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Category 2 Work Zone Device Acceptance Letter

 

 

Letter Number ________________________________
Date _________________________________________

 

CONTACT INFORMATION: Petioner / Developer Name
Title
Company
Street
City, State, and Zipcode
 
I herby certify that the device(s) covered by this Acceptance Letter meet(s) the crash – worthiness test and evaluation requirements of the FHWA and NCHRP Report 350.
Signature:
Telephone Number:
E-mail Address:

 

Engineer Name:
Laboratory Name
Street
City, State, and Zipcode
Check One:  
 
I hereby certify that the testing that supports this Acceptance Letter was conducted in accordance with NCHRP Report 350 guidelines, that the device(s) tested is/are accurately described on this form, and that the test results indicate that the device meets all applicable NCHRP Report 350 evaluation criteria.
 
I have evaluated the requested modifications to these devices previously found acceptable by the FHWA in Acceptance Letter WZ-____, and hereby certify that, in my opinion, the modifications do not adversely affect the crash performance of the devices. I also certify that these devices are accurately described on this form.
Signature:
Telephone Number:
E-mail Address:
   
KEYWORDS

Please select from the following Keywords for "Type of Device":

Longitudinal Channelizing Barricade
Curb (Curb channelizer system with or without road tubes or other channelizers) Drum
H-Footprint Sign Stand
X-Footprint Sign Stand
Trailer Mounted Signs (Does not include arrow boards or variable message signs or other Category 4 trailer mounted devices.)
Automated Flagger Device (not trailer mounted)
Tripod Sign Stand
Type I Barricade
Type II Barricade
Type III Barricade
Vertical Panel
Intrusion Detector
Ballast (Action relates to ballast on one or more devices)
Channelizer (Individual units unlike cones, road tubes, or drums)
Other (Please describe on form)

 

 

 

Type of Device:

__________________________

   
 

Please Select from the following Keywords for Composition of Sign or Rail Substrate:

Roll-up / Fabric (with fiberglass spreaders – aluminum or steel spreaders are not allowed.)
Plywood
Aluminum – Solid
Aluminum – Laminate
Corrugated Plastic
Extruded Plastic
Waffleboard Plastic
Wood / Lumber

 

Compositon of Sign or Rail Substrate:

__________________________

   
  Thickness of substrate (inches):
 

Indicate the height of sign from the ground (inches), if applicable:

 

Low 12 to 18 inches above the pavement
Mid-A 20 to 24 inches above the pavement
Mid-B 25 to 36 inches above the pavement
Mid-C 37 to 59 inches above the pavement
Tall 60 to 71 inches above the pavement
Oversized 72 inches and taller

Height of Sign:

__________________________

 

   
  Flags and or lights present during test? Indicate number of each:
  # of flags: # of lights: Weight of lights: ea.
   
DEVICE NAME: Provide Detailed Description of Device, Materials, sizes, Fasteners, Substrates, Foundation, Aux. Features Ballast, etc. (May be attached on separate page(s) )

 

   
MANDATORY ATTACHMENTS: Please include those pages as separate eletronic files as they will be posted on the FHWA websitein lieu of the entire final report.
Attachment #1: Test data summary page(s)
Attach. #1a Test #
Attach. #1b Test #
Attach. #1c Test #
Attach. #1d Test #
 
Alternative
Attachment #1: Description and discussion of modification(s) to crash tested and/or accepted device.
 
Date:
Attachment # 2: PDF drawing(s) of device(s) - Mandatory Attachments: Please include those pages as separate eletronic files as they will be posted on the FHWA websitein lieu of the entire final report.
Attach. #2a Drawing Title:
  Drawing #:
Attach. #2b Drawing Title:
  Drawing #:
Attach. #2c Drawing Title:
  Drawing #:
Attach. #2d Drawing Title:
  Drawing #:
Attach. #2e Drawing Title:
  Drawing #:
Attach. #2f Drawing Title:
  Drawing #:
Attach. #2g Drawing Title:


Please note the following standard provisions that apply to FHWA letters of acceptance:

 


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