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  • This sheet is to remain with the project records and is required to be submitted with the final construction records

    by 81 days after substantially complete.

    Place Project Label Here

    Back Up Flash Drive

    As-Built Plan Electronic File

    Design Quality Index Report (w/remarks that PM reviewed)

    DT2510 Project Teams Evaluation of Contractor

    Contractor Performance Reports

    Explanation of Variation

    Diary (w/staff listing as first page)

    Materials Binder(s) or Box(separate from construction records)o DT1310 Certification of MaterialsoWS4567 Buy America Certification (including any applicable exemptiondocumentation)

    All records turned in to:__________________Date:_________________


    All records are to be turned in to Northeast Region. An appointment is REQUIRED for records submittal. Transfer electronic contract to the Region before handing in finals.

  • Finals Checklist for Construction Project You have 81 days from substantially complete (time stopped) to submit your records The following items are required when submitting finals records to the regional office: • Flash Drive- Including AsBuilt, Backups, etc. (Follow instructions in NER Construction Admin Guide)• Report of Contractor Performance (signed by Project Engineer)• DT2510 - Team Evaluation of the Contractor• Design Quality Index Report (one for each project ID; include remarks that it was PM reviewed)• Explanation of Variation• Materials Box or Binders

    • DT1310 – Certification of Materials (Must be in the front of the first binder)• WS4567 - Buy America Certification

    NOTE: THE REQUIRED BOXES ARE AVAILABLE AT THE NER OFFICE use the template in the NER Pantry folder to label your boxes Hard copies required.

    All other documentation may be submitted as electronic documents saved on flash drive.

    Indicate N/A if it does not apply to your contract. Construction Diary (placed in soft binder available from NER Office; the first page must be the staff report from FIT)

    Item History to Date (3-ring binders available from NER Office) File by item number and include source documentation. All computations must be checked & initialed.

    Estimates Special Provisions

    Weekly Progress Reports (Working Day Contracts)

    Correspondence Folder (Preferably combined PDF) – Contractor, Property Owners, DOT, Other Agencies

    Request to Sublet (Project Leader copy) Verify Apprentice Hours with Labor Compliance Erosion Control Implementation Plans Erosion Control Diary & Weekly Inspections Meeting notes (Pre-con, weekly, business, etc) Construction Permits Haul Road Logs Stockpile Summary Reports and Supporting

    Documentation Worker’s Comp/Accident Forms

    Input Production Rates in Online Tool

    Contractors Schedules

    Photographs/Videos (to be saved on separate file on the final flash drive)

    Contractor Staking Files

    As-Staked ROW Form (Coordinate with Survey Section)

    Post Inspection Guard Rail Form Submitted Date:

    Curb Ramp Compliance Form Submitted Date:

    MAINTENANCE/STRUCTURE FORMS (Submit to appropriate contact(s))

    Bridge Painting & Concrete Staining Form Submitted Date:

    Specialty Items for Maintenance Form Submitted Date:

    Unique Structure Vertical Clearance Form Submitted Date:

    DT1924 Piling Driving Data Submitted Date:

    DT1350 Piling Record Submitted Date:

    Vertical Clearance Forms (Bridge, Signals, Signs) Submitted Date:

    Expansion Device Installation Form Submitted Date:

    Survey Docs (Benchmarks, Tie Sheets, etc) Submitted Date:

    DT2320 Field Welding Inspection Checklist Submitted Date:

    Benchmark(s) form Submitted Date:

    DT2322 Ancillary Struct. Pre-Installation Verification Test of High Strength Bolts

    DT2321 High Strength Steel Anchor Rod Installation DT2114 Pre-Installation Verification Test of High

    Strength Bolts DT2113 Rotational Capacity Test/Record Shop Drawings

    MATERIALS (Keep in separate binder or box) All documentation that applies to the project

    You must make an appointment to turn in your records. If you are having the contract electronically transferred have it done prior to bringing in your records.


  • 1aSiteHealthAndSafetyChecklist.docx Updated 2/16/15

    Site Health & Safety Checklist (post in field office)

    Project ID: HWY or Route: County: Site Address & Location: Project Begin Date: Click here to enter a date. Project End Date: Click here to enter a date.

