Title Page
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Site conducted
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Conducted on
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Utility Region
- ACE
- BGE
- DELMARVA
- PECO
- PEPCO
- Crown Castle
- Blair Park
- Storm Restoration
- Service Work
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Work Order Number
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Location
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Prepared by
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General Foreman
- Robbie Pardee
- Jeremy Houdeshell
- Jake Hutslar
- Bob Krieger
- Ryan Edwards
- Jimmie Moore
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Site Supervisor/Foreman
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Traffic Control Supervisor
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Traffic Control Lead
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Traffic Control Lead Signature
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Main Job Description
Job Brief
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On Site for the Job Briefing
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Job Briefing was Satisfactory?
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Job Briefing Form
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Are All Applicable Event Free Performance Tools Documented on the Job Briefing Form?
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Are All Applicable Event Free Performance Tools Being Utilized by the Crew?
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Job Briefing Form with Green Cone
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Traffic Control Daily Crew Checklist Completed?
Conditions
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Time of Day
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Planning for Night Traffic Control in Place and Established Properly?
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Weather
- Sunny
- Dark
- Fog
- Windy/Gusty
- Blizzard
- Snow
- Extreme Heat (> 90°)
- Mist/Light Rain
- Extreme Cold (< 5°)
- Thunderstorms
- Rain/Snow Mix
- Rain Showers
- High Winds
- Heavy Rain
- Mostly Cloudy
- Freezing Rain
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Proper Planning and Appropriate PPE Used for Inclement Weather and/or Extreme Temperatures?
Traffic Control Plan
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If these requirements cannot be physically implemented, then MUTCD PART 6 TEMPORARY TRAFFIC CONTROL standards shall apply as the minimum. The traffic control plans are to be used along with sound judgment. Proper planning, a good safety conscious attitude and full participation from the persons involved in the work zone are all prerequisites to good traffic control. Aspects of the roadway environment such as weather, time of day, traffic volumes, traffic speed, roadway geometry, roadside conditions, and your inventory of traffic control devices should all be considered when implementing the guidelines.
http://mutcd.fhwa.dot.gov/htm/2009r1r2/part6/part6_toc.htm -
Traffic Control Plan On Site and Implemented?
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Traffic Control Pattern Established and the Corresponding MUTCD/State/Local Standard
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DOT and/or other Local Authorities/Public Transportation Systems Contacted for Traffic Control Operation?
Traffic Control Operation
Safety Considerations
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Flagger Safety Considerations Identified & Mitigated (Traffic, Work Zone, Electrical, Environmental, Etc.)
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Worker Safety Considerations
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Emergency Considerations
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Pedestrian Considerations
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Roadway Safety Considerations
Traffic Control and Pedestrian Traffic Zones
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Advanced Warning Area
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Transition/Taper Area
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Activity/Buffer Area
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Termination/Taper Area
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Pedestrian Traffic/Safe Egress
Traffic Control Devices
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Advance Warning Signs
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Channelizing Devices
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Lighting Devices
Flagging Operations
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Are all flaggers trained/certified?
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Is there an escape route established for flaggers?
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Are the flagger stations preceded by advance warning signs?
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Are flaggers clearly visible to approaching traffic?
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Are the flagger stations illuminated? (Night time)
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Are flaggers using the appropriate signaling devices?
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Are flaggers using portable radios as required?
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Are flaggers wearing class 3 high visibility PPE?
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Are flaggers wearing hard hats?
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Are flaggers wearing safety glasses?
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Are flaggers wearing safety toe boots?
Housekeeping and Material Storage
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Housekeeping (Site and Vehicle)
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Material Storage (Site and Vehicle)
First Aid Kits
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First Aid Kits are on site, labeled, stored appropriately, inspected, and stocked?
Fire Extinguishers
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Fire Extinguishers are on site, labeled, stored appropriately, inspected, and are in good working order?
Additional Comments
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Additional Comments
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Pictures
