Primary Information

Inspector

Consultant

Date

Time

Highway

Limits

Project ID

Type of Project

Crew Members Present

Step 2 of 3

Personal Safety

Safety Vests Being Used (Yes / No):

Comments:

Hard Hats Being Used (Yes / No):

Comments:

Proper Footwear Being Worn (Yes / No):

Comments:

Step 3 of 3

Traffic Control Plan (TCP) Available (Yes / No):

Comments:

Proper Traffic Control in Place (Yes / No):

Comments:

Proper Equipment Available (Yes / No):

Comments:

Most Efficient Procedures Being Employed (Yes / No):

Comments:

Additional Comments:

Inspector's Signature: