Roadway Departure Countermeasure Request Form.pdf

Instructions for the Systemic Roadway Departure Countermeasure Request Form Please complete a separate form for each route and section proposed for improvement.

Applications containing greater detail may be more competitive. A fillable PDF version of this form is available online. A description of each field is below:

Location Information

• Road Name – Common description for the segment of road.

• National Tribal Transportation Facility Inventory (NTTFI) Route and Section Number –

Routes must be official in the inventory.

• Segment Length – approximate length in miles

• Alignment – Curves, Tangents (straight sections), or Both

• Surface Type – Dirt, Gravel, Paved

Risk Information –

• Traffic Volume – Qualitative responses (high or low volume) or estimates may be used in lieu of average annual daily vehicle counts.

• Posted Speed Limit

• Lane Width – Width of paved lane or half the width of unpaved surface

• Paved Shoulder Width – Paved shoulder width; Enter 0ft for unpaved.

• Additional Risk Data - What additional data indicates a high risk for roadway departure crashes here? - Describe any roadway attributes that would suggest this location needs to be improved. An elevated risk of roadway departure crashes may be indicated by:

o Roadway geometry (i.e.

sharp curve) o Intersection within a curve o Misleading visual cues o Speed study results including curve advisory speed o Pavement edge conditions o Terrain (i.e. steep drop-offs, cliff, embankment) o Shoulder design o Hazardous objects in the clear zone o Site-specific crash experience o Other site-specific conditions

Site Photos (optional) – Although optional, including a photo could help reviewers better understand the risks being described.

Countermeasures – Indicate safety countermeasures that are already in place (existing) and the additional improvements for which funding is requested. Document the requested funding amount for each proposed improvement. Only items listed in the table are eligible:

a. Horizontal alignment warning signs (see MUTCD Section 2C.06)

b. Delineators (flexible or post mounted) as described in Chapter 3F of the MUTCD

c. Center line and edge line markings - Maintenance is not eligible. TTPSF can fund striping where it does not exist or upgrades in line width or material type.

d. Rumble strip or rumble stripes - Please attach a design detail drawing, if available

e. Mitigation of roadside hazards to establish or widen clear zone - This may include clearing and grubbing, removing hazardous objects, new or upgraded guardrail, upgrading to crashworthy drainage structures and other roadside hardware. Shoulder widening and slope flattening are not eligible for this category.

https://highways.dot.gov/federal-lands/programs-tribal/safety/funds

Systemic Roadway Departure Countermeasure Request Form

Location Information

NTTFI Section

Alignment

Route Name

NTTFI Route

Segment Length

Surface Type

Risk Data

Traffic Volume Speed Limit

Lane Width Paved Shoulder Width

What additional data indicates a high risk for roadway departure crashes here?

Countermeasures Existing Requested Requested Funding

a. Horizontal alignment warning signs (see MUTCD Section 2C.06)

b. Delineators (flexible or post mounted) as described in Chapter 3F of the MUTCD

c. Center line and edge line markings (Maintenance is not eligible. TTPSF can fund striping where it does not exist or upgrades in line width or material type.)

d. Rumble strip or rumble stripes (Please attach a design detail drawing, if available)

e. Mitigation of roadside hazards to establish or widen clear zone (specify improvement in project narrative)

Click to Add Photo

(optional)

Curve(s) Tangent(s)

Appendix A. Selection Criteria Guide