Instructions for completing the Temporary Traffic Control Planning Checklist
A copy of this document MUST be available in the field to the field staff anytime work is being done.
Diagram/Drawing MUST show proposed locations of signs, flaggers, etc.
1. Proposed Work Start Date - Select from dropdown calendar. Give at least 7 days’ notice if possible, to allow for the
proper planning. If the work needs to be done immediately because of an emergency, then contact EHS at 582-3389.
2. Ca
mpus Location is a brief description of the work location.
3. Co
ntractor / LU Department Performing Work is the company name or department who will be actually performing
the work which requires temporary traffic controls. If using a contractor put in the contractor plus the LU
department who is responsible for the contractor.
4. Co
ntact Person or Project Manager and Phone Number is the main contact planning the job and is the best person
to answer any questions about the work. Their Cellphone number would be best to contact them out in the field.
5. Dur
ation – select from dropdown list.
6. Ty
pe of Work – select from dropdown list, or type in your custom text describing the work.
7. Wil
l the work require trenching & excavating, or personnel entering confined spaces – tick YES / NO boxes as
appropriate. If YES is selected, then further training may be necessary or additional permits may be required.
8. Roadway Characteristics – This information is important as it will determine the equipment required (signs, cones,
flaggers, barricades, etc.) to make the traffic control safe. Select Number of Lanes from dropdown box. Type in the
Approximate Road Width, Closure Width & Closure Length in Feet.
9. Po
sted Speed Limit – select from dropdown box the speed limit for the section of roadway that the work is planned
for.
10. S
pecific Work Location – Select from dropdown box the location of the work required.
11. A
ttach drawing or aerial photograph showing the proposed work area – This is an important part where the exact
location is identified. Show manholes, road widths, trees, light poles and the position of work vehicles, boom lifts,
ladders or any other pertinent information which related to the worksite. This should include the proposed
placement of signs, flaggers, etc.
12. D
epartment Director Approval – This Name, Signature and Date should be from the Director of the department
requesting the work (IT, Grounds, Maintenance, etc.). The Checklist can then be printed using the PRINT FORM
button at the top of the page and emailed or hand delivered to EHS for review before being sent to LUPD.
EHS-F2 Original October 2018
lusafety@liberty.edu 434-582-3389
www.liberty.edu/ehs
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