Application Revision: November 4, 2014
Qualified Traffic Control Equipment:
http://goo.gl/OS7o5N
Reflective Sheeting Materials Application
Qualified Traffic Control Equipment Submission Form for
Reflective Sheeting Materials
Submission Instructions: Please submit one application per product. A minimum 12" x 12" sample of the
sheeting material shall be included for inspection by the Department. The applicant should also include an
identification procedure, which may include digital photographs, so that field personnel may identify both the
product and manufacturer. Any other catalogue cuts should be included as attachments. Other testing results or
certifications, such as NTPEP data or FHWA letters, which may assist in product evaluation may be included. All
products shall comply with the latest edition of Section 828 - Traffic Signs and/or Section 860 - Reflectorized
Pavement Markings of the Standard Specifications
, including Supplemental and Interim editions. Upon
evaluation MassDOT Highway Division will contact you.
Part A. Applicant Information
Today's Date
Name
Company
Address
City, State ZIP
Phone
Email
Part B. Basic Product Information
Name or Model #
Description
Link to product cutsheet
Part C. Technical Product Information
ASTM D4956 Classification
ASTM D4956 Backing Class
Typical Use
Color(s)
Part D. Product Use
Has this product, or one similar, been previously submitted to MassDOT? Yes No
If Yes, please explain:
Is this a replacement product for one currently approved by MassDOT? Yes
No
I
f Yes, please explain:
Is this product currently in use in Massachusetts? Yes No
If Yes, please explain:
