Fillable Work Zone Audit Form

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Work Zone Audit Form

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The Work Zone Audit Form form is 1 page long and contains:

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  • 42 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

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Work Zone Traffic Control Audit Form
Department of Safety and Environmental Management
Created: 5/29/19
Revision: New 1 | Page
Date: _______________ Person Conducting the Audit: ____________________________________________
Work Zone Supervisor: ________________________________ Department: __________________________
Location of Work Zone: ______________________________________________________________________
Nature of Traffic: _____________________________________ Posted Speed Limit: ____________________
Answer the following questions to the best of your ability. For all “NO” answer(s), list the observation number, describe the problem
and list the corrective action(s) taken in the space provided.
Observation
Corrective Action
AUDIT
YES
NO
N/A
1.
Are all employees within the Work Zone wearing “acceptable”, high-visibility safety apparel?
2.
Are warning signs appropriately sized, properly mounted, in good condition, legible and
placed accordingly for the Work Zone?
3.
Are warning signs taken down or covered at the end of the day or when the Work Zone is not
being used (i.e. Lunch Break)?
4.
Is the Flagger station placed in the appropriate position, clearly visible to traffic, with an
escape route and preceded by advanced warning signs?
5.
Does the flagger have a minimum of 18” wide, octagonal Stop/Slow paddle?
6.
Are traffic cones and drums appropriately sized and spaced, visible with retroreflective bands
and in good condition?
7.
Are barricades set up correctly with the 45
o
stripes sloped in the correct direction?
8.
Is the Work Zone set-up in a way to provide positive guidance and minimizes any confusion
for the drivers?
9.
Is the transition area appropriately spaced, using a minimum of five cones or drums to
provide a taper?
10.
Is the Buffer Space clear of any equipment or materials and provide proper protection for
traffic and workers?
11.
Does the Work Space provide enough area for the workers to complete the task and work
safely?
12.
Does the Traffic Space allow the traffic to pass through the activity area safely?
13.
Does the Termination Area allow traffic to resume normal driving in a clear and concise
manner?
14.
Has the pedestrian traffic been adequately addressed to prevent the public from walking
through the Work Zone?
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Work Zone Audit Form

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Completed 11 July 2020

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