Proper work signs & paddle?Flaggers Visible?Nighttime flagging/lights?

Flagging Guidance Protection

G.H.I.J.K.L.M.

Travel path defined?Lane change/closure ok?Paint marks removed / restoreDevices clean/undamaged?Proper devices / spacing?Special Provisions/Plans?UDOT Standard Spec's?

N.O.P.Q.R.S.T.

Public protected?Warning of hazards?Flags / Reflectivity on signs?Device removed/not in use?Traffic devices comply?Attractive Nuisance?OTHER?

Safety

1.2.3.4.5.6.7.8.9.10.11.12.13.

Aerial lift tie offAir HosesBack up alarmsChainsConfined space entryCranes / PlatformsDrinking WaterElectrical cords/ GFCIEnvironmentalExcavation / TrenchFall ProtectionFire ExtinguisherFirst Aid Equipment

14.15.16.17.18.19.20.21.22.23.24.25.

Flammable StorageFork LiftsHand Rails on PlatformsHousekeepingImpalement ProtectionLaddersMSDS on SitePPEPower ToolsROPSQualified OperatorsSafety Bulletin Board

26.27.28.29.30.31.32.33.34.35.36.37.

Sanitation FacilitiesScaffolds + InspectionSeat Belt UseTag Lines on LoadsTool Box MeetingsWelding Tank StorageWheel ChocksOTHEREquipmentHearing ProtectionWalking/Working SurfaceWorker Safety

Reviewers:

Infraction Weight: -1 Minor -2 Serious -3 Severe x2 for Major or Repeat

Company

WORKZONE INSPECTION

TRAFFIC OPERATIONS SECTION

Project Name: Project Number: Project Resident: Date Inspected:

Inspection Report by:

Temporary Traffic Control Question Yes No N/A Comments Is the lane closure set up per the contract, as far as hours of the day, number of lanes?

Is the traffic control correct according to the approved TCP? Are all temporary signs and arrow panels clean, in good condition and do the signs display acceptable retroreflectivity?

Are traffic control devices visible to approaching traffic?

Are the appropriate channelizing devices installed, and do they employ the proper taper rates?

Are the channelizing devices clean, in good condition and do they display acceptable retroreflectivity?

Are the channelizing devices spaced appropriately according to the TCP?

Are the appropriate provisions made for pedestrian/bicycle traffic?

Are the appropriate provisions made for State Patrol/law enforcement assistance?

Are flagging operations in place and operating smoothly as called for in the TCP?

Are traffic control devices appropriate for current plans? Should existing signs in or near the work area be removed or covered?

Observations:

Page 1 of 9

Cones Question Yes No N/A Comments Are cones orange in color? If cones are used only during the daytime, or on low-speed roadways (≤ 60 km/h [40 mph]), are they at least 450 mm (18 in) in height?

If cones are used only during the nighttime, on a freeway or on high-speed roadways (≥ 70 km/h [45 mph]), are they at least 700 mm (28 in) in height?

If cones are used during the nighttime, do they have two retroreflective white bands?

Is the top white band 150 mm (6 in) in height, 75 to 100 mm (3 to 4 in) below the top of the cone, and span the circumference of the cone?

Is the bottom white band spaced 50 mm (2 in) below the top band, 100 mm (4 in) in height, and span the circumference of the cone?

Are the cones weighted properly so that they remain in place and upright?

Are the individual cones in “acceptable” condition? Is the array of cones in “acceptable” condition? Observations:

Drums

Question Yes No N/A Comments Are drums constructed of lightweight deformable material? Are drums a minimum of 36” in height and 18” in diameter? Does each drum have alternating orange and white retro-reflective strips 4-6” wide?

Does each drum have at least two orange and two white stripes, with the top stripe being orange?

Do drums have closed tops that prevent collection of debris? Are the drums weighted at the base, so as not to make them hazardous if struck?

Are the individual drums in “acceptable” condition?

Is the array of drums in “acceptable” condition? Observations:

Page 2 of 9

Signs Question Yes No N/A Comments Are the signs of acceptable quality? Are the proper number of signs present in accordance with the TCP?

Are the signs located properly according to the TCP? Do the materials and design used for the sign comply with the TCP?

Are all signs located on the right-hand side of the road except in cases where the TCP specifies otherwise?

Are the signs mounted according to the TCP? Do signs mounted on Type III barricades avoid covering more than 50 percent of the top 2 rails or 33 percent of all three rails?

