Fill - Free fillable Certifying Entity Flagger Application For First Time Or Re-certification Only (Colorado Department of Transportation) PDF form

Rev. 1/2020

APPLICATION

for FLAGGER TRAINING

Certification

Re-Certification

for:

(Print or Type Entity Name Here)

Date of Application:

CDOT Flagger Program

Traffic and Safety Engineering Branch

2829 W. Howard Pl.

Denver, Co. 80204

1-888-639-3271

303.757.9219 (Fax)

dot_cdot_flagger@state.co.us

http://www.codot.gov/library/traffic/lane-close-work-zone-safety

Page | 2 of 5

PURSUANT TO C.R.S. 43-5-308(2)(b), CDOT Authorizes Public and Private Entities to conduct

Flag-Person Certification Training.

PART 1– ENTITY REQUIREMENTS AND QUALITY ASSURANCE

The Entity will:

Apply to the CDOT for authorization to administer the Flagger Certification Program. This includes

certifying and recertifying Flaggers and Proctors, not limited to an Entity’s own employees.

Authorization granted by the CDOT’s Traffic and Safety Engineering Branch is valid for three (3)

years, unless otherwise revoked.

Have the capacity to register students, Flaggers and Proctors and record testing scores.

Provide for adequate training facilities.

Designate an authorized representative to sign all necessary documents required by the CDOT.

Apply for re-certification a minimum of 45 days before the current certification expires.

Use the CDOT training materials or the CDOT approved training materials, as set forth on the CDOT

website.

Follow the 2009 Federal Highway Administration Manual on Uniform Traffic Control Devices

(MUTCD), Part VI, as amended, and the 2011 CDOT Standard Specifications, Section 630.14, in all

training activities.

Verify that:

 Proctors are at least 18 years of age; certified Flaggers, with current card on file with the CDOT.

 The Flagger applicant is at least 18 years of age.

 The Flagger applicant meets the minimum qualifications, as outlined in Section 6E.01 of the 2009

Manual on Uniform Traffic Control Devices (MUTCD.)

 The Flagger has read and understood the training materials, understands the safety hazards of

flagging, and is capable of performing flagger activities.

 A Flagger who is issued a Flagger Certification Card has passed the flagger examination by obtaining

a passing score.

 If an applicant successfully passes the exam, the Proctor issues the applicant a Flagger Certification

Card, valid for two (2) years, with the “date issued” and “expiration date” legibly printed or typed on

the card, along with the Proctor’s signature.

 The Proctor instructs Flagger applicants who pass the exam, that they must maintain the Certified

Flagger card on their person while engaged in flagging activities.

 The Proctor instructs Flaggers that they may not engage in flagging activities with an expired or lost

card. A replacement card must be obtained.

 The applicant has presented, to the Proctor, a government issued photo identification (i.e. driver's

license, state-issued identification card, passport, military ID card, or other government issued

identification).

Require the Proctor to:

 Be present throughout the entire examination process.

 Maintain the confidentiality of the training materials, exams and answer keys, by distributing exam

materials immediately prior to the testing session, and collecting all exam materials immediately

afterwards.

Initial that you have read and understand the requirements: ___________

Page | 3 of 5

PART 1–CONTINUED ENTITY REQUIREMENTS AND QUALITY ASSURANCE

Comply with:

 All CDOT quality assurance reporting requirements, as set forth on the CDOT website.



https://codot.gov/library/traffic/work-zone-safety-and-work-zone-traffic-operations/flagger-program

 The requirements of the Americans with Disabilities Act regarding access to training facilities.

Designate a custodian of records, who will be responsible for securely maintaining all records; for

five (5) years, from date of applications, and submitting such records as requested by CDOT. Records

will include, at minimum:

 Photocopy of the applicant’s form of identification (must be a government-issued photo

identification including driver's license, state- issued identification card, passport or military ID

card).

 Whether the student passed or failed the exam.

 A list of the applicants who received flagger certification cards and date of issue. The Proctor’s

name, addresses, telephone number, and training location(s).

Notify CDOT of any changes to the information provided herein within thirty (30) days of a change,

including: designated representative, physical address, entity information, and proctor status. For a

change in proctor status, the Entity shall use CDOT’s Entity Change Form.

Allow an applicant to re-test if he or she fails the exam. An applicant may take an alternate exam on

the same day, if he or she fails it the first time.

PART 2– DENIAL OR RENEWAL, SUSPENSION OR REVOCATION OF FLAGGER

CERTIFICATION

Notice of suspension shall be sent to the Entity’s designated representative within one working day of

the suspension by certified mail.

If CDOT revokes an Entity’s authorization, the Entity shall return all unused flagger certification

cards, and cease using and destroy the flagging proficiency tests, answer keys, and blank answer

sheets within two weeks of revocation.

An Entity may submit an objection to CDOT’s suspension, revocation, or denial of a renewal by

submitting a letter to the CDOT Traffic and Safety Engineering Branch manager within thirty (30)

days from the date the notice of suspension, revocation or denial was mailed to the Entity.

The CDOT Traffic and Safety Engineering Branch Manager shall review the Entity’s objection and

issue a written decision within thirty (30) days of receipt by certified mail.

The provisions of § 24-4-104, C.R.S. shall apply to the appeal from CDOT’s denial of an Entity

Certification, denial of renewal, revocation, or immediate suspension.

If an Entity’s certification is revoked, that Entity must wait a minimum of one (1) year after

revocation to re-apply. Following re-certification, the CDOT will conduct an audit within the first six

(6) months of re-certification. If the Entity fails to pass that audit, the Entity will be barred from

reapplying for certification as an Entity to administer the Flagger Certification program.

Initial that you have read and understand the requirements:_____________

Page | 4 of 5

PART 3-REQUIRED INFORMATION

Complete the following information for the Entity that is applying. Type or print legibly. Scan and email the completed

form to: dot_cdot_flagger@state.co.us

Name of Entity:

Physical Address:(Include City, Zip Code, and County):

Mailing Address:

(if different than Physical):

Telephone Number:

Email Address:

Website Address:

Designated Contact/Representative

Name:

Title:

E-Mail Address:

Signature:

PROCTOR INFORMATION

Provide the following information for each proctor with whom you have an agreement to provide training services.

Use CDOTs Entity Change Form to update this information, or use additional sheets as necessary.

Name

(as it appears on driver’s license)

Telephone and

Email Address

Signature of Proctor

Page | 5 of 5

PART 3- CONTINUED REQUIRED INFORMATION: FLAGGER TRAINING

LOCATIONS

List all the physical location(s) that your Entity utilizes for flagger training. Use additional pages if necessary.

Location: (include Address)

If the flagger training locations are unknown, please provide any information regarding anticipated training

locations and a timeline to obtain locations. If you require additional space, please use a separate piece of paper.

_____________________________________________________________________________________

I agree to the terms and conditions set forth herein, and certify that the information set forth herein is true and accurate.

(NOTE: The parties mutually accept scanned signatures below in place of original signatures.

If scanned copies are not available, Please mail original signatures)

[Print or Type Name of Certifying Entity Here]

By:

Name (Print)

Authorized Signatory

Title (Print)

Colorado Department of Transportation

By:

Name (Print)

Authorized Signatory

Date:

---------------------------------------------DO NOT WRITE BELOW THIS LINE-------------------------------------------------

ENTITY CERTIFICATION EXPIRES:

Notes from CDOT Representative:

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Certifying Entity Flagger Application For First Time Or Re-certification Only (Colorado Department of Transportation)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Certifying Entity Flagger Application For First Time Or Re-certification Only (Colorado Department of Transportation) Form

Related forms

Fillable Certifying Entity Flagger Application For First Time Or Re-certification Only (Colorado Department of Transportation)

Fill Online, Printable, Fillable, Blank Certifying Entity Flagger Application For First Time Or Re-certification Only (Colorado Department of Transportation) Form

Related forms

First 20 documents completely FREE!