URGENT: CORRECT IMMEDIATELY

FORM #TE-97001
5 WORKING DAYS TO CORRECT
WORK ZONE SAFETY CHECKLIST
TRAFFIC ENGINEERING WHEN URGENT IS MARKED DENOTE ITEM

CONSTRUCTION / MAINTENANCE / UTILITY / PERMIT

RESIDENCY: ________________________ CONTRACTOR/AREA HEADQUARTERS: ____________________________

CITY/COUNTY: ______________________ PROJ. NO./PERMIT NO./LOCATION: ________________________________
TYPE OF OPERATION: ___________________________________ DAY/DATE: ___________________ TIME: _________
PERSON IN CHARGE: ____________________________________ POSTED SPEED: ____________ MPH
WEATHER CONDITION: ___________________________ DAY OR NIGHT WORK ( IN NOT IN) PROGRESS

A. DRIVE THRU: D. ARROW PANEL

ADEQUATE INADEQUATE
ARE MANEUVERS DIFFICULT OR
UNEXPECTED? YES NO MALFUNCTION (BULB OUT, ETC.)
ADEQUATE WARNING OF YES NO INCORRECT PLACEMENT
HAZARDS?
MISALIGNED BULBS
IS SIGNING CLEAR/UNCLUTTERED
AND PROPERLY SPACED? YES NO NOT DIMMED AT NIGHT
ARE TRAFFIC CONTROL DEVICES COMMENTS: _______________________________________________
SUFFICIENTLY VISIBLE? YES NO
__________________________________________________________
COMMENTS: _______________________________________________
E. DRUMS=D / CONES = C: D / C
__________________________________________________________
ADEQUATE INADEQUATE
B. SIGNS INAPPROPRIATE TAPER LENGTH
ADEQUATE INADEQUATE
SPACING INADEQUATE (TOO LONG/
NEED TO BE (REMOVED/REPOSITIONED/ TOO SHORT)
COVERED)
(REPAIR/CLEAN/REPLACEMENT)
NEED (CLEANING/REPLACEMENT)
REFLECTIVE BANDS (DAMAGED / MISSING)
NEED ADDITIONAL SIGNS ON (CONES / TUBULAR MARKERS)

CONFLICTING (PERMANENT/ ADDITIONAL DEVICES NEEDED

TEMPORARY SIGNING)
MISALIGNED
NON-APPROVED SIGN SUPPORT
COMMENTS: _______________________________________________
BLOCKED BY VEGETATION __________________________________________________________
COMMENTS: _______________________________________________ F. TRAFFIC BARRIER:
___________________________________________________________ ADEQUATE INADEQUATE

IMPROPER BARRIER WALL FLARE

C. PORTABLE CHANGEABLE MESSAGE SIGN: IMPROPER TERMINAL TREATMENT
ADEQUATE INADEQUATE
BARRIER NEEDS TO BE (REALIGNED/
REMOVED)
APPLICATION DOES NOT MEET
GUIDELINES WARNING LIGHT (SERVICE / CLEAN)
INAPPROPRIATE (MESSAGE DELINEATORS (CLEAN / ADDITIONAL)
TOO MUCH INFORMATION ON P.C.M.S. 8” x 12” VERTICAL BARRIER PANELS
(CLEAN / ADDITIONAL)
NOT DELINEATED, NO CONES/BARRELS
ATTENUATOR ( REPAIR / REPLACE)
COMMENTS: _______________________________________________
COMMENTS: _______________________________________________
____________________________________________________
____________________________________________________

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FORM#TE-97002

G. FLAGGING OPERATION: I. PAVEMENT MARKERS

ADEQUATE INADEQUATE PERMANENT CONSTRUCTION

ADEQUATE INADEQUATE
NEED ADDITIONAL ADVANCE SIGNING
REPLACE MISSING
ARE FLAGPERSONS:
REMOVE
CERTIFIED YES NO
NEED ADDITIONAL
POSITIONED CORRECTLY? YES NO
COMMENTS: _______________________________________________
HIGHLY VISIBLE? YES NO __________________________________________________________

PROPERLY CLOTHED? YES NO

J. TRUCK MOUNTED ATTENUATOR:
FLAGGING CORRECTLY YES NO
PROPERLY POSITIONED YES NO
COMMENTS: _______________________________________________
PROPERLY MAINTAINED/
__________________________________________________________
DELINEATED? YES NO
__________________________________________________________
COMMENTS: _______________________________________________
__________________________________________________________
H. PAVEMENT MARKING:
K. MISCELLANEOUS:
PERMANENT CONSTRUCTION
ADEQUATE INADEQUATE ADEQUATE BUFFER SPACE? YES NO

REMOVE IS THE WORK AREA PROTECTED? YES NO

REPAIR MATERIALS PROPERLY STORED? YES NO

NEED ADDITIONAL EQUIPMENT PROPERLY STORED? YES NO

UNNECESSARY (MARKINGS / ARE LANE CLOSURES IN ACCORD

NOT ERADICATED COMPLETELY) WITH ALLOWED HOURS? YES NO
-------------------------------------------------------------------------------------
ACCIDENTS:
COMMENTS: _______________________________________________
EVIDENCE OF AN ACCIDENT? YES NO
__________________________________________________________
__________________________________________________________ DAMAGED TRAFFIC CONTROL DEVICES?

SKID MARKS DEBRIS

COMMENTS / RECOMMENDATION: ____________________________________________________________________

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
REVIEWED BY:__________________________________ REVIEWED WITH: ___________________________________
(SIGN & DATE) (SIGN & DATE

COPY: CONTRACTOR, INSPECTOR, RESIDENT ENGINEER, OR OTHER_____________________________________

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