Attachment 6, Work Zone Traffic Control Compliance Checklist and Notification Form, CS-901.pdf

170 KB Posted

Attached to
7840601ADEM, Roos Blvd Mow
Solicitation number
6100048358
Issued by
Montgomery County, Koppel Borough, Pennsylvania

About this file

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This document is a Work Zone Traffic Control Compliance Checklist and Notification Form (CS-901) used by the Pennsylvania Department of Transportation (PennDOT) District 6-0 Roadside division. The form is used to inspect and document compliance with work zone traffic control requirements on PennDOT construction contracts. It includes sections to record the contract information, date and time of inspection, deficiencies identified, and required remedies to be provided by the contractor within 24 hours. The form also indicates whether Work Zone Liquidated Damages (WZLD) will be assessed for non-compliance as per PennDOT Publication 408 Section 901.3(t).

The document does not provide additional details about the specific construction project or contract. It is focused solely on the inspection and compliance process for work zone traffic control on PennDOT projects.

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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 .