Traffic Signal Maintenance Form
Report and document all maintenance work performed on traffic signals. Please complete all sections accurately.
Location / Intersection
*
Maintenance Date
*
-
Month
-
Day
Year
Date
Reported Issue / Problem Description
*
Signal Component Affected
*
Please Select
Red Light
Yellow Light
Green Light
Controller Cabinet
Wiring
Pedestrian Signal
Detection Sensor
Other
Urgency / Priority
*
Critical
High
Medium
Low
Work Performed
*
Parts / Materials Used
Outage Start Time
Hour Minutes
AM
PM
AM/PM Option
Outage End Time
Hour Minutes
AM
PM
AM/PM Option
Technician / Crew Name
*
Current Status / Completion Notes
Submit Maintenance Report
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