Category:101 Standard Forms

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 Survey 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 Permit

• Floodplain Development Permit To District Cover Letter

• Layout to District

• Layout to FHWA

• Layout to Railroad

• M-40a Sounding Request for Final Soundings of Structures

• M-40b Sounding Layout

• Memo to Design, no Permit Required

• Memo to Design, Permit Required

• Memo to District

• Missouri-Illinois Border Bridge Clearinghouse Form

• No-Rise Certificate.dot

• Request For Soil Properties

• Telefax

• Transmittal Letter

• Vertical Clearance Design Exception Coordination with SDDCTEA

Construction and Materials

• 30 Day Reminder Final Invoice Letter

• 3-Year Graduate Engr Training Checklist

• 60 Day Final Acceptance Letter

• As Built Plans Checklist - SL District

• Asbestos Survey Report - All Materials (Form T748)

• Asbestos Survey Report - All Suspect ACM (Form T746)

• Asbestos Survey Report - Nonfriable ACM (Form T747)

• Asphalt Roadway Report

• Bridge Clearance Report (C-239A).dot

• Bridge Fabrication Report

• Concrete Roadway Report

• Contingent Item Price Check

• Contractor Performance Evaluation Letter

• Contractor Performance Evaluation Signature Page

• Daily Utility Report (C-9).dot

• Documentation Record

• EEO Checklist

• Electronic Documentation Choice Request

• Erosion Control Product Questionnaire

• Estimate Cover Letter

• Fax Cover.dot

• Fence Removal Notice

• Final Acceptance - Off System.dot

• Final Acceptance (C-239)

• Final Acceptance Checklist

• Final Plans Certification

• Final Plans Checklist

• Final Utility Report (C-13)

• Force Account Worksheet (one day)

• Force Account Worksheet (multiple days)

• Inspectors Pay Qty Report (IPQR)

• Internal MoDOT Product Form

• Land Disturbance Inspection Record (Electronic Version)

• Land Disturbance Inspection Record (Print and Fill Version)

• Land Disturbance Inspection Record Summary

• Milestone Worksheet

• Mobile Mixer Verification Sheet

• MoDOT Quick Estimate Summary Request

• Nuclear Density (C-709ND)

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

• OJT-4 Trainee Contact

• OJT-5 Discrimination Complaint

• OJT-6 Final Summary

• Order Record (C-259)

• Overdimension Restrict

• Pavement Type Selection Submittal Information (PTS Submittal Form)

• Pile Driving Data

• Pore Pressure Report - Type A

• Pore Pressure Report - Type B

• PreCon Letter - Federal No Trainees

• PreCon Letter - Federal

• PreCon Letter - State

• Prestress Deficiency Report (1029-01)

• Profilograph Report

• Railroad Crossing Inspection

• RE Letterhead

• 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)

• Wage Interview (Form CR-1)

• Wage Interview (Form CR-1) - Spanish

Forms for Contractor Use

Construction and Contractor Related

• 2AA Sheet – Blank

• 2AA Sheet – Example

• Affidavit for Compliance with Prevailing Wage Law

• Conflict Resolution Flowchart

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

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

• Contractor's Monthly Trainee Report

• DBE Program Submittal

• Example Letter to Trainee to be used by Contractor

• 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

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

• Request to Subcontract Work (C-220)

• Subcontractor Certification Regarding Affirmative Action

• Trainee Notification

• Value Engineering Change Proposal (C-104)

• Wage Flowchart for Federal Jobs – Precon

• Wage Flowchart for State Jobs – Precon

• Welder Qualification Form

• Waste Disposal Agreement

Materials Related

• Aggregate Quality Control Plan

• Asphalt Inspectors Worksheets: QA Pay Factor v5.01

• Asphalt Inspectors Worksheets: Plant Inspection v4.10

• 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

• ARRA - Know Your Rights Under the Recovery Act (for ARRA projects only)

• Discrimination In Employment is Prohibited by Law in Missouri (MCHR9) (also available en español)

• EEO Policy Letter Example Letter

• Employee Rights Under the National Labor Relations Act (also available en español)

• Equal Employment Opportunity (also available en español)

• Important Wage Rate Info FHWA-1495 (also available en español)

• Job Safety and Health OSHA (also available en español)

• Jobsite Bulletin Board Checklist

• Letter Appt EEO Officer

• Minimum Wage 1088 (also available en español)

• Notice FHWA 1022

• Notice Polygraph WH 1462 (also available en español)

• Notice to Employees Davis Bacon 1321

• Notice to Workers with Disability WH 1284

• Stormwater Permit Sign

• Your Rights FMLA WH 1420

Posters, State Aid

• Discrimination In Employment is Prohibited by Law in Missouri (MCHR9) (also available en español)

• Discrimination in Public Accommodations MCHR-07

• Stormwater Permit Sign

• Unemployment Benefit Law (also available (en español)

• Worker’s Compensation Law (also available en español)

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 Order - Zero Dollar

• Change Orders

• Change Orders – Mobilization and Contract Bond

• Change Orders – Time Adjustment

• Change Orders – Value Engineering

• Check for Current Version of SiteManager

• Cognos 8 Access for SM

• Concrete Cylinder Sample Sent to Central Lab

• Concrete Mix Design Creation

• Contract Adjustments

• Contract Master List

• Contract Finalization

• Contractor Pay Estimates

• Daily Work Reports

• Diaries

• Digital Signature Frequently Asked Questions

• Digital Signature QRG1 to Capture a Signature Image

• Digital Signature QRG2 to set up Digital ID

• Digital Signature QRG3 to Submit Certificate and List of Signers

• Digital Signature QRG3a Contractor example signer list letter

• Digital Signature QRG3b MoDOT authorized project office example signer list letter

• Digital Signature QRG3c MoDOT authorized district level example signer list letter

• Digital Signature QRG4 to prepare document for Contractor

• Digital Signature QRG5 for an INITIAL Adobe Digital Signature MoDOT

• Digital Signature QRG6 for an INITIAL Adobe Digital Signature Contractor

• Digital Signature QRG7 for ROUTINE Adobe Digital Signature MoDOT

• Digital Signature QRG8 for ROUTINE Adobe Digital Signature Contractor

• District 6 Reason Codes for Time Extension Change Orders

• Disposition Remarks for PAL Materials

• Equipment Rental Rates from the Blue Book

• Estimate Based Documentation Records

• Filtering a SiteManager Pick List

• Key Dates

• Line Item Adjustments

• Milestones

• PAL Plant Inspection and Record

• 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

Microstation D-Sheets

Signing

D-28

D-29

D-30

D-32

D-33

D-34

Signals

Form D-37A

Form D-37B

Form D-37C

Form D-37D

Form D-38

Form D-38A

Form D-38B

Form D-38C

Form D-38D

Form D-38E

Typical Sections

Typical Section Bicycle Path (D-49)

Interstate Roadway (D-61)

4-Lane (Non-Interstate) Major Rural Roadway (D-61)

2-Lane Major Rural Roadway, a "Super 2" (D-60)

Minor Rural Roadway (D-64)

Diamond/Directional Ramp, Any ADT (D-50)

Diamond/Directional Ramp, Low ADT, Low Trucks (D-50)

Muti-Lane Ramp (D-53)

Loop Ramp (D-51)

Local Roadway (D-67)

Local Roadway, Low AADT (D-66)

Miscellaneous

Widening and Resurfacing (D71)

Bridge

• 404 Permits

• Bridge Survey Report Form

• Structural Rehabilitation Checklist (Excel)

• Vertical Clearance Design Exception Coordination with SDDCTEA

Checklist

• Design Progress Check List

• District Final Design Checklist - D12

• Preliminary Plans Check List

• Right of Way Check List

Computer

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

• MicroStation Computer Drawings Log Sheet - D96

Contracts

• 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

• Highway Lighting Warrants D21

• Inquiry Report

• Job Special Provisions Stylesheet

• 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

• 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

• Consultant Selection And Contract Administration Summary

• Consultant Selection And Contract Administration Summary - Bridge

• PSC Approval to Execute Contract Letter (Request to Execute Contract)

• PSC Approval to Execute Supplemental DBE Agreement Letter

• PSC Consultant Selection Approval Letter

Environmental and Cultural

• Categorical Exclusion Form

• Categorical Exclusion Determination for Hardships

• 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 Studies

• RES Instruction sheet

• 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

• RW Plans - Commission Certification (Amended)

• RW Plans - Commission Certification

• 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

• Project Development 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

• 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.dot Professional Land Surveyor Description Review Form

• RW Marker Setting

• Survey Request Form

Maintenance

• Deer Death Report Form and Map (Excel)

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

Resource Management

• Agreements Checklist

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)

• Request for Acquisition Authority_(Form 3-6_10A)

• Request for Federal Funding_Limited Acquisition Authority_(Form 3-4_1A)

• Request for Limited Acquisition Authority_(Form 3-4_1B)

• Request for Federal Funding_(Form 3-4_2A)

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

• Right of Way Cost Estimate_(Form 3-3_3C)

• Safe and Sound Acquisition Authority Date (Form 3-4.1C)

• Supplemental Page_(Form 3-3_3A)

Description Writing and Titles

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

Property Management

• Internet Posting Request

• Property Inventory Record

• Property Inventory Record Instructions

• 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

• Administrative Review Request

• ADV Profile Report

• Application for Outdoor Advertising Vegetation Permit

• Courtesy Letter ("cannot be permitted")

• Courtesy Letter ("possibly permitted")

• Cutout or Extension

• New Permit

• New Route

• Notice of Withdrawal (OAN-15)

• Notice to Property Owner

• Notice to Remove (NTR)

• Notice to Sign Owner

• Notice to Terminate (NTT)

• Notice to Void (Release of Permit)

• Outdoor Advertising Permit

• Outdoor Advertising Permit Application

• Outdoor Advertising Permit Cover Letter

• Permit Transfer Application

• Qualifying Business Checklist

• Release Letter

• Rejection Letter for Outdoor Advertising Permit Application

• Scanning Procedures

• Sign Status

• Vegetation Cost Letter

• Vegetation Rejection letter

• Void Cover Letter

Junkyards

• Application for License to Maintain a Junkyard

Local Public Agency Land Acquisition