ADA/PROWAG Inspection Summary

Job/Permit No: Date: Route: Inspector: Resident Engineer Limits: Checked: Municipality: County:

FOR ADA COORDINATOR USE ONLY Date Uploaded into ADA Uploaded By: Inventory:

List of facilities altered by construction improvement including curb ramps, crosswalks (marked/unmarked), Traffic Signals (APS), and/or sidewalks. For those facilities that are not compliant, attach ADA/PROWAG Inspection Sheet (D1 PD0031), ADA Construction Concurrence (BDE 5801), and supporting documentation justifying non-compliance. These must be presented by the Bureau in charge of the alteration at the next monthly FHWA/BDE Coordination Meeting. Submit the ADA/PROWAG Inspection Summary form to the D1 ADA Coordinator.

**FOR NON-COMPLIANT Marked Cross Street Corner or Leg Crossing ADA/PROAG FACILITIES** Facility Type Route/Street (for SW, include distance corner-NE/NW/SE/SW Direction Compliance Inspector must complete the to nearest cross street) Leg –N/S/E/W (NB/SB/EB/WB) following Curb Ramp BDE 5801 Crosswalk Completed w/ Compliant Non-Compliant Documentation Traffic Signal Date Presented to Sidewalk FHWA/BDE: Curb Ramp BDE 5801 Crosswalk Completed w/ Compliant Non-Compliant Documentation Traffic Signal Date Presented to F Sidewalk HWA/BDE: Curb Ramp Compliant Non-Compliant BDE 5801

Crosswalk Completed w/ Documentation Traffic Signal Date Presented to

Printed 5/10/2018 Page 1 of 4 D1 PD0039 (02/16/16) Sidewalk FHWA/BDE: Curb Ramp BDE 5801 Crosswalk Completed w/ Compliant Non-Compliant Documentation Traffic Signal Date Presented to Sidewalk FHWA/BDE: Curb Ramp BDE 5801 Crosswalk Completed w/ Compliant Non-Compliant Documentation Traffic Signal Date Presented to Sidewalk FHWA/BDE:

Printed 5/10/2018 Page 2 of 4 D1 PD0039 (02/16/16) ADA/PROWAG Inspection Summary (Continued)

Job/Permit No: Error: Reference source not found Date: Error: Reference source not found

Crossing Intersection ADA/PROAG **FOR NON-COMPLIANT FACILITIES** Marked Route/Street Cross Street Corner (NE/SE/SW/NW) Direction No. Compliance Inspector must complete the following (NB/SB/WB/EB) Curb Ramp

BDE 5801 Completed w/ Documentation Crosswalk Non- Compliant Traffic Signal Compliant Date Presented to FHWA/BDE: Sidewalk

Curb Ramp

Printed 5/10/2018 Page 3 of 4 D1 PD0039 (02/16/16) Curb Ramp

Curb Ramp

Printed 5/10/2018 Page 4 of 4 D1 PD0039 (02/16/16)