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Job Num
ber: B
ridge ScopingStatewide Scoping Package Master Checklist
BRIDGE CSM/CPM (Refer to Chapter 7 of the Scoping Manual for Details)
II. Project Scoping Document Package
Bridge Scoping Report & Details Worksheet MPINS Project Concept Statement
Trns*port (Itemized Estimate Report & Project Concept Estimate Report)
Constructability Checklist
I. Job and Scoping Package Information (Major Only - see page 2 for additional information)
Engineer's Estimate R&
RT&
SC
PM
Hand Calculations & Assumptions
Oth
erBy Template, if checkbox appears, item is required (unless otherwise noted).
General Items & Information
Proposed Pavement Recommendations (if applicable)
Included in Package?
Soils Information and Recommendations (If applicable, From Region Soils Engineer)
NA
TSC QC By: Date: Region QA By: Date:
Scoped By: Date:
Proposed Fix:Location:
Culvert Scope Inspection Form (for applicable templates)
Construction Cost:Construction Engineering (CE) Cost:
Preliminary Engineering (PE) Cost:Right-of-Way Cost:
Current Year RSL: Construction Year RSL:YearValue Prop Fix Life: Yrs
YesYesYesYes NAYes
Sufficiency Rating:
Page 1 of 2
Details / Checklist
Statewide Scoping Package Master Checklist - Bridge Yes
Program Revision Request (Form 2604)
Traffic
Preliminary MOT ConceptMobility AnalysisTraffic Analysis & Safety Review
Geometric Summary Review (reviewed and/or addressed per the 3R/4R Guidelines)
As-Builts/Old PlansCurrent Sufficiency Report Condition Reports for Existing Sewers (if applicable)
NBI Rating:
Brid
ge C
SM
Brid
ge R
plc
Brid
ge R
ehab
Brid
ge C
PM
%
Total Project Cost:
Control Section:Route:
Job Number:
Template:CS EMP:CS BMP:
Length:PR EMP:PR BMP:
Length:
PR Number:
Structure ID:
Featured Intersection: Route Over:
Michigan Department of Transportation
0594 (10/15)
Highway Safety Manual Analysis (Not Mandatory)
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Project Van Tour Notes or Other Project Constraints
Existing Utility Information Field Review Notes
Previous Call For Projects Information
ROW Sheets with Impacts Highlighted http://mdotwas1.mdot.state.mi.us/public/ROWFiles/index.cfm
CP
M
R&
RT&
S
Oth
erN
A
Supporting Photos (Road Approach)
Statewide Scoping Master Package Checklist
Additional CS, PR, Direction and Etc Information (other than the major listed on page 1)
Page 2 of 2
III. General Items and Background Information
Is the project to be packaged with other projects?
List potential package job numbers & templates
Yes No
Correspondence
Pavement Historical Database (PHD) Data (if applicable)Maintenance Log Sheets
Additional Information Resulting from the Worksheet
Has the project been added to ProjectWise?
Bridge Scoping Report Executive SummaryField Site ReviewRehabilitation OptionsSummary of Repair RecommendationMaintaining Traffic/Mobility SummaryAppendix:
PhotosBridge Rehabilitation Scoping Checklist (Form 1891)Estimate Sheets for Each OptionField Notes & SketchesExisting Plan Sheets (General Plan of Site & General Plan of Structure)Current Bridge Inspection Reports:
Bridge Safety Inspection Form (Form 2502)Bridge Analysis Report (Form 231)
Bridge Underclearance Measurements (Form 1190)Detail Beam Survey Report (Form 267) (If available/applicable)
Diver Inspection Report (If available/applicable)
Yes
Brid
ge R
ehab
Brid
ge C
SM
Brid
ge R
plc
Brid
ge C
PM
Condition Reports for Existing Culverts (if applicable)
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET (Refer to Chapter 7 of the Scoping Manual for Details)
III. Typical Cross SectionsExisting Typical: (Bridge/Road Approach)
Proposed Typical: (Bridge/Road Approach)
II. Executive Summary
I. Job and Scoping Package Information (Major Only)Job Number: Control Section:
Route:
Template:CS EMP:CS BMP:
Length:PR EMP:PR BMP:
Length:
PR Number:
Structure ID:
TSC QC By: Date: Region QA By: Date:
Scoped By: Date:
Proposed Fix:Location:
Page 1 of 13
Featured Intersection: Route Over:
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
IV. Existing Conditions (Typical)
B. Existing Approach - Mainline:Type: HMA Concrete Composite
Mainline Pavement Depths: Agg Base: Subbase:in in inApproach Pavement: Agg Base: Subbase:in in in
CompositeHMA Design Speed: mph
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
Structure Type:
NBI Rating:
Structure Length: Reference A Width: Deck Area:ftft sft
Condition Ratings
#58 Deck:#59 Superstructure: #60 Substructure:
#58A Deck Surface:
Is the structure scour critical?Is the structure fracture critical?
