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
Issued by
Bucks County, Chester County, Montgomery County, Northern Cambria Borough, Claysville Borough, Pennsylvania

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:
Page Number:
Page Number 2:
Stage:
Contract Number:
Month:
Day:
Year:
AM Time:
PM Time:
AM Check Box: Off
PM Check Box: Off
Inspector:
Yes: Off
No: Off
Month2:
Day2:
Year2:
AM Time2:
AM Check Box2: Off
PM Time2:
PM Check Box2: Off
WZLD: Off
Recipient Notification:
Traffic Control Devices:
0:
1:
2:
3:
4:
5:
6:
AM Yes:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
AM No:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
PM Yes:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
PM No:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
Comments:
1:
2:
3:
0:
4:
5:
6:
Date/Time Corrected:
0:
1:
2:
3:
4:
5:
6:
Remedy:
0:

File details come from the government source that posted it. Updated .