May 2004 Construction Forms A-i. Table of Contents APPENDIX A CONSTRUCTION FORMS... A-1. SCDOT Construction Form Description Table...

Transcription

1 APPENDIX A Construction Forms SOUTH CAROLINA DEPARTMENT OF TRANSPORTATION May 2004

2

3 May 2004 Construction Forms A-i Section Table of Contents Page APPENDIX A CONSTRUCTION FORMS... A-1 SCDOT Construction Form Description Table... A-2

4 A-ii Construction Forms May 2004

5 May 2004 Construction Forms A-1 Appendix A Construction Forms Figure A-1A presents a descriptive list of the most common SCDOT Construction Forms that will be used to administer SCDOT construction contracts and inspect typical pay items. The forms listed in Appendix A are available in electronic format on the SCDOT Intranet Web Site.

6 New No. Old No Name Section Description Responsibility Pre-Construction Checklist Who Fills Out the Form? Who Signs Forms? Distribution general SCDOT LAB-291 Preliminary Letter of Certification materials SCDOT /DEA, Lab Report Recommending Roads for State Maintenance final inspection SCDOT, DEA, Road/Bridge Engr Contractor Notice of Claim claim Contractor Contractor, Contractor Contractor Concurrence and Prompt Payment Distribution of Payment 100 payment Wage Regulation Report 100 general LAB-232 Monthly Report of Testing Activities with Nuclear Gauge equipment SCDOT, DEA, Dir. of Const., Dir. of Const. concurrence SCDOT Contractor, Contractor SCDOT,DEA Accounting SCDOT, Lab LAB-919 Report of Disposition of Materials Failing to meet Specifications 105 materials SCDOT, DEA, DOC Material Certification Log Materials Sampling and Testing Log A Utility Agreement 100 utility Utility Company Z Utility Field Daily Diary 100 DEA, Dir. of Const., Lab, 100 materials SCDOT N/A 100 materials SCDOT N/A Utility Company Utility Mgr, Utility Company, Utility Office utility SCDOT Slope Permission R/W SCDOT Stormwater and Pollution Prevention Plan for Highway Construction 800 NPDES Contractor Contractor Property owner,, DEA, DOC DHEC 2612 Notice of Intent - Stormwater 800 stormwater SCDOT DEA DHEC 2610 Notice of Termination - Stormwater 800 stormwater SCDOT DEA, Dir. of Const. SCDOT, Contractor, District office, DHEC, District office, DHEC PR-1391 Annual EEO Report - Contractors 100 EEO Contractor Subs, Prime Subs, Prime, DBE office, SCDOT CONSTRUCTION FORM DESCRIPTION TABLE Figure A-1A A-2 Construction Forms May 2004

7 New No. Old No. Name Section Description Responsibility Who Fills Out the Form? Who Signs Forms? Distribution DBE Quarterly Report 100 EEO Contractor Contractor Subs, Prime, DBE office, Equal Employment Opportunity Stage Type Inspection 100 EEO SCDOT EEO EEO, EEO, Contractor Request for DBE Summary 100 DBE SCDOT DBE office, Monthly Training Status Report 100 general Contractor Trainee Termination Report 100 general Contractor Final Inspection Acceptance Report Railroad Grade Crossing Signal Project Report of Acceptance of Small Quantity Materials LAB-932 Field Density Test Report (Nuclear Gauge) 200/ A Percent Compaction by Nuclear Gauge 200/ B Percent Compaction by Nuclear Gauge - Direct Read Gauge 200/300 railroad SCDOT subgrade, base, embankment subgrade, base, embankment subgrade, base, embankment SCDOT SCDOT SCDOT Contractor SCDOT, Contractor Contractor Compliance Office, DEA & Utilities Mgr., DEA & Utilities Mgr., Lab Agreement for Placing Debris on Private Property 200 clearing/grub Contractor Contractor Landowner DHEC 3428 Notification of Demolition 700 structure DHEC SCDOT Blasting Notice public notice Contractor Contractor N/A Depth Check Records 300 base DEA Landowner, Contractor, District office, DHEC Communications Office SCDOT LAB-935 Density Test Report (Nuclear Gauge) 300 stone base SCDOT, Lab LAB-935B Density Test Report (Nuclear Gauge) - Direct Read Gauge 300 stone base SCDOT, Lab W Ignition Oven Worksheet 300 asphalt Contractor N/A, Lab LAB-266 Determination of Target Density for Asphalt Concrete Materials 400 asphalt Contractor Contractor Contractor Lab SCDOT CONSTRUCTION FORM DESCRIPTION TABLE Figure A-1A (Continued) May 2004 Construction Forms A-3

