Flagger Inspection Flagger Inspection ReportInstructions This Flagger Inspection form MUST be completed daily. If there is more than one (1) crew at a work site. A form MUST be completed for each crew.Date *Time 000102030405060708091011121314151617181920212223HH000510152025303540455055MMCUSTOMER *GPCUTECPITTMANOTHERLOCATION OF WORK SITE Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryFOREMAN/SUPERVISOR *name of the customer's work site supervisorFLAGGER DRIVER *Type in the name of Traffic Troopers DriverFLAGGER NON DRIVER *Type in the name of Traffic Troopers Non DriverPOLICE OFFICER Was Officer at this location? If so please add their name.SAFETY CHECK *Is the Flagger safe? Please describe the safety parameters of Traffic Troopers Flagger at the work site by checking the appropriate boxes.Proper Uniform (hard hat, safety vest, steel toe boots)Flagger is situated in a planned escape routeVisible to approaching trafficSTOP/SLOW paddleVehicle parked off the road, away from stationSETUP *Is the Temporary Traffic Control Plan setup properly? Please describe the proper setup by checking the appropriate boxes.TA10 DOT proper setupTA33 DOT proper setupCOMMUNICATION *Has the Flagger communicated with Foreman regarding the temporary traffic control plan? Please describe based on your communication with the foreman and/or Flagger at the work site by checking the appropriate boxes.Safety BriefingSupervisorCoworkersENGAGED *Is the Flagger following company policy? Please describe the activity of Traffic Troopers Flagger at the work site by checking the appropriate boxes.Not mingled with the work crew or motoristsNot on phoneMingled with the work crew or motoristsOn phoneEQUIPMENT *Does the Flagger have the appropriate equipment? Please describe the equipment on the truck by checking the appropriate boxes.STOP/SLOW paddleFlashlightWalkie TalkiesProper amount of conesProper amount of barrelsDelineatorsStep stoolNot enough conesNot enough barrelsNOTES Please include additional information or comments if necessary.File Upload VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: