Pedestrian Signal Inspection Form 
                                                                       Must be filled out for all new pedestrian signals installed in County 
                                                                       right-of-way in Sacramento County. This from must be filled out and  
                                                                       submitted within ten days of signal installation to the SacDOT  
                                                                       Program Access Coordinator. 
 
 
          Pedestrian Signal Location:     Project Name:_______________________________ 
 
      . N/E     . N/W    . S/E     . S/W 
 
 

N/S STREET_______________________________               E/W STREET______________________________

 
   Pedestrian Signals per County Standard Drawings:  Check One: 
 . Vertical Curb . Rolled curb   . One Ramp     . Two Ramps 
 
STANDARDS: 
- EACH PUSH BUTTON LOCATED WITHIN 60" OF EXTENDED CROSSWALK LINE, AND 120" FROM OTHER BUTTONS. 
- EACH PUSH BUTTON LOCATED 120" MAX. AND 30" MIN. FROM CURB LINE. 
- PUSH BUTTON PARALLEL TO DIRECTION OF CROSSING. 
- CLEAR SURFACE SPACE OF 30" X 48" AT PUSH BUTTON. 
- HEIGHT TO C.L. OF PUSH BUTTON FROM 42" TO 46" MAX. 
- MAX. 5 LBS. OF PRESSURE TO OPERATE. 
- LOCATOR TONE FROM 2 DB TO 5 DB, & ABOVE AMBIENT. 
 
IF ONE PUSH BUTTON IS PRESENT: 
       A: 
HEIGHT OF PUSH BUTTON (IN.): _______________________ 
DIAMETER OF PUSH BUTTON (IN.): ____________________ 
ACCESSIBLE SIGNAL OPERATIONAL (Y/N): _________________ 
LOCATOR TONE OPERATIONAL (Y/N): _________________ 
PUSH BUTTON PARALLEL TO DIRECTION (Y/N): _________ 
 
 
IF TWO PUSH BUTTONS ARE PRESENT: 
       B: 
HEIGHT OF PUSH BUTTON (IN.): _______________________ 
DIAMETER OF PUSH BUTTON (IN.): _____________________ 
ACCESSIBLE SIGNAL OPERATIONAL (Y/N): __________________ 
LOCATOR TONE OPERATIONAL (Y/N): ___________________ 
PUSH BUTTON PARALLEL TO DIRECTION (Y/N): __________ 
                                                          STREET NAME: _______________________________ 
 
ANY CONDITIONS NOT IN COMPLAINCE WITH THE   DRAW LOCATION OF PUSH BUTTON(S) AT 
STANDARDS LISTED ABOVE__________________________ THE PROPER LOCATION (IF ONLY ONE RAMP, 
__________________________________________________  DRAW BUTTON LOCATION ON RAMP A) 
__________________________________________________ 
 
Inspected/measured by (print):_____________________  Date Field Measured:__________________ 
 
See reverse side for Compliance with Standards. 
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Pedestrian Signal Inspection Form 
 
Compliance with Standards: 
 
Note:  All pedestrian signals should comply with SacDOT’s current design and construction standards. Where it is infeasible to install pedestrian signals to current standards, the Designer or Inspector must complete the Findings for Non-compliance Element(s) section below and state what the non-compliant element(s) are and the reason for the non-compliance. A drawing or picture can be included in the box below. After completing this form, submit it to the SacDOT Program Access Coordinator for acceptance and then signature by the Director of SacDOT. 
 
Findings for Non-Compliance Element(s):  _______________________________________________ 
___________________________________________________________________________________ 
___________________________________________________________________________________ 
___________________________________________________________________________________ 
___________________________________________________________________________________ 
___________________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Picture or Drawing, if needed 
 
______________________   _______________________   _______________________   __________________________ 


  Designer/Inspector   Date  Reviewed by             Date  Approved by SacDOT          Approved by Chief, Disability 
                                             Program Access Coord.      Director                     Date    Compliance, Sac. Co.      Date 
 
___________________   __________________   ___________________   ______________________ 
Designer/Inspector Signature  Reviewed by Signature  SacDOT Dir. Signature       Chief Disability Comp. Signature 
                                                                                                     Page 2