Category:101 Standard Forms: Difference between revisions

Standard forms organized by functional unit are accessible from this page. The files accessible by the links below are identical to those accessed through Word, Excel or other software application by MoDOT employees. Many of these file links are also contained in Engineering Policy Guide articles that refer to the forms.

Bridge

• Bridge Division Memo

• Bridge Hydraulics Report

• Change Order

• Constructability Questioinnaire

• Culvert Hydraulics Report

• Design Exception Information

• Design Except to District

• Design Layout (Box)

• Design Layout (Grade)

• Design Layout (Stream)

• Design Layout (Wall)

• Floodplain Development Permit/Application

• Floodplain Development Permit To District Cover Letter

• Layout to FHWA

• Layout to Railroad

• Missouri-Illinois Border Bridge Clearinghouse Form

• No-Rise Certificate

• Request for Final Soundings for Structures Form

• Telefax

• Transmittal Letter

• Vertical Clearance Design Exception Coordination with SDDCTEA

Construction and Materials

• 30 Day Reminder Final Invoice Letter

• 60 Day Final Acceptance Letter

• AC Index Price Adjustment – Hot mix asphalt (per SY)

• AC Index Price Adjustment – Hot mix asphalt (per Ton)

• AC Index Price Adjustment – Sealcoat

• AC Index Price Adjustment – UBAWS Hot Mix and Membrane

• AC Index Price Adjustment – Undersealing

• ADA Checklist

• Aggregate Base Random Locations

• As Built Plans Checklist - SL District

• Asbestos Bulk Sample Bridge CL EL 5

• Asbestos Bulk Sample Parcel CL EL 5

• Asbestos Survey Report - All Suspect ACM (Form T746), Nonfriable ACM (Form T747) and All Materials (Form T748)

• Asphalt Core Spreadsheet

• Asphalt Mix Design

• Asphalt Random Locations

• Asphalt Roadway Report

• Asphalt Roadway Report Square Yards

• Bridge Bearings

• Bridge Clearance Report (C-239A)

• Bridge Fabrication Report

• Change Order

• Checklist of the jobsite posters

• Commercially Useful Function (CUF) Determination Form

• Compressive Strength for Forney

• Concrete Daily Inspection Report, C-681

• Concrete Cylinder Sample Sent to Central Lab

• Concrete Roadway Report

• Contingent Item Price Check

• Contractor Performance Evaluation Letter

• Contractor Performance Evaluation Signature Page

• Daily Utility Report (C-9).dot

• Dimensions To Tons Converter

• EEO Checklist

• Fence Removal Notice

• Final Acceptance Report (C-239), Cognos Report

• Final Acceptance Report (C-239), pdf version

• Final Plans Certification

• Final Plans Checklist

• Final Plans Memo

• Final Utility Report (C-13)

• Force Account Spreadsheet

• Form M-45 Bitumin Distributor Calibration

• Fuel Adjustment Calculation

• Inspectors Pay Qty Report (IPQR)

• Internal MoDOT Product Form

• IRI Inertial Profiler Report with Bonus

• JOC 2016 Rail Cable Fence Spreadsheet

• JOC 2017 Rail Cable Fence Spreadsheet

• JOC 2018 Rail Cable Fence Spreadsheet

• JOC Asphalt Pavement Repair

• JOC Bridge Repair Spreadsheet

• JOC Concrete Pavement Repair

• JOC Lighting Repair

• JOC Microsurfacing Spreadsheet

• JOC Signal and Lighting Repair

• Milestone Worksheet

• Mobile Mixer Calibration

• Mobile Mixer Verification Sheet

• Nuclear Density (C-709ND)

• Nuclear Density of Plastic Portland Cement Concrete (C-710ND)

• Order Record (C-259)

• Outlier Analysis

• Pavement Type Selection Submittal Information (PTS Submittal Form)

• Payroll Log Form

• Pile Driving Chart

• Pile Driving Data

• Pore Pressure Report - Type A

• Pore Pressure Report - Type B

• PreCon Letter - Federal

• PreCon Letter - State

• Prestress Deficiency Report (1029-01)

