Illinois Department of Transportation, Erica Borggren, Acting Secretary
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2006 Construction Manual

Forms and Reports

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The following forms are intended for use by personnel working on Illinois Department of Transportation contracts. It is important that the instructions for completing these forms are read and understood.

It is your responsibility to obtain and use the most current version of each form.

*Asterisks next to the links indicate that the file has been updated and is posted on the Addendum page.

Introduction

Bureau of Bridges and Structures Forms

Form Number Form Name
BBS 59 Structural Steel Fabrication
BBS 2557 Pre Project Environmental Submittal Review Checklist
BBS 2558 Pre Project Painting Submittal Review Checklist
BBS 2559 Contractor Environmental Daily Report
BBS 2560A Non-Conformance Report
BBS 2560B Non-Conformance Log
BBS 2561 Construction Inspector Project Start Up Checklist
BBS 2562 Construction Inspector Daily (QA) Report
BBS 2563 Contractor Daily (QC) Report

Bureau of Construction Forms

Form Number Form Name
BC 20* Affidavit
BC 22* Authorization of Contract Changes
BC 22 (Excel) Authorization of Contract Changes
BC 24* Request for Procurement Policy Board Waiver
BC 49 Material Allowance Affidavit
BC 71* Final Inspection Report of State Road Work
BC 107 Final Acceptance of Improvement
BC 111* Checklist for Engineer's Final Payment Estimate
BC 131* Statement of Material Allowances
BC 163 Report of Employee Interviews
BC 239* Weekly Report of Resident
BC 255 Progress Schedule
BC 260A* Request for Approval of Subcontractor
BC 261* Substance Abuse Prevention Program Certification
BC 334 Core Drill Report - Final Samples
BC 503* Assignment of Contract/Consent to Assignment of Contract
BC 608 Local Agency Certification to Accompany Engineer's Final Payment Estimates
BC 623 Quantity Book Cover Sheet
BC 625 Quantity Sheet
BC 628 Inspector's Daily Report
BC 635* Extra Work Daily Report
BC 726 Traffic Control Inspection Report
BC 775 Resident Construction Supervision
BC 776 Resident Inspection - Local Project
BC 777 Notice of Nondiscrimination Clause
BC 930 Consultant Engineer's Daily Personnel and Vehicle Time Distribution Record
BC 931 Consultant Engineer's Private Vehicle Daily Mileage Record
BC 932 Consultant Engineer's Monthly Vehicle Cost Distribution Record
BC 955 Notice of EEO Policy and EEO Officer
BC 981* Agreement on Accuracy of Plan Quantities (English)
BC 981M* Agreement on Accuracy of Plan Quantities (Metric)
BC 1012 Certification of Nonsegregated Facilities
BC 1013 Progress Documentation Review
BC 1131 Report of Telephone Calls
BC 1215 Resident Engineer's Request for Authorization for Change Orders
BC 1241 Performance Bond
BC 1256* Bidder's Employee Utilization Form Construction
BC 1465 Truck Tare Weights
BC 1777* Contractor's Performance Evaluation
BC 1778 Numerical Guidelines for Use With Contractor's Performance Evaluation
BC 2015 Qualification for Welding Steel Bearing Splices Only
BC 2019 Request for Extension of Time
BC 2115 Subcontractor Payment Agreement (Non-DBE)
BC 2240 Traffic Control Surveillance Report
BC 2256* Prior Approval Authorization of Contract Change
BC 2259* NPDES/Erosion Control Inspection Report
BC 2320 Rotational Capacity Test Worksheet
BC 2331* ICORS PC Backup Schedule
BC 2370* Equipment Expense Rate Data
BC 2448A Profile Report for Pavement Smoothness
BC 2448B Smoothness Assessment Worksheet
BC 2529 Bituminous Paving Daily Record
BC 2531 PCC Paving Daily Record
BC 2544 Report of Bridge Deck Patching Quantities

Bureau of Design and Environment Forms

Form Number Form Name
BDE 430 Invoice
BDE 804 Request for Authorization for Costs Involving Utility, Railroad or Local Agency Agreement
BDE 2289 Environmental Survey Request, Borrow/Waste/Use Areas
BDE 2342 & 2342A Contractor Certification Statement

Bureau of Operations Forms

Form Number Form Name
OPER 725 (formerly BT 725) Traffic Control Authorization Request
OPER 726 Traffic Control Inspection Report

Federal Highways Administration Forms

Form Number Form Name
FHWA 47* Statement of Materials and Labor Used by Contractors on Highway Construction Involving Federal Funds (English)
FHWA 47M* Statement of Materials and Labor Used by Contractors on Highway Construction Involving Federal Funds (Metric)
FHWA 1495 Wage Rate Information

Illinois Department of Public Health Forms

Form Number Form Name
IL 482-0631 Water Well Sealing Form

Bureau of Materials and Physical Research Forms

Form Number Form Name
LM 6 Sample Identification
LW 3 Record of Modulus of Rupture Tests
M 411 Report of Net Cost of Section
MI 303N QC/QA Quality Assurance Nuclear Density Report QC/QA
MI 305 QC/QA-B Bituminous Mixture Daily Plant Output Hot Bin/Cold Feed QC/QA
MI 308 QC/QA-B Nuclear Asphalt Content and Marshall
MI 504 Field/Lab Gradations
MI 504M QC/QA Field Lab Gradations
MI 654 Concrete, Air, Slump and Quantity
MI 655 Portland Cement Concrete Strengths
MI 701N Field Soil Compaction (Nuclear)
MIRC 08 Approved Material Inspection Report

Illinois Environmental Protection Agency Forms
Form Number Form Name
  Notice of Open Burn *
WPC 621 * IEPA Notice of Termination (NOT) of Coverage Under the General Permit for Storm Water Discharges Associated with Construction Site Activity
WPC 623 * IEPA Notice of Intent (NOI) General Permit to Discharge Storm Water Construction Site Activities
WPC 624 IEPA Construction Site Storm Water Discharge Incidence of Non-Compliance (ION)

Bureau of Small Business Enterprises Forms

Form Number Form Name
SBE 348 Statement of Compliance
SBE 746 Contractor's Weekly Payroll Certificate
SBE 750 Workforce Contact Inspection Report
SBE 956 Equal Employment Opportunity Workforce Analysis
SBE 956c Consultant's Employee Utilization
SBE 1008 Equal Employment Opportunity Checklist
SBE 1014 Weekly Trainee Report
SBE 1146 Request for Approval of Contractor's Proposed Training Program
SBE 2025 DBE Participation Statement
SBE 2026 DBE Utilization Plan
SBE 2028 DBE/WBE Final Documentation
SBE 2115 DBE Payment Agreement
SBE 2263 Notice Pertaining to False Statements

Miscellaneous

Form Number Form Name
SF 1444 Request for Authorization of Additional Classification and Rate
  Equal Employment Opportunity is the Law
  Resident's Pay Estimate Report - Line Item Detail Report of Completed Contract Work

  Link to the Construction Manual Addendum Page


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