Statewide forms
Last updated: 2025-04-22
Reference these statewide forms when administering a construction contract.
DT forms
QMP form templates
| File Name | Description |
|---|---|
| AncillaryPrePlacementDepth.docx | Ancillary pre-placement depth checks (sidewalk & driveways) |
| BADCmpctSum.docx | QMP Base Aggregate 1 1/4" Compaction Testing Summary (155 report) |
| BADSmallQntySum.docx | QMP Small Quantity Base Aggregate Testing Summary (155 report) |
| BADSum.docx | QMP Base Aggregate Testing Summary (155 report) |
| BGQVSum.docx | Beam Guard Acceptance Testing Summary (155 report) |
| CIRSum.docx | Cold In-Place Recycling Summary (155 report) |
| ConcAncSum.docx | QMP Concrete AncillaryTesting Summary (155 report) |
| ConcBarrSum.docx | QMP Concrete Barrier Testing Summary (155 report) |
| ConcPvmtSum.docx | QMP Class I Concrete Pavement Testing Summary (155 report) |
| ConcPvmtThickSum.docx | Concrete Pavement Thickness Testing Summary (155 report) |
| ConcStrucSum.docx | QMP Class I Concrete Structures Testing Summary (155 report) |
| HMAPWLSum.docx | PWL HMA Mix and Density Testing Summary (155 report) |
| HMAQMPSum.docx | QMP HMA Mix and Density Testing Summary (155 report) |
| IRISum.docx | QMP IRI Ride Testing Summary (155 report) |
| MillRelay_PulvRelayCmpctSum.docx | QMP Mill and Relay Compaction and Pulverize and Relay Compaction Summary (155 report) |
| MSEWallSum.docx | QMP MSE Wall Testing Summary (155 report) |
| NonConformance_NonPerformanceAddendum.docx | NC/NP Justification Write-Up Addendum |
| NonPerformance_NonConformanceConcurrence.docx | NC/NP Justification Write-Up |
| SubgradeSum.docx | QMP Subgrade Summary (155 report) |
WS forms
Forms beginning with A-F
| File Name | Description |
|---|---|
| ApplForPermitToInstallTempBusSignOnHwyRW.dotm | Application for Permit to Install Temporary Business Sign(s) on Highway Right-of-Way During Improvement Project |
| BenchMarks.docm | Bench Marks Location and Elevation |
| Bridge Geometry Field Measurements - Final.pdf | Bridge Vertical and Horizontal Clearance |
| ConcBrdgDeckPrePourAgenda.docm | Concrete Deck Pre-Pour Meeting |
| ConcBrdgSubStrucPrePourAgenda.docm | Concrete Substructure Pre-Pour Meeting |
| ConcPavingPrePourMtg.dotm | Concrete Paving Pre-Pour Meeting |
| ConcreteDeckPourAuthorization(StructureNo).doc | Concrete Deck Pour Authorization Form |
| ConstrPermit.dotm | Construction Permit Recommendation and Approval |
| CRIConceptEvaluation.docx | Cost Reduction Incentive (CRI) Concept Evaluation |
| CulvertPlacement.pdf | Culvert Replacement |
| CurbRampComplianceForm.pdf | Curb Ramp Compliance Post Construction Report Instructions |
| CurbRampComplianceForm_LocalProgram.pdf | Curb Ramp Compliance Form for Local Program projects |
| DamagedGirderReport.pdf | Bureau of Structures Damaged Girder Incident Report & Proposed Response |
| ElastoExpDeviceInstallData.dotm | Elastomeric Expansion Device Installation Data |
Forms beginning with G-L
| File Name | Description |
|---|---|
| GuardrailPostSamplingDataForm.xlsx | Guardrail Post Sampling Data Form |
| HMA_PWL_PrePaveAgenda.docm | HMA PWL Pre-Pave Meeting |
| HMAPrePaveAgenda.docm | HMA Pre-Pave Meeting |
