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Traffic Signal Request Form

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Traffic Signal Request Form

WHEREAS

WHEREAS, the Applicant asserts that traffic control at the location described below requires evaluation for the installation, modification, or removal of a traffic signal or related control device; and

WHEREAS, the Applicant understands that requests will be reviewed in accordance with established engineering standards, available funding, and public safety considerations, and that submission of this form does not guarantee approval or immediate implementation; and

WHEREAS, the Applicant agrees to provide accurate information and to cooperate with the reviewing agency during investigation, site inspection, and any required design or construction activities.

Applicant Information

Location of Requested Signal

If applicable, indicate exact intersection leg:

Existing Conditions

Current traffic control at location:

Traffic Data and Safety Information

Scope of Proposed Signal Work

Provide a clear description of the requested signal, modifications, or operational changes. Include lanes affected, pedestrian facilities, mast arms, detection, and any proposed phasing.

Funding and Payment Terms

Estimated cost to implement (if known):

Late fee for overdue payments (if applicable):

Proposed Schedule and Term

Requested earliest installation start date:

Requested completion or review end date:

Notice period for cancellation of applicant-funded work (days):

Attachments and Supporting Documentation

Indicate attachments provided with this request:

Justification and Narrative

Provide specific reasons why a traffic signal or other device is warranted. Explain safety concerns, operational deficiencies, and expected benefits.

Legal Certifications, Access and Indemnity

The Applicant certifies that the information provided in this request and any attachments is true, complete, and accurate to the best of the Applicant’s knowledge. Submission of false or misleading information is grounds for denial and may subject the Applicant to penalties under applicable law.

The Applicant grants the reviewing agency, its employees, contractors, and agents the right to access the identified site to perform inspections, data collection, surveying, and any reasonable preparatory work. The Applicant agrees to coordinate access and to obtain any necessary consents from property owners.

To the extent permitted by law, the Applicant agrees to indemnify, defend and hold harmless the reviewing agency and its officers, agents, and employees from claims, liabilities, losses, costs and expenses arising from negligent acts or omissions of the Applicant related to any applicant-funded design, construction, maintenance, or operation of traffic control devices.

Confidentiality, Governing Law, and Entire Agreement

Documents submitted may be maintained as public records in accordance with law. If the Applicant believes specific attachments contain confidential proprietary information, the Applicant must clearly identify such materials and assert a claim of confidentiality in writing at the time of submission. The reviewing agency will make determinations about confidentiality under applicable law.

This form, any attachments, and any subsequent written agreement reflecting approval of applicant-funded work constitute the entire agreement between the Applicant and the reviewing agency regarding the subject matter herein and supersede all prior communications. This form shall be governed by the laws of the state where the work is located. Governing law state:

Acknowledgement and Applicant Agreement

By checking the box below and signing, the Applicant acknowledges understanding of the review process, potential costs, and the fact that approval is subject to engineering evaluation, funding availability, and final agency determination.

For Agency Use Only

Recommendation:

Applicant Printed Name:

Signature:

Date:

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What the Traffic Signal Request Form Is and when it’s used

The Traffic Signal Request Form is a municipal or county application used to propose installation, modification, or removal of traffic signals at a specific roadway location. Typical users include traffic engineers, municipal staff, developers, property owners, and citizen petitioners who present safety, operational, or access concerns. The form collects site identification, traffic data, crash history, pedestrian and bicycle considerations, proposed timing or phasing, and recommended mitigation measures so transportation agencies can review feasibility, funding, and design impacts.

Why completing a clear Traffic Signal Request Form matters

A complete form focuses agency review, documents the safety justification, and creates a record for traffic studies and funding decisions. Clear, accurate submissions reduce review cycles, avoid costly redesigns, and ensure the requesting party’s issues are evaluated against established engineering standards.

Why completing a clear Traffic Signal Request Form matters

Who typically completes or submits this form

Submission pathways vary by jurisdiction; municipal public works or transportation departments provide specific intake instructions and local criteria for acceptance.

  • Municipal staff and traffic engineers: prepare technical justifications and coordinate studies with regional planning agencies.
  • Developers and property owners: submit as part of site plan approvals or access changes tied to new development.
  • Community members and neighborhood groups: request signals to address recurring safety concerns or pedestrian access needs.

