WORK ZONE TRAFFIC CONTROL INSPECTION FORM

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• Project No

• Location

• Lane Width

• Weather/Lighting Conditions

  Yes

  No

  N/A

• Competent Person

Work Duration (Circle One)

• No. of Lanes

• State

• MPH

  Yes

  No

  N/A

• Date/time

  Date

• City

• Posted Speed Limit

  Yes

  No

  N/A

• Project Type

  Yes

  No

  N/A

Short-Term Stationary

• Short-Duration

  Yes

  No

  N/A

Long-Term Stationary

• Long-Duration

Intermediate-Term Stationary

• Appropriate No. Of Signs

  Yes

  No

  N/A

• Missing Sign Series

  Yes

  No

  N/A

• Missing Specific Sign(s)

  Yes

  No

  N/A

SIGN CONDITION

• Cleanliness

  Yes

  No

  N/A

• Legibility

  Yes

  No

  N/A

• Reflectivity

  Yes

  No

  N/A

SIGN PLACEMENT

• Height

• Visibility

  Yes

  No

  N/A

• Spacing

  Yes

  No

  N/A

• Appropriate Legend

  Yes

  No

  N/A

• Color

ADVANCE WARNING SIGNS

• SIGN QUANTITY:

• (If No, Explain)

• (If Yes, Explain)

• (If Yes, Explain)

• LEGENDS

  Yes

  No

  N/A

• Appropriate Legends

  Yes

  No

  N/A

• Unneeded Signs Visible

  Yes

  No

  N/A

• Signs Posted,

  No

  Work

• ARROW PANEL A, B, C, or D

  Yes

  No

  N/A

• Placement

  Yes

  No

  N/A

• Delineated/Shielded

  Yes

  No

  N/A

• Removed When Not In Use

  Yes

  No

  N/A

• NON-STANDARD SIGNS

  Yes

  No

  N/A

• Shape

  Yes

  No

  N/A

• Size

• Mobile

  Yes

  No

  N/A

• Overall Advance Warning: Excellent Adequate Inadequate

  Yes

  No

  N/A

CHANNELIZING DEVICES

• Merging

  Yes

  No

  N/A

• TYPE OF UPSTREAM TAPER (Circle One)

• Shifting

  Yes

  No

  N/A

• Shoulder

  Yes

  No

  N/A

• One-Lane, Two-Way

  Yes

  No

  N/A

DOWNSTREAM TAPER (Optional)

• USED

  Yes

  No

  N/A

• Taper Length

DEVICE

• Barricades Type I, II, or III

  Yes

  No

  N/A

• Drums

  Yes

  No

  N/A

• Cones

  Yes

  No

  N/A

CHANNELIZING DEVICE CONDITION

DEVICE

• Tubular Markers

  Yes

  No

  N/A

• Vertical Panels

  Yes

  No

  N/A

• Warning Lights

  Yes

  No

  N/A

• Meters / Feet

CHANNELIZING DEVICE CONDITION (Continued)

• Appropriate Ballasting

  Yes

  No

  N/A

• Appropriate Battery Mount

  Yes

  No

  N/A

• Adequate Spacing

  Yes

  No

  N/A

• Adequate Taper Length

  Yes

  No

  N/A

• Appropriate No. of Devices

  Yes

  No

  N/A

• Non-Standard Device

  Yes

  No

  N/A

• (Explain)

• (Explain)

• (Explain)

• (Explain)

• (Explain)

• (Explain)

• Overall Channelization: Excellent Adequate Inadequate

  Yes

  No

  N/A

PAVEMENT MARKINGS

• Markings Used

  Yes

  No

  N/A

• Easily Understandable

  Yes

  No

  N/A

• CONDITION

  Yes

  No

  N/A

• Paint / Tape

  Yes

  No

  N/A

• Raised Markers

  Yes

  No

  N/A

USE OF PAVEMENT MARKINGS

• (If No Explain)

• Obscured

  Yes

  No

  N/A

• Damaged/Dislodged

  Yes

  No

  N/A

• Faded

  Yes

  No

  N/A

Overall Pavement Marking: Excellent Adequate Inadequate

• FLAGGING

  Yes

  No

  N/A

• FLAGGER USE

  Yes

  No

  N/A

• No. of Flaggers

• Flagger(s) Used

  Yes

  No

  N/A

• Flagger Station Preceded By Advance Warning Signs

  Yes

  No

  N/A

• Flaggers Are Clearly Visible To Approaching Traffic

  Yes

  No

  N/A

• Approaching Traffic Has Sufficient Distance To Stop

  Yes

  No

  N/A

• Flagger Stations Illuminated (Night Time)

  Yes

  No

  N/A

• Signaling Device

  Yes

  No

  N/A

• Communication Used Between Flaggers

  Yes

  No

  N/A

• Flagging Technique

  Yes

  No

  N/A

• Slow/Stop Paddles

  Yes

  No

  N/A

• Visual Contact

• High-Visibility Apparel

  Yes

  No

  N/A

• Hard Hats

  Yes

  No

  N/A

FLAGGER ATTIRE

• Flags

  Yes

  No

  N/A

• Two-Way Radio Contact

• Overall Flagging: Excellent Adequate Inadequate

  Yes

  No

  N/A

ROADSIDE SAFETY

• Timber Curb

  Yes

  No

  N/A

• Guide Rail

  Yes

  No

  N/A

• Impact Attenuator Needed

• Other

  Yes

  No

  N/A

• BARRIER DELINEATION

  Yes

  No

  N/A

• Not Working

  Yes

  No

  N/A

• Too Small

  Yes

  No

  N/A

• Concrete

  Yes

  No

  N/A

• Type of Barrier

  Yes

  No

  N/A

• Barrier Condition

  Yes

  No

  N/A

• Flared End Treatment Needed

• Lights

  Yes

  No

  N/A

• Reflectors

  Yes

  No

  N/A

• Adequate Drop-Off Delineation

  Yes

  No

  N/A

• Adequate Clear Zone

  Yes

  No

  N/A

• Overall Roadside Safety

  Good

  Fair

  Poor

  N/A

INTERNAL TRAFFIC CONTROL PLAN REQUIREMENTS

• Contact Information For The General Contractor And Subcontractors Available

  Yes

  No

  N/A

• All Site Personnel Have Been Trained on The Specific Internal Traffic Control Plan (ITCP)

  Yes

  No

  N/A

• Worker and Visitor Parking Areas Have Been Designated

  Yes

  No

  N/A

• Independent Truck Drivers Have Been Oriented Prior to Entering The Work Space

  Yes

  No

  N/A

• Areas Around Specific Pieces of Equipment and Operations Have Been Delineated

  Yes

  No

  N/A

Locations For Storing Materials And Servicing Equipment Have Been Designated

• Internal Signs And Traffic Control Devices Have Been Posted/Erected

  Yes

  No

  N/A

• Speed Limit Within The Work Zone Has Been Posted

  Yes

  No

  N/A

• Adequate Lighting Has Been Provided For Night Operations

  Yes

  No

  N/A

Channels Of Communication Regarding Changes To The ITCP Have Been Designated

• Communication Between Equipment Operators Has Been Established

  Yes

  No

  N/A

• Communication Between Workers On Foot And Equipment Operators Has Been Established

  Yes

  No

  N/A

• Overall Rating For The ITCP: Excellent Adequate Inadequate

• Adequate Travel Path

  Yes

  No

  N/A

• Adequate Protection From Hazards

  Yes

  No

  N/A

Unprotected Operations or Equipment In Roadway

• Temporary Traffic Signal Operation/Installation Effective

  Yes

  No

  N/A

• Original Signs/Delineation In Good Condition

  Yes

  No

  N/A

• Posted Speed Limit

  Yes

  No

  N/A