Pennsylvania Department of Transportation 05/17/2017
Construction Forms CS and TR Forms Listing Please note: There could be different file formats, Adobe .pdf, MS Word .doc., MS Excel .xls, MS Excel .xlt. To open a file, your computer will need the appropriate software program installed. There are different form types. Each type is indicated under the form number on the form: Fillable Fields/Print – Fields can be filled in and the form printed but cannot be saved. Fillable Fields/Save As – Fields can be filled in and saved as another filename. Reproduce Locally - Print and make copies as needed. Fill in by hand. Directions: 1. Click on the link of the desired form to open it. 2. Save a copy of the file to your hard drive. 3. Use the form from your hard drive. For information regarding forms, please contact: Michael Lentz Bureau of Project Delivery Highway Delivery Division 400 North Street, 7th Floor West Harrisburg, PA 17120 717.787.7899
[email protected] CS-2 CS-5 CS-6 CS-7 CS-101 CS-110 CS-111 CS-200 CS-201 CS-351F CS-351P CS-409 CS-430 CS-431 CS-536TT CS-600 CS-601 CS-616 CS-704 CS-705 CS-901 CS-2121 CS-4136 CS-4137 CS-4138 CS-4170
Construction Project - Quality Survey for Design Items Pile Hammer Data Pipe Installation Inspection Form Defective Bituminous Pavement Review Inspector’s Field Office and Inspection Facilities Payment Authorization for Material Stored or On Hand Subcontractor/Supplier Request for Estimate Monitoring Source of Supply – Materials Source of Supply – Traffic Items PennDOT/NECEPT Bituminous Field Technician in Training Evaluation and Sign-Off PennDOT/NECEPT Bituminous Plant Technician in Training Evaluation and Sign-Off Minimum Quality Control Plan for Field Bituminous Paving Operation Notification of Inspection Structural Material Transfer Concrete Field Technician-in-Training Evaluation Post Installation Pipe Inspection Report Post Installation 100 Year Design Life Pipe Inspection Report Request for Plant Material Substitution Minimum Quality Control Plan For Field Placement Concrete Operations Electronic Changes Form Work Zone Traffic Control Compliance Checklist and Notification Record of Contractor’s Payroll Submissions Punchlist Form Final Inspection Form Acceptance Certificate Product Evaluation Certificate of Eligibility
CS-4171 CS-4171B CS-4171C CS-4171F CS-4171LA CS-4211A CS-4211C CS-4211F CS-4211I CS-4211J CS-4211K CS-4211L CS-4211M CS-4211N CS-4220 CS-4220A CS-4221A CS-4221C CS-4221E CS-4221G CS-4225A CS-4225B CS-4225C CS-4225D CS-4225E CS-4225F CS-4225G CS-4225H CS-4300
Certificate of Compliance Certificate of Compliance for Daily Bituminous Mixtures Supplemental Cert for Epoxy Coated or Galvanized Reinforcement - Coating Facility Supplemental Cert for Epoxy Coated or Galvanized Reinforcement - Fabricating Facility Certificate of Compliance for Locally Approved Non-Bulletin Materials Material Test Results Scale Check PTM 410 Compression Tests Material Test Results Aggregate No. 57 Material Test Results Aggregate No. 8 Material Test Results Fine Aggregate Material Test Results Aggregate No. OGS Material Test Results Aggregate No. 67 Material Test Results Aggregate No. 2A Batcher-Mixer Slip Batcher-Mixer Slip (Concrete Mobile) Moisture Tests Record of Daily Orders and Releases Equipment Calibration Record Anti Skid Summary and Moisture Record Ground Rod Test Conductor Insulation Resistance Test Circuit Performance Test
Highway Illumination Test Sign Illumination Test High Mast Lighting Test Conventional Lighting Poles Static Load Test Highway Lighting In-Service Guarantee Notification Contractor Prequalification Forms (This links to the ECMS II home page: then Contractors)
CS-4307 Contractor’s Past Performance Report CS-4307Sub Contractor’s Past Performance Report CS-4311 Status of Contracts on Hand CS-4337 Annual Inspection of Transit Truck Mixers CS-4337A Producer’s Transit Truck-Mixers CS-4339R Request for Subcontractor Approval CS-4342 Field Calibration Sheet for Latex Mobile Mixers CS-4345 Borrow and/or Waste Agreement CS-4347 Force Account Daily Sign-Off CS-4347AA Final Summary (Projects Let on or After August 25, 2016) CS-4347AA Final Summary (Projects Let Prior August 25, 2016) CS-4347AS Subcontractor Summary CS-4347BA Material Breakdown CS-4347CA Labor Breakdown CS-4347CERT Liability Insurance Rate Certification CS-4347CJ Force Account Estimate Negotiated Price Cost Justification CS-4347CON Consumables Breakdown CS-4347D Daily Labor Breakdown CS-4347EER Estimated Effective Rate Computation CS-4347F Daily Equipment Breakdown CS-4347LABOR Labor Three-Part Form CS-4347MA Force Account Material Affidavit CS-4347OED Owned Equipment Breakdown - Daily CS-4347OEH Owned Equipment Breakdown - Hourly CS-4347OEN Owned Equipment Breakdown – No Blue Book Listing
Sign in then select Business Partner
CS-4347RES CS-4347SFA CS-4347WCI CS-4350A CS-4350B CS-4350C CS-4350D CS-6105
Rented Equipment and Service by Others Breakdown Force Account Salaried Foreman Affidavit Workers’ Compensation Insurance – 5 Year Average Rate Computation Work Order "Explanations" Form - Additional Work/Extra Work Category Work Order "Explanations" Form - Administrative Category Work Order "Explanations" Form - Legal Category Work Order "Explanations" Form - Value Engineering Category Weigh Team Record
FHWA-1446B Final Acceptance Report FHWA-1494 Semiannual Labor Compliance Enforcement Report FHWA-1365 Record of Authorization to Proceed with Major Contract Revision STD-21 Compliance Review
TR-50 TR-51 TR-52 TR-53 TR-54 TR-55 TR-448A TR-455 TR-478A TR-483 TR-498 TR-4109 TR-4221A TR-4238A TR-4276A TR-4276B TR-7011 TR-800
Production Joint Welding Procedure Specification (D1.1-2008) Aluminum Production Joint Welding Procedure Specification (D1.2-2008) Production Joint Welding Procedure Specification (D1.5-2008) Fillet Weld Soundness Test (FWST) Results (AWS D1.5-2008) Aluminum Weld Procedure Qualification Record (D1.2-2008) Procedure Qualification Record (D1.5-2008) Job Mix Formula Report Disposition of Failed Materials Report on Compaction Density Non-Movement Micro-Surfacing Mix Design and Materials Analysis Bituminous Concrete Plant Inspection Report Portland Cement Concrete Plant Report Concrete Mix Design Form District’s Letter of Project Material Certification Report on Compaction Density by Nuclear Method Control Strip Density by Nuclear Method Cement Mill Test Results Structural Materials Quality Comment Sheet
