Form 700-010-64 "Engineer's Maintenance of Traffic (Mot) Evaluation at Crash Site" - Florida

What Is Form 700-010-64?

This is a legal form that was released by the Florida Department of Transportation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the Florida Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 700-010-64 by clicking the link below or browse more documents and templates provided by the Florida Department of Transportation.

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Download Form 700-010-64 "Engineer's Maintenance of Traffic (Mot) Evaluation at Crash Site" - Florida

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700-
010-64
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
CONSTRUCTION
ENGINEER'S MAINTENANCE OF TRAFFIC (MOT)
09/18
EVALUATION AT CRASH SITE
Page 1 of 4
Date/Time of Occurrence:
Report Date:
FIN Project No.:
State Road No.:
District:
County:
Federal Project No.:
Contract No.:
MOT Evaluation at Crash Site:
Major crash?
If yes, fatalities?
YES
NO
YES
NO
Have there been other crashes within this area of the project?
YES
NO
If yes, give dates.
Police Investigated?
YES
NO
If available, attach police report.
Work Zone Location of Crash:
(Approach, transition, work area)
Is the immediate area at the crash site in accordance with State Standards, MUTCD and TCP?
YES
NO
Are there any recommended enhancements to the MOT at the crash site?
YES
NO
List enhancements to be made to the work site.
Distribution:
Original to Project Administrator
Copies to: District Safety and Health Managers
Contractor
State Construction Engineer
State Safety Office
Safety Program Administrator
700-
010-64
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
CONSTRUCTION
ENGINEER'S MAINTENANCE OF TRAFFIC (MOT)
09/18
EVALUATION AT CRASH SITE
Page 1 of 4
Date/Time of Occurrence:
Report Date:
FIN Project No.:
State Road No.:
District:
County:
Federal Project No.:
Contract No.:
MOT Evaluation at Crash Site:
Major crash?
If yes, fatalities?
YES
NO
YES
NO
Have there been other crashes within this area of the project?
YES
NO
If yes, give dates.
Police Investigated?
YES
NO
If available, attach police report.
Work Zone Location of Crash:
(Approach, transition, work area)
Is the immediate area at the crash site in accordance with State Standards, MUTCD and TCP?
YES
NO
Are there any recommended enhancements to the MOT at the crash site?
YES
NO
List enhancements to be made to the work site.
Distribution:
Original to Project Administrator
Copies to: District Safety and Health Managers
Contractor
State Construction Engineer
State Safety Office
Safety Program Administrator
700-010-64
CONSTRUCTION
09/18
Page 2 of 4
DIAGRAM:
Crash Diagram including all traffic control devices
present at the time of crash, vehicles involved, etc.
In addition to the above diagram, if the traffic control plan in effect
follows guidelines of MUTCD, Part VI, indicate figure number,
standard index sheet number, or plan sheet.
Attached crash site photos.
700-
010-64
CONSTRUCTION
09/18
Page 3 of 4
ANALYSIS OF CONDITIONS: if known
Pavement:
Visibility:
Routing:
Wet
Clear
Existing Pavement
Dry
Limited
Detour
Asphalt
Night (darkness)
Approach to Construction
Concrete
Day (daylight)
Other
Type of Project:
Resurfacing Undivided Median
Reconstruction Undivided Median, Urban
Resurfacing Divided Median
Reconstruction Divided Median, Urban
Widening Undivided Median
New Construction, Undivided Median
Reconstruction Undivided Median, Rural
New Construction, Divided Median
Reconstruction Divided Median, Rural
Intersection
Widening Undivided to Divided
Other (Describe)
Telephone Number (daytime)
Signature of Project Administrator
700-010-64
CONSTRUCTION
09/18
Page 4 of 4
DIRECTIONS FOR FORM NUMBER 700-010-64
ENGINEERS MOT EVALUATION AT CRASH SITE
(TYPE OR PRINT)
DATE/TIME OF OCCURRENCE:
The day-month-year and estimated time am/pm of occurrence
REPORT DATE:
The day-month-year the report was written up
FIN PROJECT NO:
State Financial Project Number
FEDERAL-AID PROJECT NO:
FAP No
STATE ROAD NUMBER:
The State Road Number, i.e., SR-8
COUNTY:
The County where the mishap occurred
DISTRICT:
The District where crash occurred
CONTRACT NO.:
Contract Number of project(s)
MAJOR CRASH:
Indicate if incident was a major crash as defined in CPAM 9.3.
OTHER CRASHES:
List dates of other crashes that have occurred in the same vicinity
POLICE INVESTIGATED:
If applicable, attach report if available. Do not hold off submitting Evaluation at Crash Site
Report.
LOCATION OF CRASH:
List the particular section of the TCP where the crash occurred
IN ACCORDANCE WITH STATE
If the MOT in the immediate area of the crash site is in substantial conformance, check
STANDARDS, MUTCD, TCP?:
yes. If not, explain thoroughly.
RECOMMEND ENHANCEMENTS:
Check YES only if considered critically necessary
DIAGRAM:
Show vehicles involved in crash and detailed collision diagram. Show all MOT devices in
the crash immediate area (drums, barriers, signs, pavement markings, etc.)
PROJECT ADMINISTRATOR:
Sign here and date. Show telephone number.