If yes, # 113 scour rating?
A. Existing Structure Features and Ratings
Reference B Width: ftSkew Angle: degrees
Sufficiency Rating:#58B Deck Bottom Surface:
Bridge Rail Condition:Bridge Rail Type:
Are any of the bridge elements considered historic? Yes No
Is the structure considered structurally deficient?Is the structure considered functionally obsolete?
Page 2 of 13
Is there existing pedestrian fencing?Is there an existing HMA overlay?
Yes NoYes No If yes, HMA thickness?
#59A Paint
inExisting beam type?
Section Loss Joint Condition
Are there any temporary supports?
If yes, what elements?
How many temporary supports are in place?What is the condition of the existing temporary supports?
Right Shoulder Left ShoulderPaved Width: Paved Width:
Total Width: Total Width :
HMA Concrete CompositeType:Widths:
ftft
ftft
Aggregate (Only)
Shoulder Pavement Depths: Agg Base: Subbase:in in inShoulder Pavement: Agg Base: Subbase:in in in
Are there existing sleeper slabs?Is there a wide-flanged beam terminal joint?
Yes No UnknownYes No Unknown
C. Existing Approach - Shoulder:
Yes NoYes NoYes NoYes NoYes No
If yes, which one?
Measure:
Is there evidence of scour? Yes No If yes, what elements?
No. of Spans:
Not Applicable?
Not Applicable?
Number of Lanes: Lane Widths: Posted Speed: ft mph
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Existing Bridge Cross Slope?
Superelevations meet Standard?
Horizontal Curve(s) meet Standard?Vertical Curve(s) meet Standard?
Lanes Shoulders
Is the structure superelevated?
% %
Is the structure curved?
Other notes on geometrics and/or existing super rates:
Yes NoYes NoYes NoYes NoYes No
Parabolic Cross Slope? NoYes NA
E. Existing Photos: (If applicable per proposed Scope)
F. Existing Geometrics:
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
Page 3 of 13
Other notes on existing ramps:
Full Accel/Decel Lanes Present on the Structure? Length: ft
Lane Tapers Present on the Structure?Yes NoYes No
D. Existing Ramps on the structure:
Elevation views (both sides of bridge)Deck surface, joints and railingApproaches
Underside of DeckSuperstructure Elements (beams, bearings, pin & hanger and etc)Substructure Abutments (including slope protection) and piersWaterways/Railroad tracksMajor deterioration areasSigns (vertical clearance signs, load posting signs or etc)UtilitiesQuadrant photos
Included NA
Included NA
Included NAIncluded NA
Included NAIncluded NAIncluded NAIncluded NAIncluded NAIncluded NA
Included NA
Not Applicable?
Not Applicable?
Building Location Relative to Structure Included NA
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
G. Existing Guardrail or Median Barrier: (attached to bridge rail)Existing Guardrail?
Existing Median Barrier?Existing Glare Screen?Existing Attenuators?
Yes No
Yes NoYes NoYes No
Existing Guardrail Retrofit?Existing Guardrail Anchorage?
Yes NoYes NoYes No
Type: Condition:Length:
Condition:Length:Condition:Length:
Type:
Number:
ft
ftft
Type: Length: ftType: (choose or enter text)
H. Existing Utilities: (on the structure)Existing Private Utilities?Existing Public Utilities?
List Utility Type & Info
Existing Water Mains? Condition:
Existing Asbestos?
