DESIGN WAIVER REQUEST FORM

TO:	Choose One

FROM: Choose One

DATE:	Click here to enter a date.

This form is to be used on projects requesting a Design Waiver to non-controlling elements of design on any roadway project.

Design Waiver:

For non-controlling element deviations, a Design Waiver Request must be completed. These requests do not require FHWA’s approval; the Regional Project Development Director (PDD) provides final approval. These requests include, but are not limited to, clear zone width, passing sight distance, vertical curves, and multimodal features.

DOCUMENTATION

Design Waivers to non-controlling criteria

A design waiver is a variance based on non-controlling criteria. All requests shall be documented on this form. Plan sheets, location map, and supplemental information (i.e. google maps) must be enclosed for a timely review by the Department. All design waivers must be justified based on the objective and context demonstrating compliance with accepted transportation engineering principles and reasons for the decisions. The proposed variation shall not diminish the existing operation and safety of the facility. Historical in-service performance or a traffic engineering study (on site or simulation) may be required.

Waivers to Non-Controlling Criteria typically require futher evaluation of the design elements to support the request such as,

Curent design criteria that could not be met.

Existing roadway characteristics.

Alternatives considered.

Comparison of the safety and operational performance of the roadway and other impacts such as right-of-way, community, environmental, cost, and usability by all modes of transportation.

Proposed mitigation measures.

Compatibility with adjacent sections of roadway.

Additional guidance can be found in the Highway Capacity Manual, Highway Safety Manual, Performance Based Practical Design, and Flexibility in Design. Design Waiver Requests located within the city limits require a letter from the local agency approving the request.

PROJECT DATA
Current Project Phase	Context/Scoping ☐ Footprint Established ☐ Plan-in-Hand ☐ PS&E ☐
County/ City
PIN
Federal Project No.
State Project No.
Project Limits
Local Program Project State Let Local Let	Yes☐ No ☐ If yes, then Yes☐ No ☐ Yes☐ No ☐
Project Type	New Alignment ☐ Reconstruction ☐ Resurfacing ☐ Road Diet/Road Reconfiguration ☐ (Note: Road Diet Evaluation form may be required) Maintenance ☐ Road Safety Audit ☐ Bridge Repair ☐ Bridge Rehabilitation ☐ Signilization ☐ Other ☐
US Route/NHS	Yes☐ No ☐
State Route	Yes☐ No ☐
Appalachian Development Highway System	Yes☐ No ☐
FHWA PODI Project	Yes☐ No ☐
Project Scope (Briefly describe the objective of project)
Project Commitments

ROADWAY GEOMETRIC DESIGN DATA
Highway Functional Classification: (See Green Book 2011 Section 1.3)	Freeway ☐ Arterial ☐ Collector ☐ Local Road/Street ☐
Rural or Urban Context	Rural ☐ Rural Town (city limits) ☐ Suburban (initially designed as rural but currently in city limits) ☐ Urban (city limits) ☐ Urban Core (in the metropolitan government jurisdiction) ☐
Roadway Typical Section Standard Drawing:
Existing Design Speed:
Existing Posted Speed:	Contact the Plans Sales Office to find original plans stating the design speed or use existing design elements to reverse engineer the design speed.
Proposed Design Speed:
Proposed Posted Speed:
Type of Terrain:	Level ☐ Rolling ☐ Mountainous ☐
Traffic Data:	ADT (20XX): D: _ / _ ADT (20XX): T: % DHV:
Access Control	None☐ Partial ☐ Full☐
Multimodal Design Elements Included in the scope of the Project	Pedestrian ☐ Pedestrian Signals ☐ Curb Ramps ☐ Shared-Use Paths ☐ New sidewalks ☐ Non-motorized Enhancement ☐ Bicycle ☐ (including bike route/lane, tract addition to existing roadway facility)
Bus Route	Yes ☐ No ☐

GEOMETRIC DESIGN NON-CONTROLLING ELEMENT CRITERIA All applicable non-controlling elements must be completed for Design Waiver requests
Existing	Proposed	Waiver
Passing Sight Distance:
Crest/Sag Vertical Curve:
Design vehicle:
Clear Zone width:
Other:

MULTIMODAL FEATURES
Facility Type: Roadway ☐ Pedestrian ☐ Bicycle ☐ Shared-Use ☐
Existing	Proposed	Waiver
Curb Shape:
Curb Ramp:
Sidewalk:
Shared-use Path:
Mid-block Crossing:
RRFB or HAWK:
Bike Lane:
Bike Lane Buffer:
Bike Route:
Bike Lane at Intersection:
Cycle Track:
Transit Facility/Stop
Other:

CRASH HISTORY
Years Reviewed	Total Crashes	Fatal Crashes	Injury Crashes

TDOT DIRECTIVES TO BE CONSIDERED FOR THE waiver REQUEST
YES	NO	N/A
SAFETY
Crash history data has been reviewed and is enclosed.	☐	☐	☐
All roadway and roadside safety mitigation measures have been considered and provided.	☐	☐	☐
The proposed variance from the minimum roadway design standards does not adversely affect the safety of the facility.	☐	☐	☐
The Highway Safety Manual was used to justify the Design Waiver.	☐	☐	☐
OPERATIONS
The operation of the proposed typical cross-section is comparable with operation of the adjacent cross-sections.	☐	☐	☐
The proposed design does not cause a reduction in capacity or adversely affect traffic flow of the facility.	☐	☐	☐
The proposed design does not adversely affect long-term operations.	☐	☐	☐
The proposed design does not impact the existing access control.	☐	☐	☐
Travel demand management solutions have been evaluated.	☐	☐	☐
ROADWAY DESIGN
It is not feasible to meet the minimum roadway design standards due to right-of-way restrictions, environmental impacts, etc.	☐	☐	☐
The proposed design maintains the same level of service compared to the design based on minimum roadway design standards.	☐	☐	☐
The proposed design results in a significant cost savings compared to the design based on minimum roadway design standards.	☐	☐	☐
ENVIRONMENTAL (Consult TDOT Environmental Division, if needed)
Does the request affect environmental permit requirements? (TDEC/TVA/CORPs/TWRA, etc.)	☐	☐	☐
Does the request affect NEPA environmental boundary?	☐	☐	☐
Does the request affect Historical Section 106 area?	☐	☐	☐
WORK ZONE
Will the proposed variation affect the TMP?	☐	☐	☐

DESIGN WAIVER REQUEST – JUSTIFIED BASED ON GUIDANCE FROM THE FOLLOWING:
Design Guidance Source	Design Guidance Met
YES	NO	N/A	Do Not Know	Source Reference if answered “Yes” (page, section, drawing, etc.)
AASHTO Publication	☐	☐	☐	☐
Highway Safety Manual	☐	☐	☐	☐
Highway Capacity Manual	☐	☐	☐	☐
FHWA Publication	☐	☐	☐	☐
NCHRP Publication	☐	☐	☐	☐
TRB Publication	☐	☐	☐	☐
TDOT Design Guidelines	☐	☐	☐	☐
TDOT Standard Drawings	☐	☐	☐	☐
Guidance from other states	☐	☐	☐	☐
Other

DESCRIBE THE REASONING AND JUSTIFICATION OF THE DESIGN WAIVER REQUEST:

(Address project needs, with consideration of all transportation modes, community engagement, safety, and with consistency towards long term planning and vision. Provide an explanation of the requested design waiver and describe other nationally recognized guidance that is met and that the design is based upon. Attach documentation of the specific design guidance met. The justification may need to include details such as: cross slope, superelevation rate, horizontal curve radius, stopping site distance, maximum grade, vertical clearance, etc.)

DESCRIBE THE ALTERNATIVES CONSIDERED

(Provide an explanation of proposed mitigation measures to offset impact such as cost, ROW, environmental, multimodal, safety and operation, community and usability, or compatibility with adjacent section of the roadway)

DESIGN WAIVER APPROVED BY:

Click here to enter a date.
Regional Project Development Director	Date

☐ Reviewer Comments Attached

☐ Additional Design Waiver Information Attached