8 New No. Old No Name Section Description Responsibility Daily Report of Asphalt Plant Inspection 400 asphalt SCDOT Daily Report of Asphalt Roadway Inspection Daily Report of Asphalt Roadway Inspection Contractor QC/QA - Placed LAB-966 Asphalt Ignition Oven Mixture Calibration Worksheet LAB-967 Asphalt Ignition Oven Mixture Calibration Verification Worksheet asphalt LAB-988 Silo Approval Overnight Storage 400 asphalt PWL-1 Lot Pay Factor Calculations SCDOT Who Fills Out the Form? Plant Roadway 400 asphalt Contractor Who Signs Forms? Plant, Roadway,, District Distribution, Lab, Lab, Lab 400 asphalt Contractor Contractor Contractor Lab 400 asphalt Contractor Contractor Contractor Lab 400 asphalt Contractor PWL-1 Lot Pay Factor Calculations - Thin Lift 400 asphalt Contractor PWL-2 In-Place Density Contractor QC/QA - Nuclear Gauge 400 asphalt Contractor PWL-2 In-Place Density Contractor QC/QA - Roadway Cores 400 asphalt Contractor Weekly Lime Anti-Stripping Additive Report 400 asphalt Contractor LAB-979 Verification of Hydrated Lime Weighing Systems for Hot Mix Asphalt Maximum and Effective Specific Gravity Worksheet 400 asphalt SCDOT In-Place Density Contractor QA 400 asphalt In-Place Density Contractor QC/QA PWL 400 Contractor Contractor Contractor Lab Plant, District, District, District, District, District Plant,, Contractor, Lab, Lab, Lab, Lab, Lab Field Lab 400 asphalt Contractor N/A, Lab SCDOT Contractor asphalt SCDOT Contractor Traffic Control Plan 600 traffic Contractor Contractor Workzone Traffic Control Inspection 600 traffic SCDOT SCDOT CONSTRUCTION FORM DESCRIPTION TABLE Figure A-1A (Continued), DEA, Contractor DEA A-4 Construction Forms May 2004

9 New No. Old No Name Section Description Responsibility BR-1 Concrete Pour 's Checklist BR-2 Concrete Pour 's Checklist - Contractor's QC 500 concrete SCDOT BR-3 Concrete Pre-Pour Checklist for Non-Bridge and Non-Culvert Items LAB-660 Ready Mix Concrete Report 500 concrete SCDOT Dry Run Depth Checks for Bridge Deck Pours Wet Depth Checks for Bridge Decks - Transverse Wet Depth Checks for Bridge Decks - Longitudinal Who Fills Out the Form? Who Signs Forms? Distribution 500 concrete SCDOT 500 concrete SCDOT Plant / field inspector Plant / field inspector 700 structure SCDOT 700 structure SCDOT 700 structure SCDOT PIT.VERIFI CSL/PDA/PIT Testing Verification 700 foundations SCDOT Slurry Inspection Log 700 foundations Contractor Contractor Drilled Shaft Concrete Placement Log 700 foundations Contractor Contractor Drilled Shaft Concrete Volumes Log 700 foundations Contractor Contractor Drilled Shaft Excavation Log 700 foundations Contractor Contractor Drilled Shaft Inspection Log 700 foundations Contractor Contractor Drilled Shaft Log 700 foundations Contractor Contractor Pile Driving Log 700 foundations SCDOT, Bridge, Construction Welding Procedure 700 structure Contractor Contractor Contractor, Lab Pile Record 700 foundations SCDOT N/A SCDOT CONSTRUCTION FORM DESCRIPTION TABLE Figure A-1A (Continued) Submit w/ Final Plans May 2004 Construction Forms A-5

10 New No. Old No Name Section Description Responsibility Swiss Hammer Readings 700 structure Who Fills Out the Form? Who Signs Forms? SCDOT Agreement for Moving Items Release R/W Contractor Contractor Landowner, 2 witnesses, Distribution, Bridge, Construction Sediment and Erosion Control Site Inspection Report 800 NPDES SCDOT CEI, CEI office SCDOT CONSTRUCTION FORM DESCRIPTION TABLE Figure A-1A (Continued) A-6 Construction Forms May 2004