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Get DoT FHWA 17-348 2016-2024

FORM FHWA 17-348 9/2016 Date Stamp U.S. DEPARTMENT OF TRANSPORTATION FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver Washington 98661 FP-14 - 109. 01 Project Name Copy Stamp Line Item Number Pay Item Number Item Description Date work Performed Daily Record of Inspection Activities Name of TCS Temperature Day S Weather Clear Pt. Cloudy Location/Today s Operations Cloudy M T Rain W F Wind Conditions Snow Calm High Light Low Name of Technician s Arrival Time Departure Time Strong Evidence Of An Accident Yes No Appropriate Number Of Flaggers Being Utilized Adequate Buffer Space Flaggers Equipped With Proper PPE Is the Work Area Protected Flaggers Stationed Proper Distance From Hazards Materials Properly Stored Traffic Delays Closures Meet Contract Specifications Advanced Warning Signs Installed Per Contract MUTCD Number Used Pilot Vehicle Flaggers Construction Signs Barricades Drums Vertical Panels Tubular Traffic Markers Pavement Markings Arrow Board Variable Message Board Message Number Stored Temporary Concrete Barrier Other Location Station Of Missing Or Damaged Devices All Correct Yes No Missing Damaged Adequate Maintenance Corrections Or Replacements Date Last Cleaned Cones Attach additional sheets if necessary. Final Measurement I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified* Signs Measured Quantity Name of person measuring work Interim Measurement Verified By FHWA Use Only PE Inspector CPE CI Approved Entered To Record Checked By FHWA Representative Contractor Representative Print Inadequate Date Clear Form. 01 Project Name Copy Stamp Line Item Number Pay Item Number Item Description Date work Performed Daily Record of Inspection Activities Name of TCS Temperature Day S Weather Clear Pt. Cloudy Location/Today s Operations Cloudy M T Rain W F Wind Conditions Snow Calm High Light Low Name of Technician s Arrival Time Departure Time Strong Evidence Of An Accident Yes No Appropriate Number Of Flaggers Being Utilized Adequate Buffer Space Flaggers Equipped With Proper PPE Is the Work Area Protected Flaggers Stationed Proper Distance From Hazards Materials Properly Stored Traffic Delays Closures Meet Contract Specifications Advanced Warning Signs Installed Per Contract MUTCD Number Used Pilot Vehicle Flaggers Construction Signs Barricades Drums Vertical Panels Tubular Traffic Markers Pavement Markings Arrow Board Variable Message Board Message Number Stored Temporary Concrete Barrier Other Location Station Of Missing Or Damaged Devices All Correct Yes No Missing Damaged Adequate Maintenance Corrections Or Replacements Date Last Cleaned Cones Attach additional sheets if necessary. Cloudy Location/Today s Operations Cloudy M T Rain W F Wind Conditions Snow Calm High Light Low Name of Technician s Arrival Time Departure Time Strong Evidence Of An Accident Yes No Appropriate Number Of Flaggers Being Utilized Adequate Buffer Space Flaggers Equipped With Proper PPE Is the Work Area Protected Flaggers Stationed Proper Distance From Hazards Materials Properly Stored Traffic Delays Closures Meet Contract Specifications Advanced Warning Signs Installed Per Contract MUTCD Number Used Pilot Vehicle Flaggers Construction Signs Barricades Drums Vertical Panels Tubular Traffic Markers Pavement Markings Arrow Board Variable Message Board Message Number Stored Temporary Concrete Barrier Other Location Station Of Missing Or Damaged Devices All Correct Yes No Missing Damaged Adequate Maintenance Corrections Or Replacements Date Last Cleaned Cones Attach additional sheets if necessary. Final Measurement I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified* Signs Measured Quantity Name of person measuring work Interim Measurement Verified By FHWA Use Only PE Inspector CPE CI Approved Entered To Record Checked By FHWA Representative Contractor Representative Print Inadequate Date Clear Form. .

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