DOT Forms 

Effective 10/15/96

APPLICATION: The Application to Receive Donated Leave is used to verify that the employee qualifies for the Leave Donation Program and to initiate the participation process. If an employee is unable to apply, a member of the immediate family, or the employee’s immediate supervisor may apply for the employee.

SPECIAL INSTRUCTIONS: The employee must complete Part I of the Application to Receive Donated Leave and have a physician or medical practitioner complete Part III of the form. If the employee is unable to apply a member of the immediate family, or the employee’s immediate supervisor may apply for the employee. If the illness is that of an immediate family member, that person’s physician or medical practitioner must complete Part III. The application must be forwarded to the Organization Manager. The Organization Manager must review Parts I and III of the Application to Revive Donated Leave to make sure they have been completed. Then, the organization manager will complete Part II.

Effective 5/1/2003

APPLICATION: The Certification of Non-Conflict of Interest is to be completed for all purchase requisitions that must be processed through Purchasing Division (Department of Administration) (all purchases over $10,000, excluding purchase types SCO, ECO, CON, PAG, RPR, RUR, and RWR). It must bear the required information on and signature of every WVDOT employee involved in the bid evaluation process. It is submitted with the Requisition Package or written award recommendation (as applicable) by Procurement Division to Purchasing Division (Department of Administration).

Effective 3/15/2007

APPLICATION: When a Purchasing Card holder identifies a questionable charge on his or her monthly Memo Statement, the first action should be to contact the vendor and seek clarification or resolution of the problem from them. If the dispute cannot be corrected in this manner, the Citibank Government Cardholder Dispute Form must be completed and submitted to the DOT Purchasing Card Coordinator and the State Purchasing Card Coordinator, as explained in Volume VI, Chapter 5 of these DOT Administrative Procedures.

Effective 2/1/99

Application: An employee, their designated representative, or both, may initiate grievance procedures by submitting an Education and State Employees Grievance Board Form for State Employees to the immediate supervisor within ten business days following the grievable event, or within ten business days of the event becoming known to the grievant, or within ten business days of the most recent occurrence of a continuous practice.

Effective: 9/1/99

APPLICATION: This form is initiated by an employee requesting admission into the DOT Educational Expense Reimbursement Program. The employee completes information in the large box at the top of the form and forwards the Application and a letter of justification to his or her immediate supervisor. The supervisor completes the next box and forwards the Application and letter to Transportation Human Resources Division within five business days. Note: an employee's immediate supervisor may not stop the application process - the Application and letter of justification must be forwarded. A copy, showing the supervisor's approval or disapproval will also be forwarded to the employee. Transportation Human Resources Division will review the Application and letter and, if all conditions have been met, forward copies to the DOT Education Expense Reimbursement Selection Committee for their review. At the Committee meeting, the Application will be considered, the bottom box completed, and the Application and letter of justification forwarded to the Secretary of Transportation (or designee) for approval or disapproval.

SPECIAL INSTRUCTIONS: To ensure adequate time for review and approval, the Application and letter of justification should be submitted three months before the course to be taken starts. The letter of justification will be a brief, informal statement of why the employee believes himself or herself qualified to participate in the program and why the education sought will be of value to the DOT. No specific format is required for the letter. If a Personal Leave of Absence will be needed, this should be requested at the same time (see DOH Administrative Operating Procedures, Volume IX, Chapter 9).

Effective 5/1/2003

APPLICATION: Employees initiate the Employee Reimbursement Request to be reimbursed for personal money spent for official state business purposes (excluding travel). Receipts for the expenditures must be attached. The form is submitted to the employee's supervisor for review and approval. Upon approval, a purchase master is set up in the REMIS system (DOT-105 purchase type) and the supervisor submits the Employee Reimbursement Request, along with a completed Form DOT-105, WVDOT Small Purchase Requisition/Receipt Record, to Finance Division, Accounts Payable Section for processing.