| IRIRideProfileNotificationTemplate.docx | Used by contractors to notify WisDOT staff when IRI ride Profiling is taking place on a contract. |
| LettertoPropOwner.dotm | Letter to Property Owner |
| LineOfCommunication.docx | Line of Communication (Associated levels of decision making) |
Forms beginning with M-R
| File Name | Description |
|---|---|
| MailboxRemoval.dotm | Mailbox Removal During Highway Construction |
| MtgNotes.dotm | Meeting Notes |
| NLEBBridgeInspectionForm.pdf | Appendix C: Bridge/Structure Inspection Form |
| NLEBBridgeInspectionGuidance.pdf | Appendix B: Bridge Inspection Guidance Preliminary Bat Inspection Guidelines for Bridges/Structures |
|
Notification for Demolition and/or Renovation (Form 4500-113)
|
Wisconsin Department of Natural Resources Handling Waste from Demolished Structures web page. Follow these steps if unable to download and open Form 4500-113
|
| PromptPymtToPrimeF2.dotm | Prompt Payment to Prime to Pay Subcontractors F2 |
| PromptPymtToPrimeF3.dotm | Prompt Payment to Prime to Pay Subcontractors F3 |
| PromptPymtToSubF1.dotm | Prompt Payment to Subcontractors F1 |
| RandNoBAD1.xlsx | Random Numbers: Location Base Aggregates Dense |
| RecycledAsphalticBinderChangeRequest.xlsx | Recycled Asphaltic Binder Change Request |
| RRChklst.dotm | Railroad Checklist |
Forms beginning with S-Z
| File Name | Description |
|---|---|
| SignBrdgVertClear.dotm | Sign Bridge Vertical Clearance |
| SignStrucSignalLeftVertClear.dotm | Sign Structure (Signal-Left Side) Vertical Clearance |
| SignStrucSignalRightVertClear.dotm | Sign Structure (Signal-Right Side) Vertical Clearance |
| SiteHealthAndSafetyChklst.dotm | Site Health and Safety Checklist |
| StrucVertClearInstructionOnly.pdf | Record Critical Vertical Clearance |
| TrafficCtrlInspectionChklst.dotm | Traffic Control Inspection Checklist |
| Utility Relocation Claim Assessment Notice.docx | Utility Relocation Claim Assessment Notice |
| Utility Relocation Claim Documentation Checklist.docx | Utility Relocation Claim Documentation Checklist |
| Utility Relocation Claim Notice of Receipt of Claim.docx | Utility Relocation Claim Notice of Receipt of Claim |
| WeeklyProgressMtgAgenda.docx | Weekly Progress Meeting Agenda |
| WDNR Notice of Termination (NOT) Website | Requires WAMS ID to log on |
| WDNR Notice of Termination (NOT) Guidance | Construction General Permit (TCGP) Guidance |
| Yield Calc&Asphalt Paving Diary Example.xlsx | HMA Paving Diary Worksheet |
Pantry Forms Committee Members (Chairperson denoted with an *)
| Member | Representing | Email address | Telephone Number |
|---|---|---|---|
| Chad Hayes* | DTSD Bureau of Project Development | chad.hayes@dot.wi.gov | 608-246-5391 |
| Korey Boehm | NC Region - Wisconsin Rapids | korey.boehm@dot.wi.gov | 715-459-2943 (M) |
| Rebecca C Frank | SW Region - Madison | rebeccac.frank@dot.wi.gov | |
| Eric Hanson | SE Region | ericd.hanson@dot.wi.gov | 414-840-9341 |
| Adrienne Protokowicz | NW Region | adrienne.protokowicz@dot.wi.gov | 715 395-3021 |
| Stacy Lehmann | NW Region | stacy.lehmann@dot.wi.gov | 715 855-7668 |
| Lisa Koca | NC Region - Rhinelander | lisa.koca@dot.wi.gov | 715-365-5708 |
| Brian Heiden | NE Region | brian.heiden@dot.wi.gov |
920-366-3743 |