Illinois Department of Transportation, Ann L. Schneider, Acting Secretary
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 Patrick J. Quinn, Governor
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TRAFFIC SAFETY FORMS

To open Microsoft Office Word 2007 .docx or .docm files with Microsoft Office Word 2003, Word 2002, or Word 2000, you need to install the Microsoft Office Compatibility Pack for 2007 Office Word, Excel and PowerPoint File Formats and any necessary Office updates.  By using the Compatibility Pack for the 2007 Office system, you can open, edit some items, and save Office Word 2007 documents in previous versions of Word.

If you have questions regarding this conversion, please e-mail Susan.Nevitt@Illinois.gov

Files below are MS Word Template files. If you do not have Word, MS Word Viewer is available to read these files. See Tips and Tools for a free copy of MS Word Viewer.

For assistance please call the Division of Traffic Safety at (217) 785-3063


Tips - Tools -Troubleshooting

The following forms are related to Highway Safety Grants. Please phone (217) 782-4972 if you have any questions.

File Name Form Title Revised Date
TS CSSS1 Child Restraint Data Collection Observational Survey 6/18/09
TS 01 Receipt of Equipment  
TS 02 Highway Safety Project Grant Budget Revision Request & Approval 02/02/12
TS 02m Highway Safety Project Grant Budget Revision Request & Approval 05/17/12
TS 04 On-Site Event Monitoring Report  
TS 06 Highway Safety Project Monitoring/Contract Report 2/19/09
TS 07 Performance Report for Non-Enforcement Grants   2/7/08
TS 08 Highway Safety Project Agreement, Conditions and Certifications  01/23/12
TS 08 Memorial Day Highway Safety Project Agreement, Conditions and Certifications - Memorial Day 03/16/12
TS 08 Labor Day Highway Safety Project Agreement, Conditions and Certifications - Labor Day 07/11/11
TS 08 STEP Highway Safety Project Agreement Sustained Traffic Enforcement Program 07/15/11
TS 08 TD Highway Safety Project Agreement, Conditions and Certifications - Teen Driving 8/27/10
TS 09 On-Site Project Monitoring Checklist and Report 1/11/08
TS 09-A State Agency Project Monitoring Checklist and Report  
TS 10 Project Monitoring/Contact Report  
TS 10-A State Agency Project Monitoring/Contact Report  
TS 11 Project File Closeout Review 2/6/09
TS 11-A State Agency Project File Closeout Review 10/2/08
TS 12 State Agency Highway Safety Project Agreement 05/22/12
TS 13 State Agency Highway Safety Project Request 12/29/10
TS 20 Highway Safety Project Notification of Change in Highway Safety Project Personnel 11/7/08
TS 20-A State Agency Highway Safety Project Notification of Change in Highway Safety Project Personnel  
TS 20 TD Operation Teen Safe Driving Notification of Change in Project Personnel 6/10/09
TS 21 Verification of Fringe Benefits and Social Security Percentages Paid by Employer  
TS 23 Final Cost Verification and Certification for Highway Safety Project  
TS 24 Claim Processing Memo 07/20/11
TS 25 Review of Local Agency's Financial Procedures 10/23/07
TS 26 Orientation Meeting Check List 1/14/08
TS 26-A State Agency Orientation Meeting Check List  
TS 27-B State Agency Project File Review 1/22/10
TS 28 PI-1 Distribution of Materials  
TS 29 PI-2 Presentation Report  
TS 30 FFY 2011 Local Project Request Review LEL, LAL, Program or Project Coordinator 12/11/09
TS 31 FFY 2011 Local Project Request Highway Safety Planning Committee Pre-Review 11/13/09
TS 32 FY 2012 State Agency Project Request Highway Safety Planning Committee Pre-Review 11/18/09
TS 33 FY 2012 State Agency Project Request Review LEL, Program or Project Coordinator  11/18/09
TS 34 Highway Safety Project Grant Holiday Mobilization Monitoring 1/23/09
TS 35 Major Equipment Inventory  
TS 36 Major Equipment Inventory Inspection  
TS 37 Grantee Planned Activities  
TS 38 Non Law Enforcement Grant Manager Checklist 8/12/09
TS 38a Law Enforcement Grant Manager Checklist 8/12/09
TS 39 Highway Safety Project Receipt of Safety Belt Policy 2/10/09
TS 52 Highway Safety Project Application Local Alcohol Program (LAP) 1/27/11
TS 56 Highway Safety Project Application Child Passenger Safety Program (CPS) 12/9/10
TS 57 Highway Safety Project Application Boost Illinois Child Passenger Safety Program (BI-CPS)  
TS 58 Highway Safety Project Application Pedestrian and Bicycle Safety Programs (PBS) 1/27/11
TS 59 Highway Safety Project Application Motorcycle Safety and Awareness Program (MSA) 11/20/09
TS 60 Highway Safety Project Application 01/19/12
TS 61 Highway Safety Project Application Regional Traffic Safety Resource Center Program (RTSC) 1/26/11
TS 63 Highway Safety Program Application MCR-XML Grant Program (MCR-XML)  
TS 64 Highway Safety Project Application State University Injury Prevention Program (SU-IP) 11/20/09
TS 65 Highway Safety Project Application and Specifications Sustained Traffic Enforcement Program (STEP) 02/09/12
TS 110 Law Enforcement Incentive Data Collection 11/09/11
TS 110-A 2011 Click It or Ticket Incentive Program Data Sheet 11/09/11
TS 110-B 2011 Click It or Ticket Grant Funded Incentive Program Data Sheet 11/09/11
TS 110-C You Drink & Drive, You Lose. Crackdown Participation 7/9/10
TS 111 Click It or Ticket Mobilization Participation Form 4/25/11
TS 111-A Increasing Blood Alcohol Concentration Reporting Project Participation Form 7/15/10
TS 112 Click It or Ticket Earned Media Results 5/13/11
TS 113 Click It or Ticket Order Form 10/26/11
TS 114 Child Passenger Safety Week Order Form 8/30/11
TS 115 Child Passenger Safety Week Distribution of Materials and Earned Media 9/6/11
TS 201 Boost Illinois Program Quarterly Booster Safety Seat Distribution 11/7/08
TS 202 Boost Illinois Program Quarterly Booster Safety Seat Income Report 11/7/08
TS 203 Monthly Child Safety Seat Income Report 11/08/11
TS 204 Monthly Child Safety Seat Distribution 11/08/11
TS 205 Speed/IMAGE/MAP Mobilization Data Collection 5/20/10
TS 206 Injury Prevention Program Monthly Income and Expenditure Report 11/21/08
TS 207 Child Safety Seat Opinion Survey - Pre 2/7/11
TS 207 Spanish Child Safety Seat Opinion Survey - Pre (Spanish Version) 01/31/12
TS 208 Child Safety Seat Opinion Survey - Post 1/11/11
TS 208 Spanish Child Safety Seat Opinion Survey - Post (Spanish Version) 1/14/11
TS 300 TLEP & LAP Data Collection Form  
TS 301 LAP Tables 2/26/09
TS 401 Speed Enforcement Program Speed Survey 5/27/09
TS 402 Speed Enforcement Program (SEP) Speed-Related Crash Data 9/12/08
TS 403 TLEP Tables  
TS 404 IMAGE Campaign - Driver and Front Seat Passenger Seat Belt Usage Survey  
TS 405 Integrated Mini-Grant Enforcement (IMaGE) Final Report - Crash Data  
TS 407 Mini-Grant Alcohol Program (MAP) Final Report - Crash Data  
TS 408 Section 408 Project Description 3/21/12
TS 409 Section 408 Project Update 2/16/11
TS 410 CMV - Speed 4/15/08
TS 480 Section 408 Monthly Project Report 7/8/09
TS 500A Highway Safety Project Claim for Reimbursement STEP & Holiday Enforcement Impaired Driving  11/8/10
TS 500B Highway Safety Project Claim for Reimbursement STEP & Holiday Enforcement Occupant Protection 11/8/10
TS 501 TD Highway Safety Project Cost Summary - Operation Teen Safe Driving 7/28/11
TS 502 TD Highway Safety Project - Request for Payment Operation Teen Safe Driving 7/21/11
TS 503 TD Operation Teen Safe Driving Application 9/6/11
TS 504 TD Setting SMART Goals 7/25/08
TS 505 TD Reporting Your Activities - Operation Teen Safe Driving Worksheet & Instructions 7/21/11
TS 506 TD Developing A Timeline 7/25/08
TS 507 TD Safety Belt Use Survey 7/25/08
TS 508 TD Making a Budget 7/25/08
TS 509 TD Request for Project Continuation Payment and Agreement Modification Operation Teen Safe Driving 7/25/08
TS 510 TD Post-Prom Event Prize Spending Summary Operation Teen Safe Driving 7/28/11
TS 512 TD Operation Teen Safe Driving Monitoring / Contact Report 9/18/08
TS 513 TD Operation Teen Safe Driving Final Report Checklist  7/21/11
TS 514 Please Return on Monday (PROM) 2011 Application 12/27/11
TS 515 Please Return on Monday (PROM) 2010 Reporting Your Activities 12/27/11
TS 517 TD Operation Teen Safe Driving Judging Checklist 8/4/09
TS 518 TD Large Spending Approval Operation Teen Safe Driving 12/18/09
TS 600 Highway Safety Project Claim for Reimbursement TLEP, LAP and Non Law Enforcement 1/6/11
TS 600 -Attachment B Claim for Reimbursement Cover Sheet  
TS 600 -Attachment C Payroll Calculation Sheet  
TS 600 -Attachment D Personal Services Time Card  
TS 600 - Attachment E Daily Activity Record  
TS 600 -Attachment F Odometer Log 7/27/11
TS 601 Highway Safety Project Request for Out of State Travel  
TS 602 2009 Staying Alive Conference Registration Form 2/19/09
TS 603 Highway Safety Project Lodging Rates Travel Exception Request for Approval 12/28/09
TS 604 State Highway Safety Office Employee Time Certification 9/29/10
TS 2309 Hours Worked on Highway Safety 01/19/12
TS 2310 Hours Worked on MCSAP 11/16/11

