NEW JERSEY DEPARTMENT OF TRANSPORTATION
REGIONAL ELECTRICAL OPERATIONS
CONTRACTOR EMERGENCY CALL RECORD

Job No.	     	Today’s Date	     	
Location:	     	
State nature of trouble exactly as reported to you:	     	
     	
Trouble reported to you by:	     	Date & Hour	     	

1	WHAT YOU FOUND WHEN YOU ARRIVED AT THE INTERSECTION	
Indicate the nature of the trouble or damaged equipment:	     	
     	
Did you check the signal timing?		yes		no	
Was the signal timing as per the directive in force?		yes		no	
If “yes,” give the directive number & date:	     	
If “no,” indicate below the timing which you found: *	

Location (Phase)	Green	Yellow	Red	All Red	Green Arrow	Arrow Clearance	Walk	Pedestrian Clearance	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
						OFFSET:	     	

2	WHAT YOU DID AT THE INTERSECTION   (Complete only if repairs or timing alterations were required)	
Indicate all equipment removed, repaired, replaced or installed:	     	
     	
Did you restore the timing to conform to the directive in force?		yes		no	
If “yes,” give the directive number & date:	     	
If “no,” indicate below the TEMPORARY timing which you installed: * 	

Location (Phase)	Green	Yellow	Red	All Red	Green Arrow	Arrow Clearance	Walk	Pedestrian Clearance	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	
						OFFSET:	     	

Temporary timing authorized by:	     	(Indicate supervisor”s name, temporary timing directive 	
	number & date, or your name, whichever applies)	
Time Started:	     	Time Finished:	     	
				
Your signature:	Reviewed & Approved by:	

*	If it is more convenient to describe timing in
	words, do so on reverse.	(Complete reverse side)

Copy:  Resident Engineer, Manager, Traffic Engineering & Investigations, Controller Cabinet
Use the sketch below (or draw your own) to indicate the location of the trouble or damaged equipment:

Indicate North By Arrow in Circle

BRIDGE
GATES

Your Sketch:

Use this space for any additional information, which you believe, may be important and/or use for explanation of timing: