Attachment 6, Work Zone Traffic Control Compliance Checklist and Notification Form, CS-901.pdf
PDF 170 KB Posted
- Attached to
- 7840601ADEM, SUBURB TRASH, 6-1, 6-2, 6-4
- Solicitation number
- 6100051712
About this file
This document is a Work Zone Traffic Control Compliance Checklist and Notification Form (CS-901) used by District 6-0 Roadside. It outlines the procedures and requirements for monitoring and enforcing work zone traffic control compliance on a state or local contract. The form is used to notify the contractor of any deficiencies observed during an inspection, document the proposed remedy, and track when the issues were corrected. The form includes sections for the inspector to record the contract number, inspection date and time, any work zone liquidated damages that will be assessed, and a detailed checklist of traffic control device compliance. The contractor is required to provide a proposed remedy within 24 hours of receiving the notification form.
The document does not provide any additional details about the specific contract or project this form is associated with. It appears to be a generic compliance monitoring tool used across multiple state or local construction contracts that involve work zone traffic control requirements.
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Text version
Page: __________ of __________
Stage:____________________________
Contract No: ______________________
Date Sent Time Sent recipient of Notification*
� AM
� PM
MONTh DAY YEAr
Inspection Time reviewed Inspector
� AM
� PM
MONTh DAY YEAr
Emailed Copy to Contractor?
� Yes � No
AM Deficiency PM Deficiency Comments Date/Time Corrected
YES NO YES NO
This Section is To Be Completed by Contractor1 Proposed Remedy:
1 - Contractor must provide a Proposed Remedy within 24 hours of receiving this Form
Work ZoNe
TrAFFIC CoNTroL
ComPLIANCe CheCkLIST AND NoTIFICATIoN
District 6-0 Roadside (12/18) CS-901 Modified
Check Box if WZLD* will be assessed
Work Zone Traffic Control Issue(s)
* Work Zone Liquidated Damages will be assessed as per Publication 408 Section 901.3(t).
| Print Button: |
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| Stage: |
| Contract Number: |
| Month: |
| Day: |
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| AM Time: |
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| AM Check Box: Off |
| PM Check Box: Off |
| Inspector: |
| Yes: Off |
| No: Off |
| Month2: |
| Day2: |
| Year2: |
| AM Time2: |
| AM Check Box2: Off |
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| PM Check Box2: Off |
| WZLD: Off |
| Recipient Notification: |
| Traffic Control Devices: |
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| AM Yes: |
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| AM No: |
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| 6: Off |
| PM Yes: |
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| PM No: |
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| 6: Off |
| Comments: |
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| Date/Time Corrected: |
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| Remedy: |
| 0: |
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