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).

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:

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