TE-401 (8-11) PREVENTATIVE MAINTENANCE REPORT CLOSED .

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TE-401 (8-11)PREVENTATIVE MAINTENANCE REPORTCLOSED CIRCUIT TELEVISION CAMERAPLEASE TYPE OR PRINT IN BLUE OR BLACK INK ALL INFORMATIONDEVICE TYPE:DATE (mm/dd/yyyy):www.dot.state.pa.usDISTRICT ID:TIME:STATEWIDE ID:COUNTY:STATE ROUTE (S.R.):SERIAL/RFID NUMBER:DIRECTION:LOCATION (Mile Marker/Segment-Offset):VERIFIED AT SITE:YESNOLATITUDE/LONGITUDE:TIME ARRIVING AT SITE:TIME LEAVING SITE:DESCRIPTION OF PROBLEM(S):CORRECTIVE ACTIONS TAKEN:PROBLEM(S) CORRECTED:YESNOPARTS:LABOR/EQUIPMENT/TRAFFIC CONTROL:ADDITIONAL COMMENTS:By signing below, the signee confirms that all four preventative maintenance checklists (General, Device, Cabinet, and Communicationsand Electrical Service) and the ITS Structures Preventative Maintenance Guide have been completed, and that all checklist items receivinga rating of Fair or Poor have been reported above.Printed NameSignatureDate (mm/dd/yyyy)Company-1-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKGeneral ChecklistCOMPLETED?G001Check clearance of tree branches or brush around powerand communication lines. Report required tree trimmingand/or brush clearing work.G002Check that CCTV system is adequately protected byguiderail. Report damaged guiderail.G003Check for damage (lightning, leaning, car impacts,vandalism, etc.). Repair as necessary.G004Verify that the ITS site plans, ITS system block diagrams,electrical details/wiring diagram, and any other necessaryrecords are located in the cabinet.CONDITION (Select NON/AExcellentGoodFair*Poor**Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-2-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistD001Perform preventative maintenance in accordance with themanufacturer's recommendations and as follows:D002Check for proper clearance of tree branches or brush;schedule any required trim work.D003Inspect for general condition, wear, rust, cracks, looseconnections, frayed cables, and damage caused by(lightning, weather, car impacts, vandalism, etc.). Repairas necessary.D004Inspect camera housings for wear, rust, cracks, looseconnections, and frayed cables. Repair/replace asnecessary.D005Note and replace any missing, damaged, rusted, cracked,or bent parts.D006Inspect mounting hardware (anchor bolts, poleattachment) for rust, cracks, etc. Repair/replace asnecessary.D007Check camera alignment (for barrel cameras only).D008Visually inspect all camera equipment for wear andcorrosion. Replace substandard equipment.D009Inspect enclosure window and lens. Clean glass withsuitable glass cleaning agent in/out.D010Operate PTZ (Pan-Tilt-Zoom) for all functions to theirextreme limits to ensure full operation and proper focus/zoom functions.COMPLETED?CONDITION (Select GoodFair*Poor*(checklist continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-3-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistD011Check operation of auto-iris and adjust for correctoperation per operational and maintenance manual.D012Check for tightness of all internal hardware.D013Inspect all wiring harnesses and interconnecting cableassemblies/connectors for tightness, wear, and corrosion.Correct as required.D014Check camera housing pressure (typically 5psi /- 1psi).Pressurize per Manufacturer's Instructions if not withinlimits and document readings on the maintenance reportform.D015Visually inspect all exposed grounding systems at thedevice for corrosion and damage.PERFORM THE FOLLOWING FOR THE CAMERALOWERING DEVICE (CLD)COMPLETED?CONDITION (Select air*Poor*COMPLETED?CONDITION (Select One)ExcellentGoodFair*Poor*D016Perform preventative maintenance in accordance with themanufactures recommendations and as follows:YESNON/AD017Verify that CLD cables are not stressed while camera islocked at top of pole.YESNON/AExcellentGoodFair*Poor*D018Lower camera per manufacturer's instructions. Verify thatthe camera lowers without difficulty, and can be locked atany point in the lowering process (including ground level).YESNON/AExcellentGoodFair*Poor*D019Visually inspect electrical and mechanical connections ofcamera housing for wear, corrosion, weather damage, andany other damage. Repair/replace where t continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-4-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistD020Visually inspect CLD cable for frays, elongation, andcorrosion (where visible).D021Return the camera to the top of the pole using theCLD. Verify that the camera locks into place and, uponreconnection, fully re-starts without manual initiation.D022Lubricate lock/crank assembly with an acceptablelubricant (per manufacturer's recommendations).COMPLETED?CONDITION (Select cument all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-5-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistC001Check the condition of surface and general cabinetappearance for damage (paint, damage, and graffiti).C002Check cabinet door and locking mechanism for properclosure. Adjust or repair if needed. Lubricate hinges andlock.C003Inspect and change filters where applicable.C004Check weatherproof seal (gasket).C005Remove any snow or brush from doorway opening or areasurrounding cabinet.C006Inspect cabinet mounting hardware (anchor bolts, poleattachment) for rust, cracks, etc. Tighten if necessary.C007Check for water accumulations and duct sealant.C008Clean and vacuum inside of cabinet and equipment toremove dust.C009Check light bulbs and replace where applicable.C010Check and inspect equipment racks/shelves (tighten anylose hardware).COMPLETED?CONDITION (Select GoodFair*Poor*(checklist continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-6-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERADevice ChecklistTASK #TASKC011Check operation of fan/air conditioner unit and heater,and replace where applicable.C012Check radio interference filter (RFI) and lightning arrestor.C013Check circuit breaker and fuses.C014Check ground fault receptacle.C015Check environmental systems.C016Check the controller and associated units, indicatorlights.C017Inspect all connections, cabling, and physical appearanceof the equipment within the cabinets.C018Ensure that cables are not stressed.C019Hand-tighten all electrical terminations as necessary.C020Check and inspect controller. Run and save controllerdiagnostics according to manufacturer’s specifications.COMPLETED?CONDITION (Select GoodFair*Poor*(checklist continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-7-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistC021Inspect all wires for loose connections, frayed wires,rodent damage, etc. Repair as necessary.C022Check incoming power for proper voltage and correct ifnot within tolerances.C023Check function and communications (modem).C024Visually inspect all exposed grounding systems at thedevice for corrosion and damage.C025Check conduit entry to cabinet. Provide duct sealant (oranother means) to prevent rodent entry if not alreadypresent.PERFORM THE FOLLOWING FOR LOCATIONS WITHUNINTERRUPTIBLE POWER SUPPLY (UPS):C026Visually inspect general condition of UPS for corrosion,wear, and any other damage. Repair as needed.C027Clean UPS and battery.C028Check all battery terminal connections for security andapply corrosion preventative compound. Tighten asnecessary.C029Verify functionality of UPS by disconnecting power atbreaker. Verify that UPS maintains operation.COMPLETED?CONDITION (Select air*Poor*COMPLETED?CONDITION (Select NON/AExcellentGoodFair*Poor**Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-8-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistE001Check to be sure hand hole covers are secure. Tighten ifnecessary.E002Check pull boxes (damage, covers missing, or damaged).Repair if necessary.E003Check conduit entry to junction box. Repair if necessary.E004Check conduit runs for settling of trench.E005Pump junction box dry if water is present remove.E006Clean garbage from junction box.E007Visually inspect lugs for burning corrosion, waterinfiltration and rodent damage.E008Visually inspect cable tags. Replace or reattach if needed.E009Visually inspect bushings for rust or damage.E010Visually inspect splice kit for integrity and waterinfiltration. Repair or replace if necessary.COMPLETED?CONDITION (Select GoodFair*Poor*(checklist continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.-9-

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistE011Inspect all equipment grounding conductors andconnections for integrity.E012Check antenna for proper communications.E013Verify communications by having a message displayedremotely from the Traffic Operations Center.PERFORM THE FOLLOWING FOR LOCATIONS WITHDIRECT ELECTRICAL CONNECTION:COMPLETED?CONDITION (Select PLETED?CONDITION (Select One)YESNON/AExcellentGoodFair*Poor*Check service pole base. Replace base cover and cleanout if necessary.YESNON/AExcellentGoodFair*Poor*E016Check cabinet/conduit mounting hardware. Replace boltcover and tighten if necessary.YESNON/AExcellentGoodFair*Poor*E017Check pole base splices for damage, water infiltration,and rodent damage.YESNON/AExcellentGoodFair*Poor*E018Visually inspect all exposed grounding systems at thedevice for corrosion and damage.YESNON/AExcellentGoodFair*Poor*E019Visually inspect the meter socket and disconnect fordamage, vandalism, and missing hardware.YESNON/AExcellentGoodFair*Poor*E014Check meter cabinet/pole/pedestal for damage (lightning,leaning, vehicle damage, vandalism, corrosion, etc).E015(checklist continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.- 10 -

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistE020Check anchor bolts for tightness and corrosion.E021Check breakers.E022Check meter cabinet for damage.E023Check meter cabinet locking mechanism. Adjust or repairif needed.PERFORM THE FOLLOWING FOR LOCATIONS WITHSOLAR POWER ASSEMBLIES:E024Using acceptable battery analyzer, perform load testand verify passing condition.E025Check batteries; clean and fill as necessary.E026Test battery charging system.E027Check all battery terminal connections for security andapply corrosion preventative compound.E028Thoroughly clean solar panels that power the batterypacks.COMPLETED?CONDITION (Select NON/AExcellentGoodFair*Poor*COMPLETED?CONDITION (Select air*Poor*(checklist continued on next page)*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.- 11 -

DISTRICT ID: STATEWIDE ID:DATE: TIME:CLOSED CIRCUIT TELEVISION CAMERATASK #TASKDevice ChecklistE029Inspect solar panel assembly for damage. Repair orreplace if necessary.E030Verify that solar panels are arranged in such a way as toallow panels to receive direct sunlight. Report any issues.E031Check clearance of tree branches or brush around solarpanel assembly, report required tree trimming and/orbrush clearing work.COMPLETED?CONDITION (Select cument all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible.- 12 -

*Document all Fair/Poor results in the Preventative Maintenance Report Form. Repair where possible. - 10 - CLOSED CIRCUIT TELEVISION CAMERA. Device Checklist E011 Inspect all equipment grounding conductors and connections for integrity. E012 Check antenna for proper communications.

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