Form OMT012 "Inspector's Daily Report" - Maryland

What Is Form OMT012?

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

Form Details:

  • Released on July 2, 2013;
  • The latest edition provided by the Maryland 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 printable version of Form OMT012 by clicking the link below or browse more documents and templates provided by the Maryland Department of Transportation.

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Download Form OMT012 "Inspector's Daily Report" - Maryland

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LINESTRIPING
MARYLAND STATE HIGHWAY ADMINISTRATION
OMT012 7-02-13
IDR Number:
INSPECTOR'S DAILY REPORT
(Field Office Use Only)
CM 7210.100.14
NTP Date:__________
Insp. Letter:__________
TEMP °F
Contract No:
Day:
Date:
Delays:
RW
Utility
Min
Sky:
Wind:
Precipitation:
Material
Other
Max
Soil
or
Grade Condition:
Details:
Stream
or
Tide Stage:
1.
2.
Item Number & Description
Location and Quantity of Work Completed
3.
(1, 2, 3)
Classification of Labor &
1
2
3
Totals
Equipment Used / *Idle
No
Hrs
Idle No
Hrs
Idle
No
Hrs
Idle
No
Hrs
1) Road Name:________ MP_____ to_____
Stripe Lines: ____C/L ___E/L___Skips
Direction: ___E/B___W/B___N/B___S/B
Road Surface:___HMA___PCC___SS___CS
5" White Pay Qty:___________LF
10" White Pay Qty:___________LF
5" Yellow Pay Qty:___________LF
2) Road Name:________ MP_____ to_____
Material Manufacturer:
Stripe Lines: ____C/L ___E/L___Skips
Direction: ___E/B___W/B___N/B___S/B
Road Surface:___HMA___PCC___SS___CS
Beads Manufacturer:
5" White Pay Qty:___________LF
10" White Pay Qty:___________LF
Type:
5" Yellow Pay Qty:___________LF
___MD Blend ___Standard
Line Striper:
3) Road Name:________ MP_____ to_____
Lot #:
Stripe Lines: ____C/L ___E/L___Skips
Yellow:
Direction: ___E/B___W/B___N/B___S/B
White:
Road Surface:___HMA___PCC___SS___CS
Glass Bead:
5" White Pay Qty:___________LF
10" White Pay Qty:___________LF
5" Yellow Pay Qty:___________LF
Visitors & SHA Staff
* Indicate (A) Standby,(B) Not Needed,(C) Broken down, or (D)
___Paint___ 40M____ 90M___Inlaid Tape___
Surface
Materials: Note Approval Status
Tape___Contrast Tape___Epoxy
and Whether Received or Used for
1, 2, or 3.
Color:___y____w Width:_______
100
200
300
400
500
600
700
800
900
Hours per Category
Inspector's Signature:
Use Other Side as Needed for Extended Remarks,
Time In:
Time Out:
Hours:
Sketches, Explanations, Delays,Etc.
Job Mileage:
LINESTRIPING
MARYLAND STATE HIGHWAY ADMINISTRATION
OMT012 7-02-13
IDR Number:
INSPECTOR'S DAILY REPORT
(Field Office Use Only)
CM 7210.100.14
NTP Date:__________
Insp. Letter:__________
TEMP °F
Contract No:
Day:
Date:
Delays:
RW
Utility
Min
Sky:
Wind:
Precipitation:
Material
Other
Max
Soil
or
Grade Condition:
Details:
Stream
or
Tide Stage:
1.
2.
Item Number & Description
Location and Quantity of Work Completed
3.
(1, 2, 3)
Classification of Labor &
1
2
3
Totals
Equipment Used / *Idle
No
Hrs
Idle No
Hrs
Idle
No
Hrs
Idle
No
Hrs
1) Road Name:________ MP_____ to_____
Stripe Lines: ____C/L ___E/L___Skips
Direction: ___E/B___W/B___N/B___S/B
Road Surface:___HMA___PCC___SS___CS
5" White Pay Qty:___________LF
10" White Pay Qty:___________LF
5" Yellow Pay Qty:___________LF
2) Road Name:________ MP_____ to_____
Material Manufacturer:
Stripe Lines: ____C/L ___E/L___Skips
Direction: ___E/B___W/B___N/B___S/B
Road Surface:___HMA___PCC___SS___CS
Beads Manufacturer:
5" White Pay Qty:___________LF
10" White Pay Qty:___________LF
Type:
5" Yellow Pay Qty:___________LF
___MD Blend ___Standard
Line Striper:
3) Road Name:________ MP_____ to_____
Lot #:
Stripe Lines: ____C/L ___E/L___Skips
Yellow:
Direction: ___E/B___W/B___N/B___S/B
White:
Road Surface:___HMA___PCC___SS___CS
Glass Bead:
5" White Pay Qty:___________LF
10" White Pay Qty:___________LF
5" Yellow Pay Qty:___________LF
Visitors & SHA Staff
* Indicate (A) Standby,(B) Not Needed,(C) Broken down, or (D)
___Paint___ 40M____ 90M___Inlaid Tape___
Surface
Materials: Note Approval Status
Tape___Contrast Tape___Epoxy
and Whether Received or Used for
1, 2, or 3.
Color:___y____w Width:_______
100
200
300
400
500
600
700
800
900
Hours per Category
Inspector's Signature:
Use Other Side as Needed for Extended Remarks,
Time In:
Time Out:
Hours:
Sketches, Explanations, Delays,Etc.
Job Mileage: