General Inspection Checklist
FOR




Preliminary Inspection
Grading Inspection
R/W & Engineering Inspection
Final Plan Inspection
Filled out ( * items ) prior to the field inspection and cross off items not applicable.
Date & Time of Inspection: ______________________________________________________
Location of Inspection:
______________________________________________________
Project Number:
______________________________________________________
Inspection Personnel:
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
1
Issued Apr_ 2008
General Inspection Checklist
PROPOSED CONSTRUCTION
*A.
This project is scheduled for the in ____________ (Month, Year)
*B.
This project is due in the Check Squad ______________ (Month, Day, Year)
C.
Are there special conditions affecting working time of scheduling.
D.
Estimated Construction Cost $________________
E.
Are City and/or County agreements needed?
F.
Work to be done by City and/or County forces prior to, or during construction.
G.
Maintenance responsibilities upon completion of project (City, County, or WYDOT)
 Yes
 No
EARTHWORK
*A.
Soils Profile received:
*B.
Clearing and Grubbing:
1.
 ACRE
2.
Clearing trees
(a.)
*C.
 Yes
 No
 LS (Explanation required)
Diameter
Removal of Structures and Obstructions:
*1.
Removal of ________________________________
(a.)
Method of Payment (List Quantity)
 EA
 SY
 TON
 Subsidiary
(b.)
 FT
 CY
 LS
 Salvage Value (Approval required)
Disposition
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Issued Apr_ 2008
General Inspection Checklist
D.
Excavation & Embankment:
*1.
*2.
3.
Borrow Special Excavation
 CY
 TON  None
*(a.)
Location
*(b.)
Ownership
*(c.)
Agreement
*(d.)
Samples submitted
(e.)
Stripping overburden (May be used in fill where large quantity)
(f.)
Haul roads
(g.)
Haul type
(h.)
Dead haul
 Yes
 No
 CYMI
 TMI
Muck Excavation
(a.)
Limits
(b.)
Quantity
(c.)
Waste area(s)
(d.)
Haul distance
Rock Excavation
(a.)
Blasting required
 Yes
 No
(b.)
Special precautions
 Yes
 No
(c.)
Use to construct embankment  Yes
 No
(d.)
Suitable for riprap
 Yes
 No
(e.)
Waste area(s)
(f.)
Dead haul
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Issued Apr_ 2008
General Inspection Checklist
4.
5.
(g.)
Seismic velocities
(h.)
Special techniques
 Pre-splitting
 Cushion blasting
Unclassified Excavation:
(a.)
Excavation below grade
(b.)
Limits & location
(c.)
Type backfill required
(d.)
Quantity (CY)
Unclassified Excavation
(Excess)
(a.) Quantity (CY)
6.
(b.)
Waste area(s)
(c.)
Dead haul
Embankment Construction
(a.)
Shrink factor
Limits
(b.)
Swell factor
Limits
(c.)
Additional embankments
 Approaches
 Dikes
7.
 Ditch berms
 Over-exc. backfill
Water (MG)
 Yes
 No
*(a.)
Prewetting
*(b.)
Estimated Quantity/CY __________ Gal.
*(c.)
Water source(s) _______________________________________
(d.)
Dust control
 Yes
 No
Gal._______
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Issued Apr_ 2008
General Inspection Checklist
8.
Grade Line
(a.)
Vertical control changes (List locations and reasons)
(1.)
(2.)
(3.)
(b.)
E.
F.
Excavation below grade
(1.)
Location
(2.)
Reason
(3.)
Type of material
(4.)
Depth
(5.)
Waste area(s)
(6.)
Source of backfill
Old Road Obliteration:
1.
Location
2.
Method of measurement
 CY
Turnouts:
1.
Mailboxes
 Single
 Double
 Multiple
 Cluster
Location(s)
2.
Scenic
3.
Schoolbus
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Issued Apr_ 2008
General Inspection Checklist
 Box beam
G.
Guardrail:
H.
Topsoil and Seeding:
 W-beam
*1.
Topsoil storing
 CY __________
*2.
Topsoil placing
 CY __________
a.
Limits  Slope stake - slope stake
b.
Depth
3.
Topsoil borrow
4.
Seeding
5.
 Cor-Tan
 R/W - R/W
 CY __________
a.
Limits
b.
Seeding recommendations from Environmental Services
Prior to the Grading Inspection, a form ARequest for Seeding
Recommendations@ should be obtained from the WYDOT
agronomist. This form is to be filled out with the required
information and returned to the agronomist for his/hers use in
recommending seeding and erosion protection items for the project.
This information should be conveyed to the Resident Engineer.
Landscaping
SUB-BASE DESIGN
A.
A.
Overburden (all pits):
1.
Removal
2.
Placing
______________CY
______________CY
Sub-base:
*1.
Pit name and/or location
*2.
Agreement
*3.
Samples submitted:
 Yes
 No
6
Issued Apr_ 2008
General Inspection Checklist
4.
Special provisions
5.
Air quality permit required
 Yes
 No
6.
Crusher Run
Crushed
Pit Run
 Yes
 Yes
 Yes
 No
 No
 No
7.
Haul
 Yes
 No
 CYMI
 TMI
BASE COURSE DESIGN
 Crushed
 Cement Treated
 Emulsion Stabilized
*A.
Pit name and/or location:
*B.
Agreement:
*C.
Samples submitted:
*D.
Mineral filler location if required:
A.
Lime:
A.
Winter protection:
A.
Special provisions:
A.
A.
 Yes
 No
 Yes
 No
Air quality permit required:
 Yes
 No
Haul:
 Yes
 No
 CYMI
 TMI
 Plant Mix Bit
SURFACING
 Plant Mix  Concrete
*A.
 Wearing Couse
 Commercial Mix
Pit name and/or location
7
Issued Apr_ 2008
General Inspection Checklist
*B.
Agreement
*C.
Samples submitted:
D.
Lime
E.
Concrete
 Yes
 No
Source
2.
Fly Ash required
3.
Placing of concrete and reinforcing
4.
Finishing and finishing equipment
5.
Joints and placement
Mineral filler location if required
G.
Seal coat
I.
 No
1.
F.
H.
 Yes
 Yes
 No
 Fog
1.
Type
2.
Shoulder widths
 < 4 feet
 Yes
Blotter
Haul
 Chip  Chip (Overshoot)
 Ton
 CY
 Yes
 No
 CYMI
J.
Rumble strips required
K.
Special provisions
L.
Air quality permit required
 > 4 feet
 No
Source:
 Yes
 No
 Yes
 No
 TMI
8
Issued Apr_ 2008
General Inspection Checklist
APPROACHES AND CATTLEGUARDS
*A.
*B.
Approaches
1.
Show locations on plans and list in summary form on R/W & Utility Plans
2.
Included approaches requested by entities B BLM, USFS, etc. ?
Cattleguards
Station on plans
Width
Cattleguard & Type
Description
1.
2.
3.
FENCING
A.
Types
Station to Station
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
1.
2.
Replace in kind
a.
Type
b.
Location:
Station____________to Station________________
Reset existing fence
9
Issued Apr_ 2008
General Inspection Checklist
*B.
Special gates (> 16 feet wide B two gates will be required unless recommended
otherwise)
1.
Location
Type
Width
Type
Width
Type
Width
Type
Width
a.
b.
2.
Replace in kind
Location
a.
b.
3.
Remove and reset gates
Location
a.
b.
4.
Remove existing gates
Location
a.
b.
C.
Snow fence
10
Issued Apr_ 2008
General Inspection Checklist
 Reset Snow Fence
 Snow Fence Repair
 Snow Fence (Wood)
(Panel lengths and height required for quantity computation) Pay unit = EA
DRAINAGE
A
Minor drainage
1.
Drainage surveys completed?
 Yes
 No
2.
Alkali samples submitted?
 Yes
 No
3.
Culvert Design System (CDS) runs complete  Yes
 No
4.
Erosion Control
Type:
B.
Source:
Major Drainage
1.
Drainage surveys competed?
 Yes
 No
2.
Alkali samples submitted?
 Yes
 No
3.
Structure selection complete?
 Yes
 No
4.
Applications for required water quality certificates and permits submitted by
Environmental Services
 Yes
 No
5.
Erosion control
Type:
C.
D.
Source:
Storm Sewer
*1.
Manholes
*2.
Drop Inlets
Detention Ponds
11
Issued Apr_ 2008
General Inspection Checklist
E.
Irrigation structures
1.
Landowner contacted?
 Yes
 No
2.
Private irrigation easement required?
 Yes
 No
3.
Separate contract with irrigation district to adjust ditches?
 Yes
4
5.
 No
Structure
a.
Location
b.
Type (concrete, wood, other)
c.
Drawing number (WYDOT)
Contract items (list)
 Force account
F.
