INSPECTION REPORT

Instructions PURPOSE: To provide adequate warning, delineation, and channelization to assist in guiding road users in advance of and through the work zone by utilizing proper pavement markings, signs, and other MUTCD compliant devices.

Date

Time HHMM

CUSTOMER

GPCPITTMANUTECOTHER

LOCATION OF WORK SITE

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

FOREMAN/SUPERVISOR

DRIVER

NON-DRIVER

FLAGGER Type in the name of Flagger if not included in (Driver / Non-Driver) drop down menu above.

POLICE OFFICER Was Officer at this location? If so please add their name.

POLICE OFFICER (not listed) Enter a police officer name not listed in the drop down above

SAFETY CHECK

Is the Flagger safe? Please describe the safety parameters of Traffic Troopers Flagger at the work site by checking the appropriate boxes.Proper Uniform (hard hat, safety vest, steel toe boots)STOP/SLOW paddleFlagger is situated in a planned escape routeVehicle parked off the road, away from stationVisible to approaching traffic

SETUP

Is the Temporary Traffic Control Plan setup properly? Please describe the proper setup by checking the appropriate boxes.TA10 DOT proper setupTA33 DOT proper setupother (see notes)

COMMUNICATION

Has the Flagger communicated with Foreman regarding the temporary traffic control plan? Please describe based on your communication with the foreman and/or Flagger at the work site by checking the appropriate boxes.Safety BriefingWalkie TalkiesCoworkersother (see notes)

ENGAGED

Is the Flagger following company policy? Please describe the activity of Traffic Troopers Flagger at the work site by checking the appropriate boxes.Not mingled with the work crew or motoristsMingled with the work crew or motoristsNot on phoneOn phoneother (see notes)

EQUIPMENT

Does the Flagger have the appropriate equipment? Please describe the equipment on the truck by checking the appropriate boxes.STOP/SLOW paddleProper amount of conesNot enough conesFlashlightProper amount of barrelsNot enough barrelsWalkie TalkiesDelineators

NOTES

Please include additional information or comments if necessary.

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