Category:101 Standard Forms

EPG articles are not referenced as "sections" but as EPG XXX.X (example: EPG 401.3) to avoid confusion with MoDOT specs (which are contractually binding).

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 Questionnaire

• 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 (PDF)

• ADA Checklist (MS Word)

• 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

• Bridge Bearings

• Bridge Clearance Report (C-239A)

• Bridge Fabrication Report

• Change Order

• Commercially Useful Function (CUF) Determination Form

• Commercially Useful Function (CUF) Determination Form (for contracts let after March 2021)

• Compressive Strength for Forney

• Concrete Daily Inspection Report, C-681

• Concrete Cylinder Sample Sent to Central Lab

• Concrete Inspection Worksheet – Mainline QC/QA Paving

• Concrete Roadway Report

• Contingent Item Price Check

• Contractor Performance Evaluation Letter

• Contractor Performance Evaluation Signature Page

• Daily Utility Report (C-9)

• Dimensions To Tons Converter

• Documentation Record

• 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

• Job Site Bulletin Board Checklist

• JOC 2020 Asphalt Pavement Repair

• JOC 2021 Asphalt Pavement Repair

• JOC 2022 Asphalt Pavement Repair

• JOC 2023 Asphalt Pavement Repair

• JOC 2021 Bridge Repair Spreadsheet

• JOC 2022 Bridge Repair Spreadsheet

• JOC 2023 Bridge Repair Spreadsheet

• JOC 2021 Concrete Pavement Repair

• JOC 2022 Concrete Pavement Repair

• JOC 2023 Concrete Pavement Repair

• JOC 2022 Fence Repair Spreadsheet

• JOC 2023 Fence Repair Spreadsheet

• JOC 2020 Rail Cable Fence Spreadsheet

• JOC 2021 Rail Cable Fence Spreadsheet

• JOC 2022 Rail Cable Fence Spreadsheet

• JOC 2023 Rail Cable Fence Spreadsheet

• JOC Lighting Repair

• JOC Microsurfacing Spreadsheet

• JOC Signal and Lighting Repair

• Milestone Memo

• Milestone Worksheet

• Mobile Mixer Calibration

• Mobile Mixer Verification Sheet

• Nonconformance Report (NCR)

• 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

• Pile Driving Data PDA

• PODI Bridge Deck Pour Checklist

• 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

• RE Letterhead – Word Format

• Retroreflectivity Payment Adjustment

• Retroreflectometer Request

• 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)

• 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

• ADA Checklist - PDF

• ADA Checklist - Word Document

• Affidavit for Compliance with Prevailing Wage

• Contractor Affidavit Regarding Settlement of Claims

• Contractor Monthly New Hire Report

• Contractor Performance Questionnaire

• Contractor Questionnaire

• CUF Determination Form

• DBE and non DBE Subcontractor Reporting Form

• DBE Change Form

• DBE Contractor/Subcontractor Project Trucker and Equipment List

• DBE Contractor/Subcontractor Project Trucker and Equipment List - Instructions

• DBE Identification Submittal Form (Excel)

• DBE Identification Submittal Form (PDF)

• DBE Termination Form

• Initial Workforce Diversity Plan

• Lead Abatement MoDOT Contractor Informational

• Lead Abatement MoDOT FA Project Notification Must be Filled out by RE

• Lead Abatement MoDOT Project Notification

• Lead Abatement MoDOT Project Re-Notification

• Lead Abatement Program Contact Info

• Monthly Workforce Reporting Report

• New Hire Notification

• OJT 1, Training Notification

• OJT 2, Contractor Monthly Trainee Report

• OJT 3, Training Completion Report

• OJT 4, Trainee Contact

• OJT 5, Discrimination Complaint

• OJT 6, Training Summary

• Pile Driving Set Calculator

• Prequalification Questionnaire

• Request to Subcontract Work (C-220)

• Request to Subcontract Work (C-220), Excel

• Sample Workforce Action Plan

• Sign Certification of Destruction (PDF)

• Sign Delivery Certification (PDF)

• 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

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

• Bluebeam Revu Training Manual

• DBE Substitution Form

• MoDOT Workforce Pre-Construction Diversity Plan Report

• Preparing As-Built (Final) Plans in Construction Using Bluebeam Revu

• Tension Log Form

Materials Related

• Buy America Materials of Origin

• Buy America Materials of Origin Non-Iron/Steel (PDF)

• https://epg.modot.org/forms/CM/Concrete%20Mix%20Design%20Submittal%20Form.xls Concrete Mix Design Submittal Form]

• Corelok Aggregate Workbook

• Durable Aggregate Calculation

• Illinois Flexibility Index Test

• PAL Program Inclusion Certifications and Guarantee Statement

• PAL Fabricators Receival Form

• PAL Shippers Transmittal Form

• CMP, RCP, Pipe Shipping Submittal Form: Precast Drainage Unit and Precast Box Culvert Shipping Report Form

• Pipe Shipping Submittal Form: Thermoplastic

• Producer Supplier Listing Form

• Recycle Binder Contribution v2.12

• Recycle Binder Contribution v2.20

• Section 1040, 1043 and 1044 Inclusion Certification Statement

• Section 1040, 1043 and 1044 Shipping Report Form

• Transfer Request of Inspected Material

• Asphalt Mix Design Submittal

• Asphalt Inspection Worksheet Cumulative Gradation

• Asphalt Inspection Worksheet Non-Cumulative Gradation

• New Product Evaluation Form

Utility or Right of Way Related

• Permit for Work on Right of Way

• MoDOT Notice of Intent to Perform Work

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.

Quick Reference Guides (QRGs)

• Digital Signatures using Adobe DC Reader/Pro

• Digital Signatures using Bluebeam Revu

AASHTOWare Project Quick Reference Guides (QRGs)

AWP QRG Revision Dates

• AWP CM AASHTOWARE Project Terminology

• AWP CM Certified Testers

• AWP CM Filters

• AWP CM Filters for Sample Records or Acceptance

• AWP CM Test Equipment

• AWP CO 1 Change Order Overview

• AWP CO 2 Change Order Adding New Item or Overrun/Underrun of Existing Items

• AWP CO 3 Change Order Time Extension

• AWP CO 4 Change Order Value Engineering

• AWP CO 5 Change Order, No Cost Contract Modification

• AWP CO 6 Change Order, Mobilization and Contract Bond

• AWP CO 7 Change Order Approval

• AWP CO Change Order Codes

• AWP CO Change Order Reports

• AWP CO Commercially Useful Function (CUF) Review Date Entry

• Commercially Useful Function (CUF) Determination Form (for contracts awarded after March 2021)

• AWP CO Construction Stockpiles

• AWP CO Contract Payment Estimate Exception Override

• AWP CO Contract Vendor Assets

• AWP CO Contract Adjustments

• AWP CO Contract Times

• AWP CO Daily Diary

• AWP CO Daily Diary Adjustments

• AWP CO Daily Work Report

• AWP CO Daily Work Report, Deleting DWR Postings and Acceptance Records

• AWP CO Disposition Remarks for PAL Material

• AWP CO Documentation Records

• AWP CO Emergency Contacts

• AWP CO Estimate

• AWP CO Estimate Final

• AWP CO Item Adjustments

• AWP CO Milestones

• AWP CO Signal Maintenance

• AWP CO SL District Reason Codes for Time Extension Change Orders

• AWP CO Subcontract

• AWP Guide for Creating QA Sample Records Using E20 Spreadsheets (Internal Use Only)

• AWP MA Adding Contract Lines For Acceptance Actions

• AWP MA Adding New Concrete Mix Design

• AWP MA Associating Material to Source

• AWP MA Checking For Unauthorized Sample Records

• AWP MA DEC Sample Record

• AWP MA Deleting materials From Acceptance

• AWP MA Editing Contract Acceptance Actions and Action Relationships

• AWP MA Generating Contract Sample Checklist

• AWP MA I.A.S. Lab Audit

• AWP MA PAL Plant Inspection Record

• AWP MA Regenerating Contract Lines for Original Materials and Acceptance Actions

• AWP MA Sample Record Acceptance By Certification

• AWP MA Sample Record Changing Material Code Source or Sample Type

• AWP MA Sample Record, General

• AWP MA Sample Record, General IAS Audit Record

• AWP MA Sampling and Testing Status Report

• AWP MA Using the Find Sample Function

Storm Water Database Quick Reference Guides (QRGs)

• How to Fill Out Land Disturbance Inspection Record

• Land Disturbance Deficiencies

• Land Disturbance Storm Water Database Closeout Procedure

• Land Disturbance Storm Water Database Initial Setup for Construction Projects

• Land Disturbance Storm Water Database Initial Setup for Maintenance Projects

• Land Disturbance Storm Water Database 7-Day Reviews

• Storm Water Land Disturbance Erosion Reporting

Design

Microstation D-Sheets

Signing

D-28, D-29 through D-34

Signals

D-37A through D-37d, D-38 through D-38e

Typical Sections

D-49 through D-70

Miscellaneous

D-71

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

Contracts

• District Award

• Computer Deliverable Contract Plans 2005

• 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

• Commission Backup Form Blank

• Commission Backup Form Instructions

• Conceptual Study Report

• Consultant Rating Form

• 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

• 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

• Project Data for BAMS

• Project Initialization Estimate Form

• Roadway Job Special Provision Formatting Guide

• Roadway Job Special Provision 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

Engineering Professional Services

Environmental and Cultural

• Categorical Exclusion Form

• Farmland Conversion Impact Rating (Corridor)

• Farmland Conversion Impact Rating (Site)

• Request for Environmental Services (RES) Form

• Instructions for the RES Form

• Sample letter requesting permission

Materials

• Request for Asphalt Cement % Grade

• Soil Info Request

• Soil Survey Request

Planning

• ARAN Report Request

• Conceptual Study Traffic Count Request

• Fis Formc

• Road User Costs Request Form

• Traffic Forecast Request Form

• Turning Movement Traffic Count Request

Public Involvement

• Public Hearing Statement Form
• Sample Letter Advertising a Public Hearing
• Sample Notice 4F
• Sample Notice of Public Hearing
• Sample Opportunity for a Public Hearing/Meeting Notice
• Sample Public Involvement Plan or Communication Plan
• Sample Request for Approval of Location and/or Design of Highways to State Design Engineer
• Sample Request for Approval of Location to the Commission
• Sample Transcript

Right of Way

Scoping

• Bridge Checklist

• Construction and Materials Checklist

• Design Checklist

• Design Liaison Checklist

• FHWA Checklist

• Maintenance Checklist

• Planning Checklist

• Project Scoping Checklist

• Public Information and Outreach Checklist

• Railroad Checklist

• Right of Way Checklist

• Traffic Checklist

• Utilities Checklist

Survey

• Bridge Survey Location Request

• Form 238.2.18.2 Plat Review Checklist

• Professional Land Surveyor Description Review Form

• Sample Letter Notifying Property Owner of Survey

External Civil Rights

DBE

• Commercially Useful Function (CUF) Determination Form

• DBE and Non-DBE Subcontractor Report Form

• DBE Contractor/Subcontractor Project Trucker and Equipment List

• DBE Identification Submittal Form

• DBE Substitution Form

OJT

• OJT-1, Trainee Notification

• OJT-2, Contractor Monthly Trainee Report

• OJT-3, Trainee Completion Report

• OJT-4, Trainee Contact

• OJT-5, Trainee Discrimination Complaint

• OJT-6, Training Summary

Workforce Diversity JSP

• Contractor's Monthly New Employee Report

• MoDOT Cumulative Workforce Hours Report (Workforce Monthly Report)

• New Hire Notification

• Sample Company Workforce/Diversity Job Special Provision Action Plan

• Workforce Pre-Construction Diversity Plan Report

Financial Services

• Agreements Checklist

Highway Safety/Traffic

• Statewide Signal/Lighting/Flasher Preventive Maintenance Checklist

Maintenance

• Facility Runoff Control Plans (FRCP)

• 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

• Hazardous Waste Transport Forms

• Household Goods Transport Forms, Tariff Information, Moving in Missouri brochure

• International Fuel Tax Agreement Forms

• International Registration Plan Forms

• Missouri Operating Authority Forms

• Oversize Overweight Permitting Forms

• Missouri Intrastate Skill Performance Evaluation for Medical Exemption Forms

• Waste Tire Transporter Forms

Planning

• MTFC Letterhead