• Price Verification

• Railroad Crossing Inspection

• RE Letterhead

• Retroreflectivity Payment Adjustment

• Retroreflectometer Request

• Retroreflectometer Results

• RM Aggregate Scale Calibration - 200

• RM Aggregate Scale Calibration - 300

• RM Aggregate Scale Calibration - 350

• RM Air Dispenser Calibration

• RM Cement Scale Calibration - 150

• RM Cement Scale Calibration - 175

• RM Cement Scale Calibration - 200

• RM Concrete Systems Form

• RM Equipment Calibrated and Verified Form

• RM Truck Mixer Information Form

• RM Water Calibration

• RoCap Test Form - Long Bolts

• RoCap Test Form - Short Bolts

• Semi-annual Labor Compliance Report

• Semi-Final Inspection (C-236)

• Sitemanager Contractor Payment Schedule

• Standard Compaction Test Blank

• Survey Calculator

• Tank Capacity

• Wage Interview (Form CR-1)

• Work Zone Inspection Form

Forms for Contractor Use

Construction and Contractor Related

• 2AA Sheet – Blank

• 2AA Sheet – Example

• Affidavit for Compliance with Prevailing Wage Law

• Contractor's Affidavit Regarding Settlement of Claims (C-242)

• Contractor Questionnaire (to bid contracts less than $2,000,000)

• DBE Contractor Project Trucker Equipment List Form

• DBE Contractor Subcontractor Project Trucker Form Instructions

• DBE Identification Submittal Form

• Lead Abatement MoDOT Contractor Informational Packet

• Lead Abatement MoDOT FA Project Notification

• Lead Abatement MoDOT Project Notification

• Lead Abatement MoDOT Project Re-Notification

• Lead Abatement Program Contact Info

• MoDOT Workforce JSP Cumulative Workforce Hours Report

• MoDOT Workforce Pre-Construction Diversity Plan Report

• OJT-1, Trainee Notification

• OJT-2, Contractor Monthly Trainee Report

• OJT-3, Training Completion

• OJT-4, Trainee Contact

• OJT-5, Discrimination Complaint

• OJT-6, Training Summary

• Prequalification Contractor Questionnaire (to bid a contract of any size)

• Request to Subcontract Work (C-220)

• Subcontractor Certification Regarding Affirmative Action

• Value Engineering Change Proposal (C-104)

• Wage Flowchart for Federal Jobs – Precon

• Wage Flowchart for State Jobs – Precon

• Waste Disposal Agreement

Materials Related

• Asphalt Inspection Worksheet Cumulative Gradation

• Asphalt Inspection Worksheet Non-Cumulative Gradation

• CMP, RCP, Precast Drainage Units and Precast Box Culvert Shipping Report Form

• Concrete Mix Design Submittal Form

• CoreLok Aggregate Workbook

• Fabricator’s PAL Receival Form

• New Product Evaluation Form

• PAL Program Inclusion Certifications and Guarantee Statement

• Producer/Supplier List

• PVC & HDPE Pipe Shipping Report Form

• Request for Transfer of Inspected Materials

• Shipper’s PAL Transmittal Form

Posters, Federal Aid

Please refer to EPG 110.2 Federal-Aid Projects, Required Notices and Posters.

Posters, State Aid

Please refer to EPG 110.2 Federal-Aid Projects, Required Notices and Posters.

Utility or Right of Way Related

• Notice of Intent to Perform Work Process

• Permit for Work on Right of Way

Quick Reference Guides (QRGs)

• Change Order Codes

• Change Order Reports

• Change Orders - Zero Dollar

• Change Orders

• Change Orders – Mobilization and Contract Bond

• Change Orders – Time Adjustment

• Change Orders – Value Engineering

• Check for Current Version of SiteManager

• Concrete Cylinder Sample Sent to Central Lab

• Concrete Mix Design Creation

• Consent Decree Close Out Procedure

• Consent Decree Deficiencies – Halting, Un-halting, Resolving (Land Disturbance Deficiency)