Step-by-step: completing a Traffic Signal Request Form

Follow this sequence to prepare a complete, review-ready submission that aligns with agency processes.

  • 01
    Gather data: Collect crash history, traffic counts, and site photos before writing the request.
  • 02
    Fill location fields: Enter the precise intersection and any approach details required by the form.
  • 03
    Attach evidence: Include supporting documents as separate uploads or labeled page attachments.
  • 04
    Sign and submit: Sign the form, include contact info, and submit via the jurisdiction’s accepted channel.

Key components you should include in a professional submission

A complete request organizes justification, technical data, and administrative details so reviewers can evaluate safety, operations, and funding implications efficiently.

Site identification

Precise intersection name, nearest address, lane geometry, and any unique features such as medians, turn lanes, or transit stops that affect signal needs.

Date and timing

Date of request, observed peak hours, and any recurring event times that justify changes to signal timing or phasing.

Crash summary

Concise crash totals and patterns over a standard review period (commonly three years) with brief description of severity and collision types.

Traffic volumes

Observed or modeled vehicle and pedestrian counts by approach and time of day; include data collection dates and methods.

Supporting attachments

Photos, intersection sketches, signed petitions, engineering study excerpts, and any prior agency correspondence should be labeled and attached.

Requestor certification

Signature, printed name, title, and contact details. If submitted on behalf of an entity, include authorization statement or corporate contact.

Required data fields at a glance

Requestor: Name and organization
Contact: Phone and email
Location: Intersection and coordinates
Dates: Request and data collection dates
Attachments: Crash and count files
Signature: Signed or e-signed approval

Where to send the completed Traffic Signal Request Form

Most jurisdictions accept submissions through public works, transportation departments, or online municipal portals. Know the required intake address or electronic channel before submission.

  • Municipal Portal: Submit via the city or county online permitting system when available.
  • Email Intake: Send to the public works or traffic division email listed on the municipality site.
  • In-Person: Deliver to the transportation office when an electronic option is not offered.
  • Third-Party: Some agencies accept submissions through authorized consultants or project portals.

Configuring an online submission workflow

If you use an online form or eSignature platform, configure fields and attachments so reviewers receive a complete packet in one transmission.

Field Configuration
Requestor Details Required text fields with validation for phone and email
Location Field Free text plus optional GPS coordinate fields
Attachments Allow PDF, JPG, CSV up to common size limits
Signature Enable eSignature and date stamp fields

Digital submission and signing requirements

Retain copies of the signed submission and audit records for your files and for any follow-up appeals or clarifications.

  • File formats: PDF, DOCX, JPEG, and CSV are commonly accepted
  • Authentication: Email verification or stronger signer ID per local policy
  • Audit record: Save a timestamped audit trail for agency records

Typical timelines and processing expectations

Processing time varies by agency workload, funding cycles, and whether additional traffic studies are required. Track follow-up steps and expected response windows.

Initial assignment:

Agency assigns reviewer within 5–30 business days

Site inspection:

Inspection typically scheduled within 2–8 weeks

Traffic study request:

If needed, studies occur over several weeks to months

Decision or recommendation:

Agency issues recommendation after analysis; timing varies

Funding and implementation:

Installation depends on available budget and design lead times

Common mistakes that delay review

  • Submitting an incomplete location description or ambiguous intersection identifier, causing reviewers to request clarifications and delaying inspection scheduling.
  • Failing to attach crash reports or traffic counts; without supporting data, agencies often deny or defer requests pending additional studies.
  • Using nonstandard file formats or large image files that cannot be opened by municipal systems, which forces resubmission in accepted formats.
  • Omitting a signature or proper authorization when submitting on behalf of an organization, which can render the request administratively invalid.

Risks and consequences of incorrect or incomplete submissions

Administrative rejection: Form returned for correction
Delayed review: Extended evaluation timelines
Unfunded recommendation: No implementation without budget
Liability exposure: Inadequate data may affect risk allocation
Permit denial: Related permits may be denied
Appeal costs: Additional studies or legal review required

Common eSignature vendor comparison for handling this form

Platforms differ on pricing, bulk send, and compliance features. signNow is listed first to align with vendor-format guidance.

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Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Yes Yes Yes Yes
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies Varies Varies

Frequently asked questions about the Traffic Signal Request Form

Answers to common submission and processing questions to help avoid delays and ensure your request is complete.


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