Yes NoYes NoYes No
Yes No
USGS Stream Gauging Station? Yes No
I. Existing Signals: (on the structure)Existing Signals?
Existing Ped Signals?Number of Intersections:
Existing Ped Push Buttons?
Existing Traffic Loops?Existing Flashers?
Yes NoYes NoYes NoYes No
Yes No Unknown
Page 4 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
Existing sidewalk? Barrier separated?:Width: ftYes NoSidewalk location
Yes No
Existing non-motorized?
Are ramps ADA compliant?
Number of ramps:Existing sidewalk ramps? Condition:Number of non-compliant ramps:
Width: ft Barrier separated?: Yes NoYes NoYes NoYes No
J. Existing Sidewalk or Non-Motorized Facility: (on the structure)
Not Applicable?
Not Applicable?
Not Applicable?
Not Applicable?
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
K. Existing General Conditions: (some items below will require photos - see manual)
Existing railroad crossings?
Is there an Access Management Plan for the project area?Is there an EA or EIS Study for the project area?
Existing freeway lighting attached?Existing ITS facilities attached?
Is this a Corridor of Significance?
L. Other General Notes on Existing Conditions:
Existing truss or cantilever signs attached? Number:
Existing slope stability issues?Existing erosion issues?
Existing maintenance issues/concerns?
Existing raised pavement markers?
Type:
Existing settlement areas?
Type:
Existing airport in the vicinity?
Page 5 of 13
Are the sign mounts welded to the structure?Are the sign mounts bolted to the structure?
Yes NoYes No
Yes NoYes No
Yes NoYes No
Yes NoYes No
Yes NoYes NoYes NoYes No
Yes NoYes NoYes No
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
Existing trees or brush within Clear Zone? Yes NoExisting encroachments within Clear Zone? Yes No Type:
Is this on a National Truck Network? Yes No
Is there evidence of pedestrian activity leading up to the structure?
Yes No
Does the community or communities have a Complete Streets Policy? NoYes
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Epoxy overlay?
Patch isolated spalls?
Replace joints? Type:
Bridge railing work? Length: ft
HMA overlay with waterproofing membrane?
Concrete deck patching?
Other fix or notes on superstructure and/or deck rehabilitation:
Beam end repairs? Material:
Reinforcing plates and/or angles?
Pin & hanger replacement? Number: eaAll?If selected number list quantity and location:
Structure painting?
Bearing replacement?
Location:Type:
Number: eaRocker re-alignment? Number: ea
Yes No
HMA overlay without waterproofing membrane?
Deck Drain Extensions?
Structural steel repairs?
Yes NoYes NoYes NoYes NoYes NoYes NoYes NoYes NoYes NoYes NoYes No
Yes NoYes NoYes NoYes No Number: ea
V. Proposed Structure WorkA. Proposed Superstructure and/or Deck Rehabilitation
Type:
Page 6 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
B. Proposed Substructure RehabilitationConcrete spall patching? Abutment area: sft Pier area: sft
Other fix or notes on substructure rehabilitation:
Yes NoTemporary supports? Yes No
Not Applicable?
Not Applicable?
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Replace bridge railing? Length: ftBlock out existing railing with thrie beam?Upgrade approach guardrail?Concrete filler wall between pier columns?Guardrail for pier protection?
Other fix or notes on safety upgrading:
Length: ftLength: ftLength: ftLength: ft
Pedestrian fence? Length: ft
Yes NoYes NoYes NoYes NoYes NoYes No
C. Proposed Miscellaneous RehabilitationScour analysis required?Scour Erosion/erosion repairs (add notes below)?
Replace approach pavement?Repair slope protection?Park or business concerns?
Other fix or notes on miscellaneous rehabilitation:
Scour countermeasures?
Yes NoYes NoYes NoYes NoYes NoYes No
Length:
D. Proposed Safety Upgrading
Page 7 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
E. Proposed Approach - Mainline:
Number of Lanes: Lane Widths: Pavement Thickness: Agg Base: Subbase:
Design Speed: ftType: HMA Concrete Composite
in in in
Do the proposed widths result in any widening?
List all work type(s) and related fix life(s):
Yes NoProposed sleeper slabs? Yes No Unknown
Approach Length: ft
Not Applicable?