• Consent Decree Erosion Reporting

• Consent Decree Initial Setup

• Contract Adjustments

• Contract Master List

• Contract Finalization

• Contractor Pay Estimates

• CRE2O - Contractor Reporting Excel2Oracle

• CRE2O QA Asphalt Guide

• Daily Work Reports

• Diaries

• Digital Signature for Adobe Reader DC or Pro DC

• Disposition Remarks for PAL Materials

• Emergency Contacts

• Equipment Rental Rates from the Blue Book

• Equipment Verification Samples

• Estimate Based Documentation Records

• Filtering a SiteManager Pick List

• How to Use Cognos Reports

• Job Order Contracts

• Key Dates

• Line Item Adjustments

• Liquidated Damage Adjustments

• Milestones

• PAL Plant Inspection and Record

• SL District Reason Codes for Time Extension Change Orders

• SL District Signal Maintenance by Contractor Key Dates

• Sample Record General Information

• Sample Record of DEC Inspection

• Sample Record of Soil Density Inspection

• Sample Record of Visual Inspection

• Sampling Checklist

• Stockpiled Materials

• Subcontracts

• SuperPave Adjustments

• Terminal Services/Remote Desktop Connection

• Vendor Master List

Design

Bridge

• 404 Permits

• Bridge Survey Checklist

• Bridge Survey Location Request

• Bridge Survey Report Form

• Structural Rehabilitation Checklist (Excel)

• Vertical Clearance Design Exception Coordination with SDDCTEA

Checklist

• Design Progress Check List

• District Final Design Checklist - D-12

• Preliminary Plans Check List

• Project Reviewing Checklist

• Right of Way Check List

Computer

• Design Computer Files & Drawings Log Sheet - D-97

• MicroStation Computer Drawings Log Sheet - D96

Contracts

• District Award

• Computer Deliverable Contract Plans 2005

• Consultant Services Contract - State Funded (MoDOT Users)

• De1

• DE11

• Sample Scope of Services - Location and Environment

• Sample Scope of Services Design

Design Forms

• 3R Conceptual Study Report

• 4R Pavement Rehabilitation Analysis Data and Conceptual Study Report

• Aerial Mosiac Submittal for Recon Study

• Commission Backup Form Blank

• Commission Backup Form Instructions

• Conceptual Study Report

• Consultant Rating Form

• Cultural Resource Assessment Letter

• D-28 Sign Design Order Form

• Design Exception Information

• Equipment and Materials List

• Form 806.8.2, Project-Specific SWPPP Information

• Highway Lighting Warrants D21

• Inquiry Report

• Job Special Provision Formatting Instructions

• Location Study Report

• M-40 Request for Drilling Services

• Pavement Distress Log Form - Asphalt - 11x17

• Pavement Distress Log Form - Concrete 11x17

• Pavement Repair Log

• Preliminary Plans Proposal Review

• Preliminary Signal Plan Submittal

• Project Assignments and Completion Dates

• Project Data for BAMS

• Project Initialization Estimate Form

• Roadway Job Special Provision Formatting Instructions

• Roadway Job Special Provision Template

• Submittal to Professional Services Committee

• Suggested Revision to a CADD Standard

• Test-Cultural Resource Assessment Letter

• Traffic Signal Warrants, Form D22

• Utility Print Submittal Letter

• Utility Print Submittal letter_Revised Plans

• Work Day Study - 124

Engineering Professional Services

Environmental and Cultural

• Categorical Exclusion Form

• Cultural Resource Assessment Letter

• Cultural Resource Structure Log

• DNR Land Survey Request

• Farmland Conversion Impact Rating (Corridor)

• Farmland Conversion Impact Rating (Site)

• Fig 2-06-9, Farmland Conversion Impact Rating

• Initial Site Assessment Form

• Request for Environmental Services (RES) Form

• Instructions for the RES Form

• Consultant information needed to fill out RES Form

• STRUCT

Hearings

• Generic Meeting Sign-Up Sheet

• Notice of Formal Public Hearing

• Open House Public Hearing

• Public Hearing Statement Form

Materials

• Hazardous Waste Removal Bid Information

• Itemized Proposal - Demolition, Asbestos, UST Removal

• Materials Suppliers, Source and Location

• Request for Asphalt Cement % Grade

• Soil Info Request

• Soil Survey Request

Photo

• Aerial Photography Requisition

• Microfilm-Print Billing Form

• Prints of Previous Photography Requistion

• Request for addition to flight program

• Request for Color Copies

Planning

• ARAN Report Request

• Conceptual Study Traffic Count Request

• Fis Formc

• Turning Movement Traffic Count Request

Right of Way

• Certification of Right of Way Plans for Condemnation Letter

• Forthcoming RW Plan Changes

• Preliminary Right of Way Estimate

• Right of Way Approval (Amended Plans) Condemnation Required

• Right of Way Plans Reviewed

• Right of Way Plans to Dist RW Agent

• RW Change Information for Microfilming

• Certification Document

• RW Plans Approval - Letter of Certification

Scoping

• Bridge Checklist

• Construction and Materials Checklist

• Design Checklist

• Draft Project Scoping Memorandum

• Environmental Checklist

• FHWA Checklist

• Maintenance Checklist

• Major Project Scope or Estimate Change

• Non-Major Project Scope or Estimate Change

• Planning Checklist

• Design Liaison Checklist

• Project Estimate Quality Assurance Report

• Project Scoping Checklist

• Project Scoping Memorandum

• Public Information and Outreach Checklist

• Railroad Checklist

• Right of Way Checklist

• Traffic Checklist

• Utilities Checklist

Survey

• Bridge Survey Location Request

• Center Line Staking - Letter to Property Owner

• Center Line Staking

• Permanent RW Marker Setting - letter to property owner

• Permanent RW Marker Settings

• Form 238.2.18.2 Plat Review Checklist

• Preliminary Surveying - letter to property owner 1

• Preliminary Surveying - letter to property owner

• Preliminary Surveying

• Professional Land Surveyor Description Review Form

• RW Marker Setting

• Survey Request Form

External Civil Rights

• Contractor's Monthly New Employee Report

• Sample Company Workforce/Diversity Job Special Provision Action Plan

• Workforce Pilot Program Employee Notification

Financial Services

• Agreements Checklist

Maintenance

• Deer Death Report Form and Map (Excel)

• Work Zone Inspection Form

Chip Seal Forms

• Application Adjustment Factor Form
• Traffic Evaluation Factor (TEF) for Asphalt Application Adjustment

Bridge Maintenance

• Blank Inspection Report
• Bridge Maintenance Repair Report (Excel)
• Cathodic System Evaluation
• CIF (Critical Inspection Finding)
• FAR (Follow-Up Action Required)
• Maintenance Material Usage (Excel)
• Maintenance Recommendation Report
• Paint Data Report (Excel)
• Photo Log Sheet (Excel)

Snow & Ice Control

• Snow and Ice Control Equipment Inventory (Excel)
• Chemical Requirements (Excel)
• Salt Storage (Excel)

Rest Areas

• Rest Area Truck Parking (Excel)
• Rest Area Inspection

Commuter Lots

• Commuter Lot Inspection (Excel)
• Commuter Lot Survey

Disasters

• Detailed Damage Inspection Report (Excel)
• FEMA Detailed Damage Inspection Report (Excel)

Performance Indicators

Pavement Management

Motor Carrier Services

• Accounting Payment Error Notice

• IRP Altered Temporary

• IRP Outstanding Temporaries

• IRP Surrendering Plates

• IRP Suspension

• IRP-IFTA Reject Letters

• MCS MoDOT Letterhead

Planning

• MTFC Letterhead

Right of Way

• RW Mortgage Analyzer (Excel)

General Information

Right of Way Organization and Personnel

Administration

• Acquisition Complete Cost Estimate Worksheet_(Form 3-3_3B)

• Categorical Exclusion Review_(Form 3-1_2)

• Right of Way Cost Estimate Worksheet_(Form 3-3_3A)

Description Writing and Titles

• Affidavit of Scrivener's Error (Form 4-6.4a)

Property Management

• Real Estate Risk Assessment Form

• Realty Asset Sale Legal Opinion Memo

• Request for Excess Parcel Survey (Form 236.5.19a)

Appraisal and Appraisal Review

Negotiation

Relocation Assistance Program

• Advance Increased Interest Payment Agreement (Form 236.8.11.4(d)(2))

• Advance Replacement Housing and Increased Interest Payment Agreement (Form 236.8.11.4(d)(1))

• Condemnation Agreement Residential Property (Form 236.8.9.3(e)(1))

• Relocation Report (Form 236.8.6.4)

• Relocatee Needs Questionnaire

Asbestos Abatement-Removal of Building Improvement

Right Of Way Condemnation

Mediation

Quality Assurance Reviews

Designing Right of Way Plans

Change in Route Status Report

Requests from Cities for Annexations

Outdoor Advertising

Junkyards

• Application for License to Maintain a Junkyard

Local Public Agency Land Acquisition