Preparation for the Field Inspection: to Be Filled out Prior to the Inspection Being Conducted

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/ Design
Plan-In-Hand Field Review Checklist
Instructions for Use: This form is to be completed by LPD PC with assistance from NDOR Roadway Design1) Proir to Inspection to authorize the PIH to be scheduled 2)During the PIH Field Inspection.
Local Public Agency (LPA): / LPA Responsible Charge:
State Project No.: / Project Name and Location:
State Control No.: / Date of Review: / This Form was Completed By:

Preparation for the field inspection: To be filled out prior to the inspection being conducted.

Item # / Task Description or Questions / Completed / If No, Define
Corrective Action / Details or Information Used to Verify Content / AdditionalComments
Yes / No / N/A
1. / Have the 30% Plans been reviewed and approved by NDOR?
2. / Have the plans been distributed to the appropriate parties? / Transmittal Letter
3. / Have the LPA RC, LPD PC, NDOR ROW, NDOR ENV,NDOR DCE, and Utilities been invited to attend the field inspection? / Transmittal Letter
4. / Were the 30% plans sent to the involved Utilities and Railroads? / Transmittal Letter
5. / Has the Utility Inspection Report Been submitted?
6. / Are the traffic analysis and recommendations complete and available for the PIH field inspection? / NDOR Traffic Recommendation Memo
7. / Does the inspection report: summarize the visual comparison with existing Permits, Plans, and One Call utility information, noting the location, type, omissions, and owner information? / Existing Permits issued by NDOR, City, Counties to be on their ROW.
One-Call Utility Information

To be fillout at the Field Inspection:

Item # / Task Description or Questions / Completed / If No, Define
Corrective Action / Details or Information Used to Verify Content / Additional Comments
Yes / No / N/A
8. / Do all participants understand the scope of the project?
9. / Were the design standards and their application to the project discussed?
10. / Was the need for any design relaxations/exceptions discussed?
11. / Was the attendance recorded? / Attendance Record
12. / Did the participants discuss the items of work to be accomplished by the LPA or others?
13. / Are encroachments within the ROW?
14. / Was there a discussion of the potential utility conflicts within the project limits?
15. / Based on the potential Utility conflicts Identified, has the LPA and Utilities decided if a Utility Conflict workshop is needed?
16. / Were there any areas that looked like wetlands that were not identified as such on the plans that may require a new delineation or consultation with the NDOR?
17. / Were all wetland, channel, 4(f), and 6(f) lands reviewed in the field to confirm the accuracy of the plans to identify avoidance, minimization or mitigation measures?
18. / Was the railroad impact reviewed during the field review?
19. / Are there airports within 4 miles of the project for which coordination with NDA and FAA will need to take place?
20. / Was the need for additional survey discussed and identified during the field review?
21. / Did discussion of the salvage of any removal items take place, even if nothing is to be salvaged?
22. / Did the LPA indicate availabilty of sources of borrow material within the public right of way?
23. / Was phasing of the project to maximize the mobility of the traveling public discussed?
24. / Were any special erosion control considerations noted during the field review?
25. / Did the LPA note any special maintenance issues that they have experienced that need to be corrected with the project?
26. / Was the condition of sidewalks and bike paths under the jurisdictional responsibility of the LPA reviewed and remedial measures identified?
27. / Was the accommodation of persons with disabilities during construction discussed and a plan proposed during the field review?
28. / Is any consideration given to increased mobility or accommodation for pedestrian or bicycle traffic?
29. / Will it be necessary for property corners and land monuments to be established or re-established under the contract?
30. / Was a discussion of the NEPA process and its requirements conducted as a part of the field review?
31. / Are there areas or locations within the limits of the project which will require special studies?
32. / Was each access reviewed for sight distance and alignment?
33. / Was the project reviewed in detail to identify any existing feature which may not be represented on the plans or may have been represented in error?
34. / Was the work at each major structure reviewed to determine any constructability issues and if additional ROW is needed?
35. / Were the phasing proposals reviewed?
36. / Were each of the drainage sites reviewed for drainage issues not identified on the survey?
37. / Was access for residents on the project discussed?
38. / Were the traffic engineering recommendations discussed?

06-20, July 2012Version 1.00Checklist No. 06-20