Not Applicable?
Not Applicable?
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
F. Proposed Approach - Shoulder:
Page 8 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
G. Proposed Geometric Corrections:
Type:Right Shoulder Left Shoulder
Paved Width: Paved Width: Total Width: Total Width :
HMA Concrete Composite
Widths:
Pavement Thickness: Agg Base: Subbase:
ftft
ftft
in in in
Do the proposed widths result in any widening?
Aggregate (Only)
Yes NoWill the existing shoulders be left in place in the proposed project (if yes, continue)?
Will the existing shoulder be used for Maintaining Traffic (if yes, continue)?
Yes No Unknown
Yes No Unknown
Are shoulder cores for the existing shoulders needed?Are existing shoulder cores available?
Is the existing shoulder density 92% or greater?Is the existing shoulder density 90% or greater?
Yes No UnknownYes No UnknownYes No UnknownYes No Unknown
YesYes
Proposed Normal Section Cross Slope: Lanes:
Superelevation Modification(s)?
Other notes on geometrics and/or existing super rates:
%Cross Slope Modification(s)? Yes No
Yes NoHMA Wedging? No
NoHMA Wedging?
Proposed Guardrail? Type: Length:
Proposed Median Barrier? Length:
Proposed Glare Screen? Length:
Proposed Attenuators?
Type:
Type: Number:
ft
ftft
Yes No
Yes NoYes NoYes No
Proposed Guardrail Retrofit?Proposed Guardrail Anchorage?
Type: Length: ftYes NoYes No
Type: (choose or enter text)
Proposed Signals?Proposed Flashers?Proposed Ped Signals?
Number of Intersections:
Proposed Ped Push Buttons?
Proposed Traffic Loops:Yes NoYes NoYes NoYes No
Yes No
Proposed non-motorized?Proposed sidewalk? Barrier separated?Width:
Number of ramps:Proposed ADA ramps?
ftWidth: ft Barrier separated?
Yes NoYes NoYes No
Yes NoYes No
H. Proposed Guardrail or Median Barrier: (attached to bridge rail)
I. Proposed Signals: (on the structure)
J. Proposed Sidewalk or Non-Motorized Facility: (on the structure)
Not Applicable?
Not Applicable?
Not Applicable?
Not Applicable?
Not Applicable?
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Page 9 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
K. Proposed General Conditions:
Proposed freeway lighting attached?
Proposed truss or cantilever signs?
Proposed ITS facilities attached?
Number:
Proposed railroad impacts?
Proposed slope stabilization work?
Proposed ROW fence replacement?
Will a Phase I Site Assessment be needed?
Proposed erosion control items?
Is the proposed work consistent with an EA or EIS Study for the proposed project?
Any features from an existing Access Management Plan being incorporated into the proposed project?
Yes NoYes NoYes NoYes NoYes NoYes NoYes NoYes NoYes No
Yes No
L. Other General Notes on Proposed Improvements:
VI. Bridge Underclearances (see Design Manual for Details)Corridor Underclearance Requirements (14' 6” or 16'):
Structures underclearance requirements:Grade separated facilities:
Grade separated railroad meet underclearance requirements (23'): Yes No NARR Horizontal Clearance: lt rt
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Lane WidthDesign Speed
Shoulder WidthBridge WidthStructural Capacity Cross Slope
GradeVertical (SSD)Vertical AlignmentVertical Clearance
Horizontal Clearance SuperelevationHorizontal Alignment Accel & Decel LengthsHorizontal (sightline offset)
VII. Anticipated Design Exception(s) (check all that apply)
IX. Environmental Information
Statutory Participation (Act 51)
Drainage AgreementCorp of EngineersCounty Drain (for review, not permitting)
DEQParking AgreementsUtility Relocation AgreementsNon-motorized Maint. Agreements
Participation (other)Variance (noise, other...) Maintenance AgreementsFAA (obstruction evaluation)
VIII. Permits & Agreements Required (check all that apply)
Page 10 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
X. Stakeholder InformationProposed Activity Level of Stakeholder Engagement
Level ILevel IILevel IIILevel IVLevel V
Yes NoYes NoYes NoYes NoYes No
XI. Supplemental InformationIs this project in an Metropolitan Planning Organization (MPO)?
Is there pavement coring information available?Is there survey information available?
