Form TE-97001 "Work Zone Safety Checklist - Traffic Engineering - Construction / Maintenance / Utility / Permit" - Virginia

What Is Form TE-97001?

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

Form Details:

  • The latest edition provided by the Virginia Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form TE-97001 by clicking the link below or browse more documents and templates provided by the Virginia Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Form TE-97001 "Work Zone Safety Checklist - Traffic Engineering - Construction / Maintenance / Utility / Permit" - Virginia

318 times
Rate (4.7 / 5) 16 votes
URGENT: CORRECT IMMEDIATELY
FORM #TE-97001
5 WORKING DAYS TO CORRECT
WORK ZONE SAFETY CHECKLIST
TRAFFIC ENGINEERING
WHEN URGENT IS MARKED DENOTE ITEM
CONSTRUCTION / MAINTENANCE / UTILITY / PERMIT
RESIDENCY: ________________________
CONTRACTOR/AREA HEADQUARTERS: ____________________________
CITY/COUNTY: ______________________
PROJ. NO./PERMIT NO./LOCATION: ________________________________
TYPE OF OPERATION: ___________________________________ DAY/DATE: ___________________ TIME: _________
PERSON IN CHARGE: ____________________________________
POSTED SPEED: ____________ MPH
WEATHER CONDITION: ___________________________
DAY OR NIGHT WORK (
IN
NOT IN) PROGRESS
D.
ARROW BOARD
A.
DRIVE THRU:
ADEQUATE
INADEQUATE
ARE MANEUVERS DIFFICULT OR
UNEXPECTED?
YES
NO
MALFUNCTION (BULB OUT, ETC.)
ADEQUATE WARNING OF
YES
NO
INCORRECT PLACEMENT
HAZARDS?
MISALIGNED BULBS
IS SIGNING CLEAR/UNCLUTTERED
AND PROPERLY SPACED?
YES
NO
NOT DIMMED AT NIGHT
ARE TRAFFIC CONTROL DEVICES
: _______________________________________________
COMMENTS
SUFFICIENTLY VISIBLE?
YES
NO
__________________________________________________________
: _______________________________________________
COMMENTS
E.
DRUMS=D / OTHER = O:
D
/
O
__________________________________________________________
ADEQUATE
INADEQUATE
B.
SIGNS
INAPPROPRIATE TAPER LENGTH
ADEQUATE
INADEQUATE
SPACING INADEQUATE (TOO LONG/
TOO SHORT)
NEED TO BE (REMOVED/REPOSITIONED/
COVERED)
(REPAIR/CLEAN/REPLACEMENT)
NEED (CLEANING/REPLACEMENT)
REFLECTIVE BANDS (DAMAGED / MISSING)
ON DRUMS/ OTHER DEVICES
NEED ADDITIONAL SIGNS
ADDITIONAL DEVICES NEEDED
CONFLICTING (PERMANENT/
TEMPORARY SIGNING)
MISALIGNED
NON-APPROVED SIGN SUPPORT
: _______________________________________________
COMMENTS
BLOCKED BY VEGETATION
__________________________________________________________
_______________________________________________
F.
TRAFFIC BARRIER:
COMMENTS:
___________________________________________________________
ADEQUATE
INADEQUATE
IMPROPER BARRIER WALL FLARE
C.
PORTABLE CHANGEABLE MESSAGE SIGN:
IMPROPER TERMINAL TREATMENT
ADEQUATE
INADEQUATE
BARRIER NEEDS TO BE (REALIGNED/
REMOVED)
APPLICATION DOES NOT MEET
GUIDELINES
WARNING LIGHT (SERVICE / CLEAN)
INAPPROPRIATE (MESSAGE
DELINEATORS (CLEAN / ADDITIONAL)
TOO MUCH INFORMATION ON P.C.M.S.
8” x 12” VERTICAL BARRIER PANELS
(CLEAN / ADDITIONAL)
NOT DELINEATED, NO CONES/BARRELS
ATTENUATOR ( REPAIR / REPLACE)
: _______________________________________________
COMMENTS
: _______________________________________________
COMMENTS
____________________________________________________
____________________________________________________
1 of 2
URGENT: CORRECT IMMEDIATELY
FORM #TE-97001
5 WORKING DAYS TO CORRECT
WORK ZONE SAFETY CHECKLIST
TRAFFIC ENGINEERING
WHEN URGENT IS MARKED DENOTE ITEM
CONSTRUCTION / MAINTENANCE / UTILITY / PERMIT
RESIDENCY: ________________________
CONTRACTOR/AREA HEADQUARTERS: ____________________________
CITY/COUNTY: ______________________
PROJ. NO./PERMIT NO./LOCATION: ________________________________
TYPE OF OPERATION: ___________________________________ DAY/DATE: ___________________ TIME: _________
PERSON IN CHARGE: ____________________________________
POSTED SPEED: ____________ MPH
WEATHER CONDITION: ___________________________