 Lump sum
 Subsidiary
Channel Changes
1.
Do proposed channel changes conflict with recent changes, additions or
corrections to the plans?
 Yes
 No
If yes, explain:________________________________________________
G.
 Yes
 No
2.
Is material usable for balancing?
3.
Waste area. if required
4.
Irrigation structures affected by channel changes?
 Yes
 No
5.
Should Ch.Ch. be fenced inside right-of-way?
 Yes
 No
Subsurface pipe (Underdrain)
*1.
 Recommended
 Not recommended
12
Issued Apr_ 2008
General Inspection Checklist
*a.
H.
Location
*b.
2.
Waste area (Location)
3.
Backfill material (Location)
Size
*c.
Type
Edge drain
*1.
 Recommended
2.
Location
 Not recommended
ENVIRONMENTAL CONSIDERATIONS
A.
A.
Wetlands
1.
Wetland encroachments
2.
Mitigation measures required
3.
Have wetland permit applications been made and approved by the Corps of
Engineers?
 Yes
 No
Any stipulations or changes required?
b.
Have agreements been obtained from the landowner?
Additional Corp of Engineer Permits required
1.
A.
a.
 Rivers
 Streams
 Drainages
Additional permit requirements
1.
DEQ - Air quality permits
2.
DEQ - NPDES permit
a.
Has plan been completed for:
 Roadway
 Pit and plan sites
13
Issued Apr_ 2008
General Inspection Checklist
b.
Responsibility
 Contractor
A.
 WYDOT
Archeological clearances obtained
 Yes
 No
 Yes
 No
 Yes
 No
TRAFFIC
A.
Detours
*1.
Typical section
*2.
Design speed
3.
Type of surfacing
4.
Special structures
5.
Method of payment
6.
Detour obliteration:
a.
7.
B.
Waste location
Pipe Salvage
a.
Location
b.
Disposition
c.
Estimated quantity
Traffic will be carried through construction
1.
Temporary guardrail required
2.
C.
Temporary connections
*1.
 Yes
Was survey made?
 No
14
Issued Apr_ 2008
General Inspection Checklist
D.
*2.
Typical section
*3.
Design speed
4.
Type of surfacing
5.
Method of payment
Traffic control:
1.
E.
F.
 Yes
 No
Quantities obtained from Traffic design and field engineer
Temporary median cross-overs
*1.
Location
*2.
Drainage culvert size
Intersections or interchanges
*1.
Location
*2.
Special design required?
3.
Special recommendation by field
G.
Traffic signals required?
H.
Lighting
I.
Service roads
 Yes
 Yes
*1.
Locations (show on plans)
2.
Inside of outside right-of-way
*3.
Fence location
*4.
Design
a.
Typical section
b.
Sub-base:
 Yes
 No
 No
 No
Depth________
15
Issued Apr_ 2008
General Inspection Checklist
5.
c.
Base:
 Yes
 No
Depth________
d.
Plant mix
 Yes
 No
Depth________
e.
To be set up by Materials and Project Development
Method of payment
Excavation (include with balance?)  Yes
 No
Equipment hours
 Bulldozer
 Roller Type ___________
 Truck
 Motor Grader
 Scraper
 Loader
Compaction
RIGHT-OF-WAY
 Yes
 No
A.
Section ties complete
A.
LUCO and LUFJ complete
A.
Recommended changes since previous inspection (show on plans)
A.
Additional topography (show on plans)
A.
Recent ownership changes that would affect design (show on plans)
A.
Construction permits
 Yes
 No
UTILITIES
A.
Recent utility changes (show on plans)
*B.
Private utilities to be set up in contract
1.
Location
a.
16
Issued Apr_ 2008
General Inspection Checklist
b.
2.
Contract item
 FA
 LS
 Unit
SPECIAL PROVISIONS
Sequence of work, etc
MISCELLANEOUS ITEMS
*A.
*B.
Historical signs, markers & monuments
1.
Location
2.
Disposition
Turnouts and rest areas -- show on plans and explain
Median cross-overs -- show location on plans and explain
Special design items
*1.
Retaining walls
*2.
Wells
*3.
Sewage systems
*4.
Crops involved
Special precautions
*6.
 Yes
 Yes
 No
 No
Picnic Facilities
17
Issued Apr_ 2008
General Inspection Checklist
*7.
Curb & Gutter
Type
A
*8
Double gutter
*9
Sidewalks
*10
Median paving
11.
Climbing lanes
B
C
18
Issued Apr_ 2008