Are post-mounted signs installed on the side of the road in rural areas, mounted at a height of at least 1.5 m (5 ft) measuring from the bottom of the sign to the near edge of the pavement?

Are post-mounted signs in business, commercial, and residential districts, (where parking and/or pedestrian movement is likely to occur or where there are other obstructions to view) mounted at a height of at least 2.1 m (7 ft), measuring from the bottom of the sign to the near edge of the traveled way?

Are all signs that do not apply covered or removed as necessary?

Is the covering method such that the sign face is completely covered, and stable enough to resist wind loadings?

Do all signs that are to be visible at night meet minimum retroreflectivity standards? (Refer to the Retroreflective Sheeting Checklist for further information).

If the above question was answered NO, does the sign have separate illumination, internal or external, that provides for sufficient night visibility?

Are sign faces construction zone orange as specified in the TCP?

Are any flags or warning lights used placed in such a way as to prevent the possibility of blockage of the sign face?

Do existing signs on the job site conform to the requirements of the MUTCD and the TCP?

Do signs called for in the TCP avoid producing significant conflicts with existing signs on the job site?

Are signs spaced correctly according to the TCP, and do the spacings allow enough time for motorists to absorb the information the sign is intended to convey?

Observations:

Portable Changeable Message Signs

Page 3 of 9

Question Yes No N/A Comments Is the device located properly according to the TCP?

Do the messages displayed by the PCMS comply with those specified by the TCP or the project engineer?

Are all letters displayed on the PCMS at least 450 mm (18 in) tall?

Are all abbreviations used in the PCMS messages clear and easily understood?

Are there no more than two phases in each message? Are 90 percent or greater of the pixels operating properly in each individual character module?

Is the PCMS message easily read twice from all approaching traffic lanes at a distance of at least 200 m (650 ft)?

Is the message displayed short enough that it can be easily read twice while driving past the PCMS at the posted speed limit?

Are all PCMS located on one side of the roadway only? Are drivers able to see only one PCMS at a time? Are PCMS moved or are their messages changed every one to two weeks?

Do all PCMS messages depicting signs or pavement markings have the appropriate signs or pavement markings adjacent to the PCMS?

Is the bottom of the PCMS mounted at least 2.1 m (7 ft) above the surface of the roadway?

Observations:

Sign Supports- Ground Mounted Question Yes No N/A Comments Are the sign posts for ground-mounted signs, plumb and firmly set in the ground?

Are posts of sufficient strength and number to support the signs?

Do posts extend above the sign? Are posts free of external bracing? Are the posts spliced? Is the post stub height of a 2-part post no more than 4”? Are the posts spliced to the back of the bases in such a manner that they will break away and lay down, if struck?

Observations: Sign supports well done

Sign Supports- Portable Question Yes No N/A Comments Do portable signs interfere with the movement of pedestrians or bicyclists?

Are portable sign stands crashworthy and NCHRP compliant?

Page 4 of 9

Is the face of the sign at least 1 foot above travel way? Are only sandbags used as ballast for sign supports? Are the sandbags placed as near to the ground as possible? Is the sign clearly visible to approaching traffic? Observations:

Flagger/Devices Question Yes No N/A Comments Is the flagging equipment used of the proper size and color as shown in the TCP?

Do flagging paddles used meet the requirements of the MUTCD?

Are flaggers equipped with any special equipment called for in the contract (cones, flashlights, protective clothing, etc.)?

Are proper advance warning signs in place? Are “Flagger Ahead” signs removed when not needed? Are all flaggers properly attired and equipped with approved clothing, including class 2 vests?

Are all flags, paddles, vests, communication devices and other flagging equipment in good working condition?

Is the flagger located properly as shown in the TCP? Is the flagger station far enough in advance of the work space? Is the flagger location visible to oncoming traffic and at a sufficient distance to allow drivers time to respond to the flagger’s signal?

Is the flagger standing alone? Are flaggers free of personal radios or other distractions? Are flaggers certified if required? Are flaggers relieved regularly? Are flaggers using proper flagging etiquette and conducting themselves appropriately to send a clear, respectful message to passing drivers?

Are flaggers using proper techniques to signal messages to traffic?

On single-lane, two-way, flagger-controlled work zones, is there a safe means of communication between the flaggers, so that traffic control may be properly coordinated?

Observations:

Page 5 of 9

Pavement Markings Question Yes No N/A Comments Prior to marking installation, is the marking material that which is specified in the TCP or Specifications?

Drive through the work zone. Are the locations and patterns of markings installed according to the TCP?

Drive through the work zone. Are markings no longer applicable completely removed or obliterated so that they are not visible in the daytime?

Are the markings applied according to the TCP: White-separating traffic traveling in the same direction?

Are the markings applied according to the TCP: Yellow-separating traffic traveling in the opposing direction?

Are the markings applied according to the TCP: Width? Are the markings applied according to the TCP: Cycle length and length of broken lines?

Are the markings the same color (white markings appear white and yellow markings appear yellow) during the day and night?

Perform the sunlight/shadow test on the markings during the daytime and observe the bead distribution. Is there sufficient number and uniformity of embedded beads?

Are standard markings in “acceptable” condition? Observations:

Temporary Markings Question Yes No N/A Comments Prior to marking installation, is the marking material that which is specified in the TCP or Specification?

Drive through work zone. Are the locations and patterns of markings installed according to the TCP?

Have temporary markings been in place less than two weeks? Are temporary markings in “acceptable” condition? Review TCP, specifications, and your state’s MUTCD policy for markings on low-volume roads. Has the low-volume road been unmarked for a period longer than permitted by the policy?

Do the temporary broken line markings have the standard cycle length specified with a stripe length of at least 0.6 m (2 ft), except at road sections with severe curvature where half-cycle lengths and 0.6 m (2ft) strips may be used?

Page 6 of 9

Are the markings applied according to the TCP: White-separating traffic traveling in the same direction?

Are the markings applied according to the TCP: Yellow-separating traffic traveling in the opposing direction?

Are the markings applied according to the TCP: Width? Are the markings the same color (white markings appear white and yellow markings appear yellow) during the day and night?

Are markings that are no longer applicable to current conditions in the work zone completely removed so that they are not visible either during the day or at night?

On a two- or three-lane road with no-passing zones, where NO PASSING ZONE signs have been used in lieu of pavement markings, has the road been unmarked for a period of three calendar days or less?

Observations:

Page 7 of 9

WORKZONE NIGHT INSPECTION TRAFFIC OPERATIONS SECTION

Project Name: Project Number: Project Resident: Date Inspected:

Inspection Report by:

Signs Question Yes No N/A Comments Are the signs clearly visible to drivers? Is the retroreflective sheeting uniform on the sign faces? Are all PCMS dimmed sufficiently at night to avoid glare problems for drivers?

Observations:

Cones, Drums and Barricades Question Yes No N/A Comments Do channelizing devices display acceptable retroreflectivity? Is the traffic flow clearly apparent to drivers? Are hazards delineated and protected? Observations:

Page 8 of 9

Page 9 of 9

Pavement Markings Question Yes No N/A Comments Drive through the work zone. Are markings no longer applicable completely removed or obliterated so that they are not visible in the: Night time?

During the night inspection, under low-beam headlights, do the markings “glow” along the entire length and width illuminated by the headlights (no evidence of dark bands or stripes within the markings)?

Do white markings appear white? Do yellow markings appear yellow? Observations:

Flagger/Devices Question Yes No N/A Comments If flagging is done at night, is the flagger station illuminated? If flagging is done at night, are the flagger’s outside garments retroreflective?

Observations:

Page 1Project Name

Statewide Work Zone Review

Page 1Project Name


STATEWIDE WORKZONE TRAFFIC CONTROL REVIEW

SR: REGION: DATE/TIME: DESIGN PEO:CONTRACT # CONSTRUCTION PEO:F.A. # CONTRACTOR:% COMPLETE: TRAFFIC CONTROL SUB:

CONTRACT $

PROJECT NAME:

Major items of work in progress:

Review Team:

Night review:

Report prepared by:

Page 2Project Name


Page 2Project Name


CONTRACT PLAN REVIEW FOR CONTRACT #

DESIGN EVALUATION:

Has the contract adequately addressed the needs of the following items either through aspecification, plan detail or traffic control plan?

