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All MDOT forms can be located at the MDOT Forms homepage located at: MDOT - WebForms (state.mi.us)
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MDOT users can view a listing of all forms that have been updated for the last 3 months by going to the MDOT Sharepoint Forms?Intranet webpage and clicking on New/Revised Forms on the left side of the screen in the navigational bar.?
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The following forms were created, modified, or made fillable last month.? All forms are available electronically at Inside MDOT Forms Management Page and the public website as appropriate:
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REVISIED |
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Form Number |
Form Name |
Division Name |
Form Revision Date |
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0193 |
Disadvantaged Business Enterprise (DBE) Supplier Participation Affidavit |
Office of Business Development |
6/8/23 |
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0204 |
General Computation |
BFS-Construction Field Services |
6/14/23 |
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0371 |
Continuing Education Activity Request for Professional Engineers and Surveyors |
Design Division |
6/8/23 |
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0397 |
Work Zone Audit Report |
BFS-Construction Field Services |
6/2/2023 |
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0426 |
Quotation Request for Services or Equipment |
BFS-Transportation Systems Management Operations |
6/8/23 |
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0501 |
Materials Source List |
BFS-Construction Field Services |
6/7/23 |
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0561 |
MDOT Lane Closure Notification/ Request Form |
BFS-Construction Field Services |
6/14/23 |
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0565 |
Work Zone Enforcement Agreement with Local Agency Police and MDOT |
BFS-Construction Field Services |
6/28/23 |
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0612D |
Restricted Appraisal Report for Non-Condemnation Related Valuation |
DSD-Appraisal |
6/5/23 |
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0633A |
Noncompensable Items of Damage in Eminent Domain Proceedings and Michigan Law Regarding Benefits |
DSD-Appraisal |
6/5/23 |
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1100A |
Extension of Contract Time-Request Number |
BFS-Construction Field Services |
6/2/2023 |
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1105A |
Final Estimate Submittal Form |
BFS-Construction Field Services |
6/8/23 |
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1107 |
Daily Weight Record |
BFS-Construction Field Services |
6/2/2023 |
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1013S |
Inspector's Checklist for Inspection for Solar Boards |
BFS-Construction Field Services |
6/7/23 |
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1122B |
Inspector's Daily Report |
BFS-Construction Field Services |
6/22/23 |
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1122C |
Inspector's Daily Report Worksheet |
BFS-Construction Field Services |
6/7/23 |
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1126 |
National Pollutant Discharge Elimination System (NPDES) and Soil Erosion and Sedimentation Control (SESC) Inspection Report |
BFS-Construction Field Services |
6/13/23 |
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1130 |
Progress Schedule |
BFS-Construction Field Services |
6/7/23 |
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1130A |
Progress Schedule - 2020 Spec Book |
BFS-Construction Field Services |
6/22/23 |
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1156-T1 |
Minimum Wage Rate Interview Sheet Tier 1 |
BFS-Construction Field Services |
6/2/2023 |
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1156-T2 |
Minimum Wage Rate Interview Sheet Tier 2 |
BFS-Construction Field Services |
6/6/23 |
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1160A |
Concrete Cylinder/Core Compression Test Results |
BFS-Construction Field Services |
6/8/23 |
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1165 |
Notice of Non-Compliance with Contract Requirements |
BFS-Construction Field Services |
6/5/2023 |
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1302-FED |
Subcontract - FED |
BFS-Construction Field Services |
6/8/23 |
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1302-State |
Subcontract- State |
BFS-Construction Field Services |
6/8/23 |
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1366 |
Contractor's Affidavit of Indebtedness |
Contract Services Division |
6/8/23 |
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1367 |
Consent of Surety for Payment to Contractor |
Contract Services Division |
6/8/23 |
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1585 |
Pavement Marking Material Verification Checklist |
BFS-Transportation Systems Management Operations |
6/13/23 |
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1903 |
Daily Report of Bituminous Plant Inspection |
BFS-Construction Field Services |
6/22/23 |
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1907 |
Report of Compacted Bituminous Mixture Core Density & Percent Compaction |
BFS-Construction Field Services |
6/22/23 |
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1907J |
Report of Compacted Longitudinal Joint Core Density & Percent Compaction |
BFS-Construction Field Services |
6/22/23 |
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1994 |
Stake Request Form |
BFS-Construction Field Services |
6/2/2023 |
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1967 |
Jobsite Poster Inspection Checklist |
BFS-Construction Field Services |
6/6/23 |
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2620 |
Operation of New Public Transportation Service |
Transportation Planning |
6/22/23 |
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2071 |
Funding Application for Local Agency Highway-Railroad Grade Crossing Surface Improvement Projects |
Office of Rail |
6/8/23 |
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2142 |
Category B: Community Service Infrastructure Fund Application |
Office of Economic Development |
6/8/23 |
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2217 |
Notice and Order to Remove Encroachment |
DSD-Permits-Construction |
6/13/23 |
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2224 |
Notice and Order to Comply |
DSD-Permits-Construction |
6/13/23 |
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2480 |
Letter Requesting Utility Information at Base Plan Stage |
DSD-Permits-Utility Coordination |
6/13/23 |
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2481 |
Letter to Public/Private Utilities at Preliminary Plan Stage |
DSD-Permits-Utility Coordination |
6/13/23 |
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2482 |
Letter to Municipal Utilities at Preliminary Plan Stage |
DSD-Permits-Utility Coordination |
6/13/23 |
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2492 |
Non-Holiday Coffee Break Permit Application Return Letter |
DSD-Permits-Construction |
6/13/23 |
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3757 |
Affidavit of Notification |
DSD-Permits-Construction |
6/13/23 |
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3764D |
Temporary Closing Order for ORV Connector Route on State Highway |
DSD-Permits-Construction |
6/13/23 |
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3765 |
Authorization to Re-Open ORV Connector Route on State Highways |
DSD-Permits-Construction |
6/13/23 |
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3766 |
Order to Close ORV Connector route on State Highway |
DSD-Permits-Construction |
6/13/23 |
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4106 |
Small Business Program Application |
Office of Business Development |
6/21/23 |
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5022 |
Request for Payment |
Office of Economic Development |
6/30/23 |
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5105 |
Contract Request |
Contract Services Division |
6/15/23 |
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5601 |
MDOT Core Log and Chain of Custody |
BFS-Construction Field Services |
6/6/23 |
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UP-67 |
Parade Event Permit Application |
DSD-Permits-Construction |
6/8/23 |
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NEW |
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Form Number |
Form Name |
Division Name |
New Form Create Date |
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3536 |
Compliance Certification Form for LAP Projects With Federal Aid Highway Program (FAHP) Funding |
DSD-Local Agency Program |
6/14/23 |
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3593 |
Lane Closure and Oversize/Over Width Restriction Request |
BFS-Construction Field Services |
6/28/23 |
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1861C - Transverse Shear Test Data ? Worksheet |
Transfer from CFS to BOBS-Geotechnical Services Section |
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1174S ? Inspector's Report of concrete Placed - Structure 1031 - Request for Electronics Equipment Repair |
Transfer from CFS to BOBS-Bridge Construction |
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Obsolete Forms:
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0072 - Employer Inquiry for Special Placement in the Transportation Maintenance Work Element Program |
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0434 - Emergency Information Form |
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1886 - Life Cycle Cost Analyst Assumption Sheet |
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