Inventory Forms



NEW JERSEY DEPARTMENT OF TRANSPORTATIONITS ASSET MANAGEMENT SYSTEM [TRAFFIC SIGNAL SITE] ITS-100-002-Rev 2 Oct 2017Project Name: FORMTEXT ?????Project Manager: FORMTEXT ?????Designer: FORMTEXT ?????Fed. Project Number: FORMTEXT ?????Contract Number: FORMTEXT ?????UPC No: FORMTEXT ?????DP No: FORMTEXT ?????Site Identification NameRoute:000 FORMDROPDOWN Mile Marker: FORMTEXT 000.000Direction/Lane: FORMDROPDOWN Letter: FORMDROPDOWN Site InformationFacility Owner: FORMTEXT ?????Latitude: FORMTEXT ?????County: FORMTEXT ?????Longitude: FORMTEXT ?????Municipality: FORMTEXT ?????Signal Head no from TS Plan: FORMTEXT ?????Serving Area: FORMTEXT ?????Control Section No: FORMTEXT ?????Controller ID: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Directive No: FORMTEXT ?????Distance from edge of pavement(ft.): FORMTEXT ?????Directive Date: FORMTEXT ?????Intersection name from current Timing Directive: FORMTEXT ?????Fallback Operation: FORMTEXT ?????Traffic Signal Management System: FORMTEXT ?????If coordinated, reference intersection name: FORMTEXT ?????Zone No: FORMTEXT ?????Lane closure required:? NO ? FORMDROPDOWN Bucket truck required:? NO ? FORMDROPDOWN Signal CabinetCabinet Location: FORMTEXT ?????Filter Installed: FORMTEXT ?????Cabinet Size: FORMTEXT ?????Filter Type: FORMTEXT ?????Skirt height, if Provided: FORMTEXT ?????Filter Dimension: FORMTEXT ?????Cabinet Access Type: FORMTEXT ?????Located in Clear Zone: FORMTEXT ?????Distance from edge of pavement (ft.): FORMTEXT ?????If HeatedMake: FORMTEXT ?????Model: FORMTEXT ?????Serial number: FORMTEXT ?????Signal ControllerNEMA Type: FORMTEXT ?????Software version: FORMTEXT ?????Manufacturer: FORMTEXT ?????Model: FORMTEXT ?????Serial Ports: FORMTEXT ?????IP Address: FORMTEXT ?????Serial Number: FORMTEXT ?????MAC Address: FORMTEXT ?????List all cards in the controller: FORMTEXT ?????Ethernet Ports(Copper ports In/Out): FORMTEXT ?????Signal Controller/Image Detection Management System Component at SiteTraffic Signal System: FORMTEXT ?????If In Sync, adaptive processor detail :( size etc.) FORMTEXT ?????Serial Number: FORMTEXT ?????System IP Address: FORMTEXT ?????Model number: FORMTEXT ?????System Firmware version: FORMTEXT ?????If In Sync, Vehicle Image Detection System:? In Sync ? In Sync Tesla ? In Sync FusionDetection System Firmware version: FORMTEXT ?????If SCATS, controller card type: FORMTEXT ?????Acceptance Date Site Deployment: FORMTEXT ?????Acceptance Date Sub System Integration: FORMTEXT ?????Acceptance Date System Integration: FORMTEXT ?????ElectricalElectrical Job Number: FORMTEXT ?????Meter Cabinet Lat: FORMTEXT ?????Power Source? Load Center ? Pole Number FORMTEXT ????? FORMTEXT ?????Meter Cabinet Long: FORMTEXT ?????Meter Cabinet Size: FORMTEXT ?????Meter number/Account Number: FORMTEXT ?????Power Company: FORMTEXT ?????Power Requirement: FORMTEXT ?????Surge Suppressor: FORMTEXT ?????Project Installed under: FORMTEXT ?????Manufacturer: FORMTEXT ?????Installer: FORMTEXT ?????Handover date to NJDOT: FORMTEXT ?????Communication ? Fiber? Wireless? ISPIf ISP Service, Include The FollowingISP Name: FORMTEXT ?????Service Type: FORMTEXT ?????Service Details (Static IPs, Bandwidth etc) FORMTEXT ?????Pole No: FORMTEXT ?????Account No: FORMTEXT ?????PO Box: FORMTEXT ?????ISP Service Handover date to NJDOT: FORMTEXT ?????Network Backhaul, If Fiber or Wireless (NJDOT Network)Device Type: FORMTEXT ?????Firmware version: FORMTEXT ?????Model: FORMTEXT ?????Backhaul Device IP: FORMTEXT ?????Serial no: FORMTEXT ?????Subnet Mask: FORMTEXT ?????Software version: FORMTEXT ?????Default Gateway IP: FORMTEXT ????? FORMTEXT ?????Backhaul Device MAC ID: FORMTEXT ?????Image Detector ModulesImage Detector No 1 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 2 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 3 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 4 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 5 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 6 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 7 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Detector No 8 ?YES ?NODetector Location Latitude: FORMTEXT ?????Detector Location Longitude: FORMTEXT ?????Manufacturer: FORMTEXT ?????Interface Panel IP address, if applicable: FORMTEXT ?????Model : FORMTEXT ?????Subnet mask: FORMTEXT ?????Serial Number: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????Software Version: FORMTEXT ?????Accept TS2 Time set Commands: FORMTEXT ?????Chassis Number: FORMTEXT ?????Detector Port Protocol: FORMTEXT ?????Slot Number: FORMTEXT ?????Detector Port Master Type: FORMTEXT ?????Site Acceptance Date: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Project Installed Under: FORMTEXT ?????Installer: FORMTEXT ?????Detector Port Master CPU ID: FORMTEXT ?????Area of View (no and type of lanes and distance covered): FORMTEXT ?????Time Zone: FORMTEXT ?????Geo Coded Site Image File Name attached: FORMTEXT ?????Approach name: FORMTEXT ?????Approach Direction:Warranty Start Date : FORMTEXT ?????Warranty End Date: FORMTEXT ?????Technical Support Start Date: FORMTEXT ?????Technical SupportEnd Date: FORMTEXT ?????Associated Radar Detector ModulesSITE ID 1 FORMTEXT ?????Pole Location Latitude: FORMTEXT ?????Pole Location Longitude: FORMTEXT ?????If Detector Cabinet is not co-located with sensor inputLatitude: FORMTEXT ?????Longitude: FORMTEXT ?????Acceptance Date: FORMTEXT ?????SITE ID 2, if applicable FORMTEXT ?????Pole Location Latitude: FORMTEXT ?????Pole Location Longitude: FORMTEXT ?????If Detector Cabinet is not co-located with sensor inputLatitude: FORMTEXT ?????Longitude: FORMTEXT ?????I Hereby Certify That All of the Above Information Is Accurate As Constructed to the Best of My Knowledge.Submitted By: FORMTEXT ????? Date: FORMTEXT ?????Contractor’s Number: FORMTEXT ????? Contractor: FORMTEXT ????? ................
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