ACCEPTABLE CHANGES RECOMMEND NOTREQUIRED REVISIONS APPLICABLE

A) Work Zone strategyB) Advance warning sign planC) Lane & shoulder closure operationsD) Temporary channelization plansE) Conflicts with Existing Roadway FeaturesF) Constructability IssuesG) Vertical Hazards (drop-offs?)H) Barrier protected work areasI) Pedestrian access (ADA needs)J) Bicycles (bike path or detour?)K) Ramp/Road closuresL) Traffic stop/rolling slow downM) Detours/Alternate routesN) Work Zone Speed reductionsO) Temporary pavement marking detailsP) Temporary signal & IlluminationQ) Falsework openings & bridge plansR) Oversize LoadsS) Lane closure restrictions and considerationsT) Local Road ImpactsT) Local Road ImpactsU) Overlapping ProjectsV) Law enforcement assistanceW) Transit, Schools & Emergency ServicesX) Public Information & Special eventsY) Summary of Quantities & QtabsZ) General effectivenessAA) Other issues??

Comments:

Contract Bid Items:

Are the bid items as set up in the contract adequate? Any missing items that were added by change order or should have been considered? Comments:

Page 3Project Name


Page 3Project Name


Work Zone Clear Zone:

Does the WZ clear zone fit the actual conditions?

Comments:

Lane Closure Work Hour RestrictionsContract Work hours:

Are the contract work hours adequate? Have they been adjusted by PE in field?

Do the work hours fit actual traffic volume conditions? Were they analyzed as part of the design PS&E?

Comments:

Safety & Constructability:

Project staging (if applicable), is it adequate? Has it addressed all traffic issues?

Any special closures on the contract? (ramp closures, weekend closures, rolling slow downs, etc?)

Do the traffic control plans cover all potential work areas & special closures?

Comments:

Page 4Project Name


Page 4Project Name


IN OFFICE - CONSTRUCTION ITEM EVALUATION

Traffic Control Plans:

Have the TCP's been revised? By WSDOTBy Contractor

Who reviewed and approved the revisions?Was the Region Traffic Engineer consulted on revisions?

Traffic Control Management:

WSDOT Construction Project Office's "Responsible Person" for Traffic Control:Name:Certification number & association:

Contractor's Traffic Control Supervisor:Name:Certification number & Association:

Contractor's Identified Traffic Control Manager:

Accidents:Accidents: Have any occurred in the work zone on project?

Who evaluated work zone accidents?

Have any changes been made to the Traffic Control Plans in response to accidents?

Traffic Control Comments:

Have there been comments about the traffic control on your job from:other agencies/local governments?the public?Others? (WSP?)

Do you keep a complaint file?

Have you made any changes in the TCP's in response to complaints?

Additional Comments:

Page 5Project Name


Page 5Project Name


CONSTRUCTION FIELD REVIEWField Reviews:Have work zone reviews been done by WSDOT on this project?

By who - Region, PEO, others?

Are they documented and were changes made to contract due to comments?

Comments:

IMPLEMENTATION OF TRAFFIC CONTROL PLANS ACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEAppropriate for field conditions & operationStaging plans appropriate for work operationRegulatory speed(s) appropriateAdvisory speed(s) appropriateAppropriate choice of TCP?General effectivenessWhat contract TCP is in use today?Comments:

CONSTRUCTION SIGNS ACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEConditionPlacementA i t i f tiAppropriate sign for operationSign covering of conflicting signsVisibilityNCHRP 350 approved installation?Sign CredibilityGeneral effectivenessComments:

CHANNELIZATION DEVICES(drums, cones, barricades, etc.) ACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEConditionPlacement & spacingPositive guidanceAppropriate device for operationVisibilityNCHRP 350 approved?General effectivenessComments:

Page 6Project Name


Page 6Project Name


ACCEPTABLE CHANGES RECOMMEND NOT

PAVEMENT MARKINGS ACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLETime in placeCondition, Placement & VisibilityAppropriate channelizationRemoval of conflicting markingsTemporary Pavement Marking Plan or Detail?General effectivenessComments:

FLAGGING OPERATIONSACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEAppropriate use/need (alternatives?)Placement & ProtectionEscape routeSpottersPilot car operation Night Visibility(coveralls, light plant)Special Devices (AFAD?)General effectivenessComments:

SEQUENTIAL ARROW BOARDSACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEPlacementDaytime & Night Visibility (dimmed at night?)General effectivenessComments:

PORTABLE CHANGEABLE MESSAGE SIGNS


Placement (protected by devices?)Proper messageVisibility (Day & Night)In use & on site / removed when not in useGeneral effectivenessComments:

Page 7Project Name


Page 7Project Name


TEMPORARY ALIGNMENT / LANE SHIFTS


Alignment, Channelization & SigningTemporary merging & ramp tapers?Roadway widthNight VisibilityAppropriate traffic control plan for operationGeneral effectivenessComments:

DETOUR OR ALTERNATE ROUTEACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEAdequate signing & follow through guidanceRoute improvements necessary?Condition of roadwayAdequate width for trucksCoordination with local agencyDetour/alternate route approved plan?General effectivenessComments:

TRAFFIC IMPACTSACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEDriver expectancyAdequate advance warning?Work hour restrictions, delay & queue lengthGeneral effectivenessComments:

HAZARDS ACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEFixed ObjectVertical Drop-off, abrupt lane edgesDrainage, water, debrisWork Zone Clear Zone conflictsConflicts with clear zoneComments:

Page 8Project Name


Page 8Project Name


BARRIERSACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEAdequate work area protectionPlacement (location & shy distance)Appropriate attenuation & flare rateAnchoringDeflection/slide distance appropriateDelineation & signingGeneral effectivenessComments:

TEMPORARY IMPACT ATTENUATORSACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLECorrect installation and appropriate deviceDelineation & signingShoulder closure in advance of attenuator?General effectiveness

Device typeAccidents / number of hits?Comments:

TRUCK MOUNTED IMPACT ATTENUATORS


Placement & useUsed for worker protection (nuke gauge?)Arrow board or pcms messageGeneral effectivenessComments:

WORK AREA & INSPECTOR SAFETYACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEWork area ingress & egressExposure to trafficWorker safety assessmentAppropriate tcp usedWorkarea & traffic separation(buffer)General effectivenessComments:

Page 9Project Name


Page 9Project Name


PERMANENT SIGNS(maintaining existing signs) ACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEConflicting messages?Detailed in contract plans?Temporary replacement for permanent signs?General effectivenessComments:

SPECIAL CONSIDERATIONSACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEHaul routeSpecial event coordinationBusiness accessTransit coordination (temporary bus stop?)Oversize loads (advance signing?)Noise & other local restrictionsRoadway condition (need sweeping?)WSPComments:

TEMPORARY (PORTABLE) SIGNAL SYSTEMACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLESignal timing appropriateS g g pp pPlacement & VisibilityAppropriate with plan & specs?General effectivenessComments:

TEMPORARY ILLUMINATIONACCEPTABLE CHANGES RECOMMEND NOT

REQUIRED REVISIONS APPLICABLEPlacement & VisibilityAppropriate with plan & specs?General effectivenessComments:

Page 10Project Name


Page 10Project Name


6 Additional comments on safet or the project?

GENERAL WORKZONE COMMENTS:

1. Regulatory concerns - any legal or liability concerns? (L&I, WSP, etc.)

2. Safety code violations?

3. Could safety or mobility be improved with tcp revisions?

4. If any previously listed items were marked "not applicable", should any of these items be made available for use?

5. Appropriate traffic control plan use, or modified contractor proposal?

6 Additional comments on workzone safety or the project?. workzone y

7. Any roadside permanent clearzone or workzone clearzone conflicts?

8. General comments to project traffic control:

Page 11Project Name


Page 11Project Name


TRAFFIC CONTROL "ACTION LIST"SR #

CONTRACT NO: DATE:

CONTRACT:

CONTRACTOR: TCS:

Listed items require action by the Contractor as described. Status of items shall be noted in the daily TCSreport. (refer to "STATEWIDE WORKZONE TRAFFIC CONTROL REVIEW" report for additional information)

Item: Location:Required Action:

PEO Response:


PEO Response:


PEO Response:


PEO Response:


PEO Response:


PEO Response:


PEO Response:

Wisconsin�Department�of�Transportation2012�OSOW�Work�Zone�Inspection�ChecklistGenerated:�6/15/2012

**�Sections�1�&�2�are�to�filled�out�prior�to�inspection

1.��Project�Information

Traffic�Flow:

Project�ID: Roadway: Region: County:

Travel�Time: Project�Description:

Time: Date: Weather:

Inspector: Road�Closed�to�Through�Traffic:Project�on�OSOW�Priority�Network:

Corrective�Action�Required: Conditions�Differ�from�LCS:If�Other�Specify:

2.��LCS�Reported�Conditions LCS�#:

Traffic�Control�Contractor:

Closure/Restriction: Lane�Detail: Duration:

Begin�Location:

End�Location:

HorizontalClearance: ft in ft in

Location:

Structure�ID:

Detour�Route:

Other�Conditions:

5�=�Acceptable��3=�Marginal��1�=�Unacceptable

LCS�EntryEntered�correctly

Limits�accurate

Disc.�Accurate

Advance�signingWidth�Restriction

Height�Restriction

Distance�to�work�zone

PCMS

Approved�message

Placement

Arrow�Board�Placement

Meet�MUTCD�Req.

Detour�signage

Detour�RouteProperly�signed

Meet�MUTCD�Req.

Width�Restriction

Clearance

Height�Restriction

Clearance

Turns�~�90�deg

Int.�obstructions

Work�Zone�ConditionsChannelizing�devices

Taper

Spacing

Lights�in�taper

Temp.�Conc.�Barrier

Shoulders�(if�travelled)

Pavement�drop�off

Temporary�pavement

Evaluation�Guide:�Classification�is�described�in�ATSSA�(see�below).��Review�device�location,�position,�visibility,�adequacy�&�manner�of�use

Yes No ConditionField�Conditions

Effectiveness Missing�Devices�(#) Comments

Prime�Contact: Phone�Number:

Vertical

AM PM

YES NO

Immediate Urgent (24hrs) Other YES NO

YES NO

None

Light Medium Heavy

Wisconsin�Department�of�Transportation2012�OSOW�Work�Zone�Inspection�ChecklistGenerated:�6/15/2012

5�=�Acceptable��3=�Marginal��1�=�UnacceptableEvaluation�Guide:�Classification�is�described�in�ATSSA�(see�below).��Review�device�location,�position,�visibility,�adequacy�&�manner�of�use

Yes No ConditionField�Conditions

Effectiveness Missing�Devices�(#) Comments

Crossovers�<2%

Pavement�marking

Old�markings�removed?

Temporary�markings

Ped�access/protection

Sidewalk�access

X�walks�maintained

Flagging�operation

Hi�Vis�Vest

Paddle

Radio

Signals

Temporary�signage

Work�zone�specific�signs

Stop�signs

Yield�signs

Speed�limit�signs

End�Road�Work�signs

Lane�taper�signs

Comments:

�

�

�

�

�

�

�Definitions��LCS�Entry�

� Total�throughput:�Total�width�of�available�pavement.��In�the�example�of�two�lanes�in�one�direction�the�throughput�is�the�sum�of�left�shoulder,�left�lane,�right�lane,�and�right�shoulder.�

��Advance�Signing�� Width�restriction:��Is�there�a�posted�width�restriction�approaching�the�work�zone?�� Height�restriction:��Is�there�a�posted�height�restriction�approaching�the�work�zone?�� Distance�to�work�zone:��Is�the�actual�distance�approximately�the�signed�distance�from�sign�to�work�zone.�� PCMS:�Are�PCMSs�deployed�on�the�site�

o Approved�Message:�Does�the�message�conform�to�TGM�6�2�55�&�17�2�1�o Placement:��Are�PCMS(s)�deployed�in�correct�locations(s)�

��Work�Zone�Conditions�� Channelizing�devices:��Can�be�flexible�tubular�markers,�drums,�cones,�or�a�combination.��Should�be�clean�and�reflective�tape�is�functioning.�� Overall�placement:��Are�channelizing�devises�impeding�the�traveled�way?��Is�spacing�appropriate�for�conditions?��Is�spacing�shorter�in�tapers

and�curves?�� Temporary�concrete�barrier:��As�of�January�2011,�10’�sections�of�TCB�are�not�acceptable.�� Shoulders:��If�shoulders�are�travelled�as�part�of�project�document�the�condition.��Rutting?�Pavement�failure?��Break�up?�� Pavement�drop�off:��Is�there�a�drop�off�adjacent�to�travelled�way?�� Temporary�pavement:��If�temporary�pavement�is�used,�document�its�condition�similar�to�travelled�shoulders.�� Crossovers:��If�project�has�crossovers�is�the�transition�(horizontal�and�vertical)�acceptable�for�OSOW�vehicle�movement.�� Pedestrian� access/protection:� � If� the� segment� being� worked� on� has� pedestrian� infrastructure� (sidewalks,� crossings)� is� access� maintained

during�work?��Are�there�hard�or�soft�barriers�protecting�pedestrians�from�construction�activities?��