The following form is to be used by contractual workers from outside state agencies.
Please phone (217) 524-4040 if you have any questions.

File Name Form Title Revised Date
TS 2300 Contractual Employees Time Report. 3/31/11

The following forms are related to the Cycle Rider Safety Program. Please phone (217)785-1181 if you have any questions.

File Name

Form Title

 Revised Date
TS 700 Illinois Cycle Rider Training Program On-Site Monitoring Report for Classroom  
TS 701 Illinois Cycle Rider Training Program On-Site Monitoring Report for Range  
TS 702 Waiver or Release of Liability 10/21/10
TS 703 Monthly Report  
TS 704 Motorcycle Crash / Incident Report For Student  
TS 705 Cycle Rider Safety Training Program (CRSTP) Reimbursement Claim 9/21/09
TS 706 Instructor Update Attendance Record  
TS 707 Motorcycle Crash/Incident Report for Instructor  
TS 709 Windshield Washing Permit  
TS 710 Windshield Washing Project Request 01/31/12
TS 711 Windshield Washing Project Sign In Sheet  

The following forms are related to Commercial Vehicle Safety. Please phone (217) 785-1181 if you have any questions.

File Name Form Title Revised Date
TS 05 Diesel Emission Requisition Form  
TS 1200 Application for Certified Safety Tester Examination 4/28/08
TS 1985 Report of Returned Certificates of Safety  
TS 1188 Official Testing Station Personal Questionnaire  
TS 2258 School Bus Brake Inspection Report  8/24/11
TS SVI 1165 Bond Form 11/17/10
TS SVI 1187 Application for Official Testing Station Permit  
TS SVI 1274 Requisition Form  
TS SVI 1241 Report of Lost or Stolen Safety Certificates  
TS SVI 1280 Defective, Mutilated or Voided Certificate of Safety Report  

The following form is related to Illinois Coroners reporting traffic crash fatalities. Please phone (217) 782-2575 if you have any questions.

File Name Form Title Revised date
TS SR8 State of Illinois Coroner's Report of Deaths Resulting from Motor Vehicle Crashes 2/14/08
TS SR8 Instructions Instructions For the Use of Form TS SR8 2/14/08
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