SPECIAL INSTRUCTIONS: "State Org. Name" means, for DOT purposes, the Division of Highways, Division of Motor Vehicles, State Rail Authority, Public Transit, Port Authority, or Aeronautics Commission – not one of the divisions within any of these agencies. "State Org. Number" is the State's organization number for Highways, Motor Vehicles, etc.; this number may be found on the FIMS screen on the mainframe computer system. The "WVFIMS Vendor ID" may also be obtained from FIMS by going to Vendor Inquiry and entering the employee's Social Security Number beside FEIN/SSN. "WVFIMS Document ID" will be completed by Accounts Payable.

Effective 10/15/96

APPLICATION: Once an employee’s Application to Receive Donated Leave has been verified by the organization manager a Notice of Eligibility is to be prepared. A copy of this notice and all other documentation will remain in the organization’s personnel files, a copy will be prepared for the employee, and all originals will be submitted to Transportation Human Resources.

Effective: 9/1/2006

APPLICATION: This form will be used to evaluate employee performance during the Performance Evaluation Period, as prescribed in Volume III, Chapter 8 of the DOT Administrative Procedures. It is completed, primarily, by the employee's supervisor and must be reviewed and signed by the supervisor's supervisor. At the end of each Evaluation Period, the original of this form, as well as other pertinent documents, will be submitted to Transportation Human Resources Division. Supervisors will retain copies of all forms used in evaluation.

Special versions of the Assistant District Engineer - Maintenance, County Highway Administrator, Maintenance Assistant, Transportation Crew Chief, Transportation Crew Supervisor, and Transportation Worker 2 and 3 - Equipment Operator Employee Performance Appraisal form have been developed. Job classification specific standardized objectives have been provided in the Performance Standards and Expectations section. All supervisors conducting employee performance appraisals for employees in the subject classifications must use the corresponding variant. Supervisors are encouraged to add any other performance expectations and standards that are appropriate to their particular organization

Effective: 9/1/2006

APPLICATION: This form will be used to evaluate employee performance during the Performance Evaluation Period, as prescribed in Volume III, Chapter 8 of the DOT Administrative Procedures. It is completed, primarily, by the employee's supervisor and must be reviewed and signed by the supervisor's supervisor. At the end of each Evaluation Period, the original of this form, as well as other pertinent documents, will be submitted to Transportation Human Resources Division. Supervisors will retain copies of all forms used in evaluation.

Special versions of the Assistant District Engineer - Maintenance, County Highway Administrator, Maintenance Assistant, Transportation Crew Chief, Transportation Crew Supervisor, and Transportation Worker 2 and 3 - Equipment Operator Employee Performance Appraisal form have been developed. Job classification specific standardized objectives have been provided in the Performance Standards and Expectations section. All supervisors conducting employee performance appraisals for employees in the subject classifications must use the corresponding variant. Supervisors are encouraged to add any other performance expectations and standards that are appropriate to their particular organization

Effective 9/1/04

APPLICATION: Each organization's Purchasing Card Sub-Coordinator is responsible for maintaining the P-Card Coordinator's Cardholder Log, the P-Card Logs and Reconciliations - Monthly General Review and the Monthly Detailed Review of P-Cardholders.

The P-Card Coordinator's Cardholder Log is maintained on a continuous basis and provides a summary record of audit results and monthly reviews for each Cardholder of the agency/organization. This log must be updated at least once per month after the monthly reviews are completed.

The P-Card Logs and Reconciliations - Monthly General Review is conducted each month following receipt of a copy of the reconciled Cardholders Logs, receipts and P-Card Statements from all of the organization's Cardholders. Each Cardholder's records will be reviewed and answers to each question of the Monthly General Review will be recorded on the form. Any problems and the corrective action to be taken must be documented and addressed in writing to the Cardholder and supervisor. All documentation of the problem and actions taken will be maintained in the Cardholder's file.

The Monthly Detailed Review of P-Cardholders is then performed by selecting a sample of approximately 20% of the organization's Cardholders with a minimum of five Cardholders being selected (if available). Base the selection of Cardholders for detailed review upon: the results of previous reviews, the results of previous audits and the time since the last Cardholder review or audit. However, a detailed review must be performed for each Cardholder at least once in any 12 month period.

Card Sub-Coordinators must notify the DOT Card Coordinator and Transportation Auditing first, for any significant problems or indications of misuse or abuse of the Purchasing Card. Any problems and the corrective action to be taken must be documented and addressed in writing to the Cardholder and supervisor. All documentation of the problem and actions taken will be maintained in the Cardholder's file.

SPECIAL INSTRUCTIONS: A copy of the P-Card Logs and Reconciliations - Monthly General Review is transmitted (by e-mail) to the Director of Transportation Finance Division along with a transmittal letter that answers the required questions that summarize the results of the monthly general and detailed reviews and any referrals or disciplinary action taken.

Effective 4/1/2002

APPLICATION: The Purchasing Card Vendor Complaint Form is to be used when a cardholder continuously has problems with a certain vendor, in regard to disputed items or other Purchasing Card policies and processes. It should be completed by the cardholder and submitted to the Purchasing Card Program (State Auditor's Office) through the DOT Purchasing Card Coordinator.

Effective: 5/1/2007

APPLICATION: The State of West Virginia Purchasing Division Purchasing Affidavit is used to certify that vendors or any related parties do not owe any debts of more than one thousand dollars in aggregate to the state or to any of its political subdivisions. A signed and dated Purchasing Affidavit is required before a vendor may be awarded a contract or a one-time purchase over $5,000.

The purchase organization ensures that the prospective vendor completes and returns the form to them. It is then attached to the Requisition Package, which is submitted to the Procurement Section of Transportation Finance Division. The form must also be completed and submitted with every successive contract renewal.

Effective: 9/1/2006

APPLICATION: This form will be used to evaluate employee performance during the Performance Evaluation Period, as prescribed in Volume III, Chapter 8 of the DOT Administrative Procedures. It is completed, primarily, by the employee's supervisor and must be reviewed and signed by the supervisor's supervisor. At the end of each Evaluation Period, the original of this form, as well as other pertinent documents, will be submitted to Transportation Human Resources Division. Supervisors will retain copies of all forms used in evaluation.

Special versions of the Assistant District Engineer - Maintenance, County Highway Administrator, Maintenance Assistant, Transportation Crew Chief, Transportation Crew Supervisor, and Transportation Worker 2 and 3 - Equipment Operator Employee Performance Appraisal form have been developed. Job classification specific standardized objectives have been provided in the Performance Standards and Expectations section. All supervisors conducting employee performance appraisals for employees in the subject classifications must use the corresponding variant. Supervisors are encouraged to add any other performance expectations and standards that are appropriate to their particular organization.

Effective: 9/1/2006

APPLICATION: This form will be used to evaluate employee performance during the Performance Evaluation Period, as prescribed in Volume III, Chapter 8 of the DOT Administrative Procedures. It is completed, primarily, by the employee's supervisor and must be reviewed and signed by the supervisor's supervisor. At the end of each Evaluation Period, the original of this form, as well as other pertinent documents, will be submitted to Transportation Human Resources Division. Supervisors will retain copies of all forms used in evaluation.

Special versions of the Assistant District Engineer - Maintenance, County Highway Administrator, Maintenance Assistant, Transportation Crew Chief, Transportation Crew Supervisor, and Transportation Worker 2 and 3 - Equipment Operator Employee Performance Appraisal form have been developed. Job classification specific standardized objectives have been provided in the Performance Standards and Expectations section. All supervisors conducting employee performance appraisals for employees in the subject classifications must use the corresponding variant. Supervisors are encouraged to add any other performance expectations and standards that are appropriate to their particular organization

Effective: 5/1/2004

APPLICATION: A Telecommunications Change Form (TCR) is to be completed and submitted to Information Services Division in the following cases:

When service is needed on telephone lines and circuits which are billed by IS&C, for example any changes to the lines, such as adding new services, resetting voice mail passwords, moving lines, billing changes and new accounts, changes to features, and disconnects; When the organization's listing in the governmental pages of the Verizon directory need updated; When long distance service is needed, or changes to the existing long distance service; When a change is needed on a service that IS&C provides (such as Maxstar); and When the organization intends to purchase telecommunications equipment. Submit completed TCR forms to Information Services Division by interdepartmental mail, fax or as a file attached to an e-mail. The fax number is 558-0674. The e-mail address is DOT.TCRRequests@wv.gov. All TCR forms must be signed/submitted by an approved authority, namely the organization manager (Commissioner, Director or District Engineer) the Comptroller or an employee registered with Information Services as the TCR Coordinator. No telephone requests will be accepted.