    Local Emergency Telephone Numbers: Ambulance: Poison Control Center: Fire Department: Police Department: Hazardous Materials Response Unit:

    Medical Emergency: (In any medical emergency dial 911) Hospital: Phone: Hospital Address: Directions to Nearest Hospital:

    Severe Weather Emergency: Shelter Area I: Shelter Area II:

    Notify District Contact Region Office: Northeast Region Phone: 920-492-5623Supervisor: Phone: Project Manager: Phone: Other: Phone:

    Safety Equipment Inventory: Item Qty Location Inspect. Freq. Comment First Aid Kit 1 Office Weekly Fire Extinguisher 1 Office Monthly Ear Plugs 1 box Office Weekly Safety Glasses several Office Weekly Safety Vests several Office Weekly Hard Hats several Office Weekly Other:

    Contractor MSDS Location:

    REVIEW IS REQUIRED BY ALL ONSITE PERSONNEL BEFORE BEGINNING WORK Name: Initials: Date: Click to enter date. Name: Initials: Date: Click to enter date. Name: Initials: Date: Click to enter date. Name: Initials: Date: Click to enter date.

    See Attached Map for Shelter Areas and Route to Hospital

  • SBD-9301P (06/14)

    Public Employee Safety and Health

    Authority Wisconsin statues section 101.055 requires the Wisconsin Department of Safety and Professional Services to adopt and enforce safety and health standards that will provide protection to public employees at least equal to that provided to private sector employees under standards promulgated by Federal Occupational Safety and Health Administration (OSHA).

    Inspection A public employee or public employee representative who believes that a safety or health standard is being violated, or that a situation exists which poses a recognized hazard likely to cause death or serious physical harm, may request the department to conduct an inspection. If the requestor so designates, the identity of the requestor will be kept confidential. If the department decides not to make an inspection, the requestor will be notified.

    A representative of the employer and a public employee representative will be permitted to accompany the department inspector during the inspection. The employee shall not be discriminated against with respect to either pay received or withheld for time spent on the inspection.

    Enforcement If the department finds a violation of state standards, abatement orders will be issued to the employer. The employer shall post a copy of the orders at or near the site of the violations for 3 days or until the violation is corrected, whichever is longer. Copies of the order will be sent to the top elected official, the bargaining unit and to the person requesting the inspection.

    If the department decides not to issue orders in response to a request, a written notice of that decision shall be sent to the public employee who requested the investigation. If decisions are disputed they will be reviewed.

    Discrimination No public employer may discriminate against or discharge any public employee for exercising any right afforded by his section. A state employee who believes he or she has been discriminated against may file a complaint with the personnel commission within 30 days of employee’s receipt of knowledge of the discrimination. A public employee, other than a state employee, may file a complaint with the state Division of Equal Rights within 30 days.

    For more information, contact: Wisconsin

    Department of Safety and Professional Services

    Industry Services Division

    PO Box 2658

    1400 E Washington Ave. Madison, WI 53701-2658 608-266-2112



  • Hazardous Chemicals in the Workplace?

    You as a public employee have the right, under the Wisconsin public employees' right-to-know law, to be informed about hazardous chemicals and substances in the workplace. *


    ♦ A list of all hazardous chemicals and information on toxic substances,

    pesticides, and infectious agents in the workplace.

    ♦ Access to Material Safety Data Sheets and container labels.

    ♦ Formal training in proper procedures for managing hazardous chemicals.

    ♦ A written chemical hazard communication program.

    For more information contact: Wis. Dept.of Safety and Professional Services Industry Services Division 1400 E Washington Avenue Madison, WI 53703 608-266-1816

    * State Statute 101.581(1)

    SBD-6894-P (R09/13)

  • WisDOT’s Contact List

    Leaks, Spills and Other Hazardous Materials

    Who do you call?

    Spills on the Right of Way – caused by others If you need assistance in stopping or containing the spill, use the Emergency Response (24-hour)

    hotline: 1-800-943-0003 (Note: this is a touch-tone only number)

    To report a spill during work hours, contact the Department of Natural

    Resources (DNR) Emergency Spill Response Coordinator (7:45 AM – 4:30 PM)

    Spill Response Coordinator Region Office

    24 Hour Hotline 800-943-0003Tauren Beggs Northeast 920-662-5178

    Carrie Stoltz

    West Central


    If you have internet access, refer to the WDNR Website for the most current list:

    To report a spill at all other times, or if you cannot

    reach the DNR spill response coordinator, use the

    24-hour Emergency Response Hotline (1-800-943-


    Agricultural Product Spills

    To report an agricultural product spill, in addition to the DNR Emergency Spill Response

    Coordinator or the Emergency Response Hotline, contact the Department of Agriculture, Trade and

    Consumer Protection (DATCP) spill coordinator at (608) 224-4500.

    If there is no immediate threat to public health, public welfare, or the

    environment, reporting requirements are based on the quantity released, as follows:

    • Dry Fertilizer: Report the discharge to the DNR if the amount is 250 lbs. or greater.

    • Liquid Fertilizer: Report the discharge to the DNR if the amount is 25 gallons or greater.

    • Registered Agricultural Pesticides: Report the discharge to the DNR if the amount, when

    diluted according to the label, would cover one acre or more of land if applied according

    to the label instructions.

    For further guidance on agricultural chemical spills refer to

    Margaret Brunette Gina Keenan

    South CentralNorthern



    Janet DiMaggio

  • Abandoned Containers

    1. Contact the DNR Region Spill Coordinator in the area the containers were found (refer toDNR region map on Page 1):

    2. Notify Risk, Safety and Facilities Management : Chris Luttrell (608) 381-2340 and BTS:

    Pat Trainer 608-264-7330

    Petroleum Spills by DOT Personnel – on the R/W (over one gallon) 1. Contact the DNR Emergency Spill Response Coordinator (see list above).

    2. Also contact the Bureau of Technical Services, Robert Pearson at 608-266-7980 or Shar

    TeBeest at 608-266-1476 to arrange for cleanup.

    Petroleum Spills by County Personnel, Contractor or Consultant (any quantity)

    Contact DNR Emergency Spill Response Coordinator (see list above).

    The county, contractor or consultant is responsible for cleanup of the spill.

    Hazardous Waste Spills by DOT Personnel

    Petroleum Spills at DOT Non-Highway Facilities

    1. Contact the DNR Emergency Spill Response Coordinator (see list above).

    2. Contact Risk, Safety and Facilities Management – Chris Luttrell (608) 381-2340 and BTS –

    Pat Trainer 608-264-7330 to arrange for cleanup.

    Hazardous Waste Spills by County Personnel, Contractor or Consultant

    Contact the DNR Emergency Spill Response Coordinator (see list above).

    The county, contractor or consultant is responsible for cleanup of the spill.

    DOT Remediation of Petroleum Contaminated Sites

    Contact DTSD – Bureau of Technical Services (BTS) – Robert Pearson at 608-266-7980, or Shar Te

    Beest 608-266-1476.

    Remediation of DOT Owned Facilities (Sign Shops, Radio Towers, State Patrol Offices, Weigh

    Stations, etc.)

    Contact DBM Risk, Safety and Facilities Management – Chris Luttrell (608) 381-2340 and BTS –

    Pat Trainer 608-264-7330.

    DOT Remediation of Hazardous Waste

    Contact BTS – Pat Trainer 608-264-7330

    Third Party Liability Claims

    If there is a claim or potential for a claim by a third party who is damaged by a release of a

    contaminant from a source that is under DOT’s control or from a source which we own or control,

    contact DBM Risk, Safety and Facilities Management – Chris Luttrell (608) 381-2340.

    For further information, or to receive an update of this contact list, contact the Bureau of Technical Services,

    Environmental Services Section

    Shar TeBeest (608) 266-1476

    Last Revised –Jan 30, 2019

    dotllmText Box

  • 1eTopSafetyTips.docx 2/7/18

    1. Watch out for traffic: Don’t ever forget where you are…particularly on jobs being buildunder traffic.

    2. Wear protective clothing and equipment: Today’s high visibility clothing lets you be seenand can give you the edge on the job. Hard hats, vests, safety shoes, safety glasses, and sometimes earplugs may be appropriate…Use them!

    3. Bridge safety is fundamental: Be alert and be careful! There is always a lot of hangingfrom bridges. Ladder safety is crucial. Use your harness.

    4. Watch out for heavy equipment: Stay as far away from heavy equipment as you can, andremember, all construction equipment can easily topple over. Don’t be downhill!!

    5. Beware of trenches and tight spaces: You may not get a second chance to practicetrench safety. The walls can collapse or trap you. Make sure others know where you are, andthat you know where they are. Be able to identify a confined space and do not enter if apermit is required to enter.

    6. Practice good job safety habits: Identify and report unsafe conditions. Correct them ifyou can and warn others about them. Remember to report accidents. Everyone is responsiblefor safety. Do your part to prevent an accident from happening to someone else.

    7. Look up and live: Live wires, cranes, booms and loads, tree branches, and scaffolding are afew things that may be overhead on your job. Be alert! Look up and live!

    8. Be sure of your footing: Slips and falls can cause sprains, strains, breaks, fractures, andworse. Uneven footing on construction jobs is the rule. Think about your next step!

    9. Lifting things properly: Carry a balanced load, pick it up properly, and don’t let your loadobstruct your vision.

    10. Always following safety rules and procedures: Professional athletes know theimportance of fundamentals. Retrain yourself regularly on the fundamental rules of safetyprocedures. Remember Lombardi’s training camp opener, ‘This gentlemen, is a football!’

    Safety is a team effort. Make sure all members of your construction staff follow these habits, especially the employees that are new to your construction project. Remember to report all accidents or injuries as soon as they occur.

    Northeast Region TOP 10 SAFETY TIPS

  • LifeMatters800-634-6433

    We’re Only A Phone Call Away

    Employee Assistance Program for State of Wisconsin Employees Northeast Region Employee Assistance Contact: Patricia Schmitz


    Confidential Convenient Free

  • 1/30/19


    ESS Contacts: Bob Pearson 608-266-7980; Shar Te Beest 608-266-1476, 608-381-4789 (cell)

    Date: Click to enter date. Time: Your Initials: ESS person who took call: Phone: Consultant ESS contacted: Who will be the consultant representative? When will they be able to get on- site?

    INFORMATION TO REPORT In describing the problem for ESS please include as much of this information as possible.


    Project ID: REGION: NE COUNTY: Choose County HIGHWAY NO./STREET NAME: Stationing/Plan Sheet number: LOCATION OF PROBLEM:

    SITE CHARACTERISTICS Appearance, odor of soils in area: Appearance, odor of liquids in area: Tanks (UST's) or pipes present: Approximate size and dimension of UST: Location of UST or contamination relative to centerline and station: Obvious liquid or product in the tank: Are utilities marked? Yes/No Any previous land use knowledge that would be useful: Soil types, depth to groundwater:

    STATUS OF CONSTRUCTION PROJECT Status of highway construction near site (type of job, are you just starting, or at the end of the job?)

    How soon does work in the impacted area need to be completed? Can work continue in an area away from contamination? Yes/No; for how long? Can the impacted area be avoided? Yes/No Could design in the contaminated area be changed? (Easier to tell once consultant has definednature and extent of contamination). Yes/No

  • 1/30/19


    Has the Construction or demolition contractor:

    1. Stopped work in the area? Yes/No 2. Secured the area? Yes/No 3. Contacted the local fire department? Yes/No4. Contacted the area DNR representative? Yes/No 5. Located an area where contaminated soil could be stockpiled if necessary? Yes/No

    [See CMM 1.30.2 for further instructions]

    See following page for NE Region HazMat construction emergency contact info.

  • 1/30/19


    • Have contractor stop work in the area. Secure area and contact fire department if there is animmediate risk associated with the release.

    • Record as much information as possible on the NER Construction ESS Emergency Checklist (acopy can be found in the project binder). Additional instructions can be found in CMM 1.30.2.

    • NER first point of contact is:Kathie VanPrice 920-492-7175

    • If Kathie is not available, contact one of the following:Mike Helmrick 920-492-7738Jen Gibson 920-492-4160

    • If NER staff are not available, contact one of the following (BTS-ESS):Shar TeBeest 608-266-1476Bob Pearson 608-266-7980

    • If you are unable to reach any WisDOT contacts listed above, contact one of our hazmatconsultants directly. Current contact info is listed below. If you are working directly with ourconsultants, please send an e-mail to Kathie VanPrice and [email protected] thatincludes project ID, description of construction emergency, and which consultant you are workingwith. NOTE: if Shar TeBeest is out of the office and has her automatic reply set, you can find a listof current contact info in her Out of Office Reply.

    GEI: Roger Miller 920-455-8657 or 920-737-6373 (cell)Mike DeBraske 920-455-8200 or 920-412-4779

    AECOM:Kyle Wagoner 715-342-3038

    TRC:Dan Haak 608-826-3628 or 608-886-7423 (cell)

    NRT:Mark Walter 414-837-3563 or 608-220-2480 (cell)

    mailto:[email protected]

  • Revised 1/30/19

    NER Construction Computer Software Request PCL fill out all fields that apply to your request. Notify the Region Office at least one week in advance to schedule an appointment to have programs

    installed or uninstalled. Computers are REQUIRED to be loaded at least one week in advance of the preconstruction conference.

    Load Construction Programs (if you need Field Book, note the quantity and user names in the Notes below)

    Only Send Field Manager Contract file (current construction programs were previously loaded)

    Unload Construction Programs – Do you still need your FieldNet ID? Yes No Remove contract(s) and all WisDOT construction software.

    (This is the typical process. If you have an exception, please select one of the following options.) Remove contract(s) and leave programs, I have other active contracts on this pc. Remove contract(s) and leave programs, I will be administering other contract(s) this construction season with NER or Other Region.

    FieldNet ID: (required for unloading programs or sending FM contract files)

    Notes: __________________________________________________________________________________________________________________________________________________

    For Consultants Only:

    Administrator Logon ID:

    Administrator Password:

    You will be notified when your PC is ready.

    This form is to be submitted to Steve Nies stephen.nies[email protected] or Kristie Robinson [email protected] when contacting him to schedule a computer request. If you have any questions when filling out the form use the NER Construction Guide, Who to Contact, NER Contract Administration Support.

    NER STH 441

    Date: Click here to enter a date. Preconstruction Conference Date: Click here to enter a date.

    Name: Consultant: WisDOT (first name, middle initial, last name) (Firm Name)

    E-Mail Address: Office: ( ) - Cell: ( ) -

    Contract ID: Project ID: Project Manager:

    mailto:[email protected]:[email protected]

  • Electronic Field Files 201xxxxxxxxx Field Files Folder

    The following folders contain contract documents. It is your responsibility to verify that these files have been forwarded to you and are saved correctly when submitting your finals.

    See the NER Field Const Admin Guidelines for instructions on naming and saving your files.

    If you are missing files you need to contact your PM. If you are missing any utility documents you may contact Jeff Orr directly at [email protected] or (920) 492-3511.

    Administrative Labels

    Plan & Proposal (AsLet Proposal & Plan, you willuse this plan file to create your AsBuilt plan) Please deleteonce your AsBuilt is complete and prior to submitting yourfinals


    Approved Environmental Document(contains the approved ECIP this is required on almost all contracts)

    Railroad (If there is a RR on your contract at minimum this will contain a copy of the certification of insurance, it may have the policy too)

    RW Commitments (All R/W acquisitions or agreements from conception through the letting)

    Traffic Management Plan (file should be added)

    Utilities (If there is utility work on your contract these folders will have files)

    Permits (signed permits) Work Plans (approved work plans)

    mailto:[email protected]

    000SheetToRemainWithProjRec00 NE Finals Checklist 1aSiteHealthAndSafetyChecklist1bPublicEmployeeSafetyAndHealth1cHazardousChemicalsInTheWorkplace1dLeaksSpillsAndOtherHazardousMaterialsContacts1eTopSafetyTips1fNERLifeMattersPoster2ConstrESSEmergencyChklst.dotm4ConstrComputerSoftwareRequest5ElectronicFieldFiles