Will there be FHWA Oversight on this project?
Will there be Multi-Modal or Modal Connectivity opportunities?Have different alternatives been analyzed?
Will a Value Engineering (VE) be required (cost > $25 Million)?Yes No UnknownYes No UnknownYes No UnknownYes No UnknownYes No UnknownYes No UnknownYes No Unknown
Not Applicable?Wetland impacts?Floodplain impacts?Known contamination sites (LUST, etc...)?Known threatened or endangered species?
Approx Acreage:100 Yr Flood Elev:
Yes No UnknownYes No UnknownYes No UnknownYes No Unknown
Known archaeology? Yes No UnknownTribal coordination required? Yes No Unknown
Not Applicable?
Not Applicable?
Known historic bridges or other structures?
Tree removals and/or replacements?River or stream impacts?
Clearing required?Yes No UnknownYes No UnknownYes No UnknownYes No Unknown
Impacts to local park facilities (4F, 6F)? Yes No UnknownImpacts to US National Forest land? Yes No Unknown
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
XII. Site Visit Notes
Page 11 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Please list any known traffic restrictions (including detour route)
XIII. Traffic and MobilityA. Maintenance of Traffic (MOT) Scheme:
Please give a brief description of MOT plan (including detour route)
Full Closure:
Full Detour Route:
Combination:Closure Type:Traffic Routing:
Will detour route utilize local roadways?If yes, will local approval of the detour route be attainable?Will detour route require improvements?
On existing Route:
Will project require pedestrian detours?
B. Safety Items:
C. Mobility (see Mobility Manual):Existing Capacity Analysis (includes V/C calc, travel time, LOS, etc) Proposed Capacity Analysis (includes V/C calc, Delay Worksheet, LOS, etc)Preliminary Transportation Management Plan (TMP) (if applicable)
Traffic Restrictions?
Other Delay Mitigation Notes:
Delay Mitigation Measures:
Brid
geC
PM
R&
RT&
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Oth
er
Page 12 of 13
Yes No UnknownYes NoYes NoYes No Unknown
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
Yes No
Temporary CrossoversTemporary Widening
Incentive/ Disincentive
Night or Weekend WorkMobile ClosureFlag ControlTemporary Signal
Lane Rental
Dynamic Lane Merge System
A + B
Moveable Temp Barrier
Part width Construction:Directional Detour Route:
Signed Alternate Route:
Has this project been identified on the FHWA Transparency Report? http://safety.fhwa.dot.gov/hsip/fivepercent/
Safety Review/Crash Analysis
TOR Package a. TOR Calculation Spreadsheet b. UD-10s; Only for miss codings or additional crashes
Geometric Sketch
Has this proposed project been identified on the High Crash List? YearYes NoYes No
Highway Safety Manual Analysis (Not Mandatory)
Year
Crash History (Information from One Line Listing)
NA
MDOT 0594 (10/15)Job N
umber:
Bridge Scoping
Transportation Alternatives Program
Tree Removals
XIV. Concept Statement Info (check all that apply)
Adjacent JobsBridge PaintingContaminated Site in AreaCrosses FarmlandCrosses Streams/Lakes/DrainsDetour or Road/Ramp Closure
Heritage RouteHigh Tourist RouteNatural/Federal Landmarks
Over 5 Acres Earth DisturbanceReduced Traffic FlowROW/Grading Permit on Recreational PropertyROW/Grading Permit on Farmland
Work Outside of Existing Shldr/Curbs Work Outside Toe of Slope
Over 1 Acre Earth Disturbance
Change in Bus Access/ParkingControversialCrosses FloodplainsCrosses WetlandsDisplacements of Residences/Businesses
Hazardous MaterialsHigh Impact ProjectHistoric Bridge
Public ControversyRip Rap RequiredROW/Grading Permit NeededTraffic GeneratorsWidening of Road or Bridge
Engineering Survey RequiredEnvironmental Issues
Other Environmental IssuesOther
Agency Permit Required
Page 13 of 13
BRIDGE CSM/CPM SCOPING REPORT & DETAILS WORKSHEET
Community or Communities have Complete Streets Policy