Road Diet Questionnaire

This form shall be completed when roadway projects are identified as a candidate for a road diet. See Roadway Design Guidelines (RDG) Section 2-1401.00 for further information.

Project Data:

PIN:
County:
Federal Project No.:
State Project No.:
Facility Type:	Roadway	Pedestrian	Bicycle	Shared-Use
Local Program Project:	Yes	No
Project Type:	New Alignment Reconstruction Resurfacing, Restoration, Rehabilitation (3R) Other maintenance	Road Diet Signalization Road Safety Audit Other:

Roadway Data:

Route:
Project Limits:
ADT:
Design Speed:
Posted Speed:
Functional Class:	Arterial	Collector	Local
Access Control:	None	Partial	Full

Questionnaire	Yes	No
Is the current Average Daily Traffic (ADT) greater than 25,000?
Is the current posted speed limit greater than 45 MPH?
Is the highway a diversionary route for an interstate highway?
Is the existing per hour/per lane peak hour volume greater than 1700?
Does the facility have a bus route with stops? (for 4 lanes to 3 lanes reduction requests)
Are there more than 10 driveways per mile present? (for 4 lanes to 3 lanes reduction requests)
Will the existing roadway pavement drainage be affected?

Table 1-1

A Road Diet can be implemented without further evaluation at roadway locations where the current traffic volume is less than 10,000 ADT and all Road Diet questionnaire responses are NO. A letter from the local agency indicating community support for a proposed Road Diet or an overriding safety justification letter by TDOT is required.

ALL Questionnaire Responses are NO and Traffic Volume is <10,000 ADT One of the following additional documentation is required.
Local Agency Coordination Letter	Yes No
TDOT Overriding Safety Justification Letter	Yes No

Table 1-2

Any project answering YES for any question in Table 1-1 will require further evaluation considering the Road Diet Context Elements listed under Road Diet Manual Section 6.5. Figure 11 should be used to determine if an Intersection/Corridor Analysis is needed. This request should include the following:

Questionnaire Responses are YES and Traffic Volume is >10,000 ADT and <25,000 ADT or <1700 veh/hr/ln The following additional documentation is required.
Traffic Engineering Study	Yes No
Intersection/Corridor Analysis of Existing Corridor (Use the flow chart)	Yes No
Local Agency Coordination Letter	Yes No
Plan Sheets	Yes No
Identified and Evaluated Context Elements Report	Yes No

Table 1-3

Completed/Submitted by:

Name:

Date:

Division/Firm:

Title:

Signature:	_______________________________