Attachment 8, Work Zone Traffic Control Compliance Checklist and Notification Form, CS-901.pdf
PDF 170 KB Posted
- Attached to
- 7840601ADEM, Mowing, Miscellaneous, Phil
- Solicitation number
- 6100065051
- Issued by
- Philadelphia County, Philadelphia City, Pennsylvania
About this file
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 for roadside projects. The form serves as an inspection and notification tool to document work zone traffic control compliance issues identified during project execution. The document is designed to be completed in stages throughout the contract period, with inspectors documenting the date, time, and specific traffic control deficiencies observed on-site. Contractors are required to provide a proposed remedy within 24 hours of receiving a notification form that identifies non-compliance issues.
The form includes provisions for assessing Work Zone Liquidated Damages (WZLD) in accordance with PennDOT Publication 408 Section 901.3(t) when traffic control violations occur. The checklist addresses traffic control devices and related compliance matters, with sections for inspector observations, corrective action tracking, and documentation of when deficiencies are corrected. An email confirmation mechanism is built into the process to ensure contractors receive notification of compliance issues. This form is part of the administrative framework for managing traffic control standards on roadside maintenance and construction projects, including mowing, string trimming, and trash removal services procured through the Department of Transportation's contract opportunities.
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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).
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