DAY OR NIGHT WORK (
IN
NOT IN) PROGRESS
D.
ARROW BOARD
A.
DRIVE THRU:
ADEQUATE
INADEQUATE
ARE MANEUVERS DIFFICULT OR
UNEXPECTED?
YES
NO
MALFUNCTION (BULB OUT, ETC.)
ADEQUATE WARNING OF
YES
NO
INCORRECT PLACEMENT
HAZARDS?
MISALIGNED BULBS
IS SIGNING CLEAR/UNCLUTTERED
AND PROPERLY SPACED?
YES
NO
NOT DIMMED AT NIGHT
ARE TRAFFIC CONTROL DEVICES
: _______________________________________________
COMMENTS
SUFFICIENTLY VISIBLE?
YES
NO
__________________________________________________________
: _______________________________________________
COMMENTS
E.
DRUMS=D / OTHER = O:
D
/
O
__________________________________________________________
ADEQUATE
INADEQUATE
B.
SIGNS
INAPPROPRIATE TAPER LENGTH
ADEQUATE
INADEQUATE
SPACING INADEQUATE (TOO LONG/
TOO SHORT)
NEED TO BE (REMOVED/REPOSITIONED/
COVERED)
(REPAIR/CLEAN/REPLACEMENT)
NEED (CLEANING/REPLACEMENT)
REFLECTIVE BANDS (DAMAGED / MISSING)
ON DRUMS/ OTHER DEVICES
NEED ADDITIONAL SIGNS
ADDITIONAL DEVICES NEEDED
CONFLICTING (PERMANENT/
TEMPORARY SIGNING)
MISALIGNED
NON-APPROVED SIGN SUPPORT
: _______________________________________________
COMMENTS
BLOCKED BY VEGETATION
__________________________________________________________
_______________________________________________
F.
TRAFFIC BARRIER:
COMMENTS:
___________________________________________________________
ADEQUATE
INADEQUATE
IMPROPER BARRIER WALL FLARE
C.
PORTABLE CHANGEABLE MESSAGE SIGN:
IMPROPER TERMINAL TREATMENT
ADEQUATE
INADEQUATE
BARRIER NEEDS TO BE (REALIGNED/
REMOVED)
APPLICATION DOES NOT MEET
GUIDELINES
WARNING LIGHT (SERVICE / CLEAN)
INAPPROPRIATE (MESSAGE
DELINEATORS (CLEAN / ADDITIONAL)
TOO MUCH INFORMATION ON P.C.M.S.
8” x 12” VERTICAL BARRIER PANELS
(CLEAN / ADDITIONAL)
NOT DELINEATED, NO CONES/BARRELS
ATTENUATOR ( REPAIR / REPLACE)
: _______________________________________________
COMMENTS
: _______________________________________________
COMMENTS
____________________________________________________
____________________________________________________
1 of 2
FORM#TE-970
G.
FLAGGING OPERATION:
I.
PAVEMENT MARKERS
ADEQUATE
INADEQUATE
PERMANENT
CONSTRUCTION
ADEQUATE
INADEQUATE
NEED ADDITIONAL ADVANCE SIGNING
REPLACE MISSING
:
REMOVE
CERTIFIED
YES
NO
NEED ADDITIONAL
POSITIONED CORRECTLY?
YES
NO
: _______________________________________________
COMMENTS
HIGHLY VISIBLE?
YES
NO
__________________________________________________________
PROPERLY CLOTHED?
YES
NO
J.
TRUCK MOUNTED ATTENUATOR:
FLAGGING CORRECTLY
YES
NO
PROPERLY POSITIONED
YES
NO
: _______________________________________________
COMMENTS
PROPERLY MAINTAINED/
__________________________________________________________
DELINEATED?
YES
NO
__________________________________________________________
: _______________________________________________
COMMENTS
__________________________________________________________
H.
PAVEMENT MARKING:
K. MISCELLANEOUS:
PERMANENT
CONSTRUCTION
ADEQUATE BUFFER SPACE?
YES
NO
ADEQUATE
INADEQUATE
IS THE WORK AREA PROTECTED?
YES
NO
REMOVE
MATERIALS PROPERLY STORED?
YES
NO
REPAIR
EQUIPMENT PROPERLY STORED?
YES
NO
NEED ADDITIONAL
ARE LANE CLOSURES IN ACCORD
UNNECESSARY (MARKINGS /
WITH ALLOWED HOURS?
YE S
NO
NOT ERADICATED COMPLETELY)
-------------------------------------------------------------------------------------
ACCIDENTS:
: _______________________________________________
COMMENTS
EVIDENCE OF AN ACCIDENT?
YES
NO
__________________________________________________________
DAMAGED TRAFFIC CONTROL DEVICES?
__________________________________________________________
SKID MARKS
DEBRIS
COMMENTS / RECOMMENDATION: ____________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
REVIEWED BY:__________________________________ REVIEWED WITH: ___________________________________
(SIGN & DATE)
(SIGN & DATE
COPY: CONTRACTOR, INSPECTOR, RESIDENT ENGINEER, OR OTHER_____________________________________
2 of 2
Page of 2