Illinois Department of Transportation, Ann L. Schneider, Secretary
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ILLINOIS DEPARTMENT OF TRANSPORTATION
BUREAU OF MATERIALS AND PHYSICAL RESEARCH
 Standard Materials Forms and Templates

If you have questions regarding this conversion, please email: Vickie.Prill@illinois.gov

The standard* materials inspection and testing forms are listed below.  The files are Microsoft Word documents that can be viewed or downloaded.

 

Form Number Form Name Revised
 
Aggregate
BMPR AGG01 Aggregate Shipping Tickets Information Form for Producers  
BMPR AGG02 Aggregate Shipping Tickets Information Form for Suppliers and Terminals  
BMPR AGG03 Aglime Submittal Form  
BMPR AGG04 Application for Aggregate Gradation Technician Course 02/02/12
BMPR AGG05 Witness Verification of Aggregate Gradation Technician Course 01/18/12
BMPR AGG06 Template Aggregate Producer Certification Letter 12/30/13
BMPR MI 504 Field / Lab Gradations 11/20/12

Chemical Tests

BMPR 3415 Certificate of Analysis on Performance Graded Asphalt Binders 06/18/09
BMPR 3553 Certificate of Analysis on Cutback Asphalt 04/7/09
BMPR 3555 Certificate of Analysis on Emulsified Asphalt 04/7/09
BMPR ACCTG1 Glass Bead Certification Statement 03/13/14
BMPR ACCTW1 White Traffic Paint Certification Statement 05/11
BMPR ACCTY1 Yellow Traffic Paint Certification Statement 05/11
 

Hot Mix Asphalt (HMA)

BMPR MI303N Quality Assurance Nuclear Density Report 07/02/09
BMPR RASSPL Supplier Certification Form for Manufacturer's Salvaged and Post-Consumer (Tear-Off) Asphalt Shingles 06/19/12
BMPR RASCRT Reclaimed Asphalt Shingles (RAS) Source Certification Form 06/19/12
 

Miscellaneous

BMPR LM6 Template Sample Identification
(Access database DOWNLOAD Only)
10/01/12
BMPR LM6 Import Table Import table for updating lookup table in LM6 database 04/01/14
BMPR MI082 Assignment of Material – Aggregate 12/06/07
BMPR MI083  Assignment of Materials – Miscellaneous 12/06/07
BMPR MT01 Fastener Identification 04/01/08
 

Portland Cement Concrete (PCC)

BMPR CM01 Cement / Finely Divided Materials PRE / PRO Sample Identification 03/10/11
BMPR CM02 Portland Cement Producer's Test Report 03/10/11
BMPR CN004 Concrete Compressive Strength Record 10/04/13
BMPR CN005 BMPR Concrete Laboratory Compressive Strength Testing Form 10/04/13
BMPR CN012 Concrete Laboratory Strength Testing 10/04/13
BMPR PCC001 Concrete Plant Survey 01/18/12
BMPR PCC002 Annual Inspection Certification for Concrete Plant 03/11/14
BMPR PCC003 Annual Inspection Certification for Concrete Delivery Trucks 03/11/14
BMPR PCCQ01 Calibration of Concrete Testing Equipment, SLUMP 09/17/12
BMPR PCCQ02 Calibration of Concrete Test Equipment Air Meter Type A 02/07/13
BMPR PCCQ03 Calibration of Concrete Testing Equipment Air Meter, Type B 02/07/13
BMPR PCCQ04 Calibration of Concrete Testing Equipment, Air Meter, Volumetric 09/17/12
BMPR PCCQ05 Calibration of Concrete Testing Equipment, Unit Weight 09/17/12
BMPR PCCQ06 Calibration of Concrete Test Equipment Cylinder Molds, Plastic 08/28/13
BMPR PCCQ07 Calibration of Concrete Test Equipment, Beam Molds, Steel  
BMPR PCCQ08 Calibration of Concrete Test Equipment Metal Retainers & Neoprene Pads 07/28/09
BMPR PCCQ09 Calibration of Concrete Test Equipment, Capping Cylindrical Strength Specimens 10/17/13
BMPR PCCQ10 Calibration of Concrete Test Equipment, Cylinder Molds, Plastic, 4" x 8" 08/29/13
BMPR PCCW01 Water/Cement Ratio Worksheet 12/06/11
BMPR PCCW02 Aggregate Moisture Worksheet Pychonometer Jar Method  
BMPR PCCW03 Mobile Mixer Mix Design Calibration Worksheet  
BMPR PCCW04 (.xlsx) Modulus of Rupture Test Worksheet for Concrete Beams  
BMPR PCCX01 Illinois Modified AASHTO T 22 Checklist Procedure for Obtaining Compressive Strength of Cylindrical Concrete Specimens  
BMPR PCCX02 Illinois Modified AASHTO T 23 Checklist Making and Curing Concrete Test Specimens in the Field, Casting Beams  
BMPR PCCX03 Illinois Modified AASHTO T 23 Checklist Making and Curing Concrete Test Specimens in the Field, Casting Cylinders 7/22/13
BMPR PCCX04 Illinois Modified AASHTO T 119 Checklist Slump of Portland Cement Concrete  
BMPR PCCX05 Illinois Modified AASHTO T 121 Checklist Unit Weight, Yield, and Air Content (Gravimetric) of Concrete  
BMPR PCCX06 Illinois Modified AASHTO T 141 Checklist Sampling Fresh Concrete 10/17/13
BMPR PCCX07 Illinois Modified AASHTO T 152 Checklist Air Content of Freshly Mixed Concrete by the Pressure Method, Type A Meter  
BMPR PCCX08 Illinois Modified AASHTO T 152 Checklist Air Content of Freshly Mixed Concrete by the Pressure Method, Type B Meter  
BMPR PCCX09 Illinois Modified AASHTO T 177 Checklist Procedure for Obtaining Flexural Strength of Concrete (Using Center Point Beam Loading)  
BMPR PCCX10 Illinois Modified AASHTO T 309 Checklist Temperature of Freshly Mixed Portland Cement Concrete 02/14/14
BMPR PCCX11 Illinois Test Procedure SCC-1 Checklist A Sampling Fresh Self-Consolidating Concrete 10/24/13
BMPR PCCX12 Illinois Test Procedure SCC-1 Checklist B Unit Weight, Yield, and Air Content (Gravimetric) of Self-Consolidating Concrete 08/20/09
BMPR PCCX13 Illinois Test Procedure SCC-1 Checklist C Making and Curing Self-Consolidating Concrete Test Specimens in the Field 10/08/10
BMPR PCCX14 Illinois Test Procedure SCC-2 Checklist Slump Flow and Stability of Self-Consolidating Concrete 08/20/09
BMPR PCCX15 Illinois Test Procedure SCC-3 Checklist Passing Ability of Self-Consolidating Concrete by J-Ring and Slump Cone 08/20/09
BMPR PCCX16 Illinois Test Procedure SCC-4 Checklist Passing Ability of Self-Consolidating Concrete by L-Box 08/20/09
BMPR PCCX18 Illinois Test Procedure SCC-6 Checklist Static Segregation of Hardened Self-Consolidating Concrete Cylinders 09/12/12
BMPR PCCX19 Illinois Test Procedure SCC-8 Checklist Assessment of Dynamic Segregation of Self-Consolidating Concrete During Placement 12/03/13
BMPR MI654 Concrete Air, Slump and Quantity 11/01/12
BMPR MI655 P.C. Concrete Strengths 11/01/12
 

Precast Concrete Products

BMPR PC01 Annual Precast Plant Inspection Form 03/1/12
BMPR PC02 QA Log for Precast Concrete Plant 03/1/12
 

Precast Prestressed Concrete Products

BMPR PS01 Qualification Test for Welders and Welding Technique 12/06
BMPR PS02 Notice of Unacceptable Product at Plant or Jobsite 06/25/08
BMPR PS03 Inspection Feedback to Precast Prestressed Concrete Producer 11/17/09
BMPR PS04 Inspection Form for Precast Prestressed Concrete Product Plants 03/1/12
BMPR PS05 Tracking Log for PS02 Forms   
BMPR PS06 Tracking Log for PS03 Forms  
 

Soils

BMPR 507A Summary Report on Pavement, Base and Sub-Base Design 06/28/13
BMPR 508A Soil Test Data Sheet 08/23/13
BMPR MI701N Field Soil Compaction – Nuclear (formerly MI701N) 05/07/09
BMPR SL01 Sieve Analysis Worksheet  
BMPR SL02 Moisture-Density Worksheet 03/17/10
BMPR SL11 MSE Wall Chemical Analysis 03/31/14
BMPR SL17 IBR Worksheet  
BMPR SL22 Hydrometer Analysis of Soils  
BMPR SL23 Limit Test Data and PI 01/23/09
BMPR SL24 Shelby Tube Test Results 12/27/11
BMPR SL25 Unconfined Compression Strength 01/14/14
BMPR SL26 Water Content and Density Data Sheet 01/23/09
BMPR SL28 Specific Gravity Worksheet 01/23/09
BMPR SL29 One Dimensional Consolidation 01/23/09
BMPR SL30 Dynamic Cone Penetration Test 03/17/10
BMPR SL31 Static Cone Penetration Test 03/17/10

* Please contact your IDOT district materials office prior to using these forms.

Research Forms

BMPR PROD01 Preliminary Information for Product Evaluation
*The Preliminary Information for Product Evaluation (PIPE) form is not required for products that meet current IDOT specifications.
12/06
BMPR RC002 Technical Review Panel (TRP) Evaluation of Principal Investigator 02/25/13
BMPR RC003 Research Project Closeout Evaluation by Technical Review Panel Chair(s) 02/25/13
BMPR RC004 Pooled Fund Study Evaluation 02/25/13
BMPR RC005 Time Extension and/or Budget Change Request Form 02/25/13
BMPR RC006 Implementation Planning Worksheet 10/08/13
BMPR RC007 Pooled Fund Study Closeout Evaluation 02/26/13
BMPR RC008 Pooled Fund Approval Form 05/28/13
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