Information Services will review all TCR's and those that will increase expenditures will also be reviewed by the Business Manager. TCR's that will cost more than $1,000 will also be forwarded to IS&C for their approval. If the request is approved, authority will be granted for the requesting organization to proceed. If the request is not approved, Information Services will contact the requesting organization with the reason for disapproval. A copy of the completed TCR with the approval/disapproval signature will be returned to the requesting organization.

When IS&C receives a TCR, they enter it into their system and a TCR number is generated. IS&C reviews the request and then sends their decision to Information Services Division via fax memorandum that includes the TCR number and the status of the request.

When telephone service is required in an independent territory, the organization is to submit a TCR to the telephone company. A copy of the TCR should be sent to Information Services Division with the telephone numbers installed or other pertinent information.

No TCR is required when service is needed on phone equipment which the organization has purchased (the vendor should be called directly), or when an organization is using a vendor to move telephone lines internally.

SPECIAL INSTRUCTIONS: If service is needed urgently, enter the next reasonable actual date in the "Requested Due Date" field; five to seven days from the date of the request is recommended for most requests. The DOT Telecommunications Manager will contact IS&C directly to expedite the request. Do not leave the "Requested Due Date" blank or enter the current date or the next day's date - IS&C attends to these kinds of requests last.

Do not sign on the "Agency Authorization" signature line. All communications from IS&C regarding TCR's will be directed to Information Services Division.

The "Agency Detail" field is for internal information. It may be used for internal tracking numbers, county names or organization numbers, project numbers, etc.

P.O. Box addresses are acceptable for the "Bill To" address, but not the "Service Address" – TCR's with a P.O. Box in the "Service Address" will be rejected. For "Service Address", enter the telephone address or an address as near to the actual location as possible – no telephone pole numbers. It is important to provide as much information as possible to identify a new telephone site. If possible, provide the closest telephone number to the site.

In the "Service Detail" field, enter the specifically needed service in as much detail as possible (example: number of jacks, phone lines or FAX lines, data circuit number).

Effective 5/15/2003

APPLICATION: Employees who are expected to travel on official state business will complete the "Applicant Information" and "Applicant Signature" portions of the United Bank West Virginia Travel Card Application and submit the form to their immediate supervisor for review. Upon approval, the supervisor will forward the form to the DOT Travel Coordinator, who will review it and (if approved) submit it to United Bank.

SPECIAL INSTRUCTIONS: The "Billing Address" blocks under "Applicant Information" need not be completed if the applicant receives personal mail at his or her home address, but should be completed if personal mail goes to another address (i.e. Post Office Box). The applicant's work (DOT) address will not be entered as a "Billing Address".

The United Bank West Virginia Travel Card is a MasterCard credit card. It is for official State business travel only. It is issued in the employee applicant's name and the employee will be billed for all charges. Charges are to be paid in full when the bill is received, or as soon as the State reimburses the employee for the travel expenses incurred. The employee has 60 days, on average, to repay the total balance before an 18% finance charge is imposed (minimum finance charge on unpaid balances is $.50). Late payments will incur a fee of 5% of the minimum payment amount (not less than $1.00 or more than $15.00). There is a $20.00 fee charged for all checks returned for insufficient funds.

Cardholders may receive cash advances for travel from tellers at bank windows or at ATM machines. When possible, cardholders should get cash advances from tellers, rather than ATM machines, as $1.50 is charged for each ATM transaction. The minimum transaction amount for cash advances is $100.00. No more than $1,000.00 may be advanced through the card in one month.

Cardholders should contact the DOT Travel Coordinator with any questions or special requests pertaining to the Travel Card.

Effective: 9/1/2002

APPLICATION: DOT organization P.M. Warranty Coordinators use the Warranty Claims Summary to document warranty claims repair of DOT equipment units. A Summary is completed and submitted to Equipment Division each month and a final Warranty Claims Summary is submitted at the end of each fiscal year.

Effective 4/1/98

APPLICATION: This form, as part of the employee performance evaluation program, is designed to permit the employee an opportunity to provide their input to the evaluation process. Through the employee's completion of Form AH-501, the supervisor is provided insight to the employee's views and a line of communications is established which is essential to improved employee evaluations.

Evaluating supervisors must submit this form to each of their employees at least one week prior to each year's primary counseling session and must return the form to the employee a week before the mid-point and final review sessions. However, it is the employee's option to complete and return this form to the supervisor. If the employee completes the form, he/she will return it to the supervisor within three days of the scheduled evaluation.

SPECIAL INFORMATION: Before giving the form to the employee, the supervisor will write in the employee's name, the date and time scheduled for the evaluation meeting and the applicable time period (such as, 1 month, 3 months, 1 year, etc.) being evaluated. If returned completed by the employee, a copy of the Form AH-501 will be retained with a completed State of West Virginia Employee Evaluation System form, before forwarding the original to Transportation Human Resources Division.

Reasonable Suspicion Documentation

Effective 7/15/2001

APPLICATION: Form AH-505 is to be completed each time that an employee is suspected of drug and/or alcohol abuse as indicated by the physical, behavioral, speech, or performance indicators (listed on the form), which constitute a major change in the employee’s appearance or behavior. It is to be completed by a supervisor with the assistance of the employee who witnessed indicators, if not the supervisor, and signed by both of these individuals as well as a confirming supervisor (if possible). The form is then submitted to Transportation Human Resources Division to gain authorization to have the suspect employee tested for drugs and/or alcohol.

SPECIAL INFORMATION: Retention of the AH-505 will be at the discretion of Transportation Human Resources Division with the following stipulations. If permission to test for drugs and/or alcohol is denied, Form AH-505 will not be retained. Furthermore, if the tests are performed and are negative (no drugs/alcohol evidence found), Form AH-505 will not be retained.

Financial End Date Adjustment and Project Completion Notification

Effective 9/1/99

APPLICATION: The BF-150 Financial End Date Adjustment and Project Completion Notification is used to instruct the General Accounting section of Transportation Finance Division when and how to deactivate an authorization. This form is also used to set an extended date on an authorization that has not been completed, but has overrun the present set date. When the Deactivate - Authorization Complete option is used, the BF-150 must be completed and sent to Transportation Finance in advance with the BF-98 that establishes the authorization.

The original of the BF-150 is sent to Finance Division and a copy is retained in the originating organization.

Effective 2/1/97

Effective 2/1/97

APPLICATION: The BF-98 Authorization is a multi-purpose accounting/authorization document. It is used to communicate an originating DOT agency’s or organization’s need for Transportation Finance Division to establish an accounting authorization. Examples of such a need might include the opening of new offices, the undertaking of a new work project, or the fabrication of an inventory unit from several discrete units (PMI authorization).

SPECIAL INFORMATION: Organizations should contact Transportation Finance Division, General Accounting Section for guidance in completing this form.

Effective: 5/1/99

APPLICATION: The BZ-24, Request for Photographic Services is used by organizations to submit requests to Office Services Division for photographic printing and developing services. The BZ-24 must be signed by an employee of the requesting organization who has an Authorized Signature Card for Office Supplies and Forms on file with the Office Services Division.

The BZ-24 consists of an original and two copies. The original and first copy must be transmitted to Office Services Division with the exposed film. The last copy will be maintained by the requesting organization. A copy of the BZ-24 will be returned to the requesting organization along with the processed film.

Effective 4/15/98

APPLICATION: The DOT-104 is used to transmit all invoices to Transportation Finance Division for processing and payment. In the event that Transportation Finance returns an invoice to the originating organization for corrective action, the invoice will be resubmitted to Transportation Finance on a new DOT-104.

The DOT-104 is numbered sequentially, on a fiscal year basis. The series of numbers will be issued by the organization’s finance office or a designee. It is mandatory that only one series of these transmittal numbers be used per organization. Each organization will devise their own log to control and monitor the issuance of DOT-104 numbers. The first two digits of the transmittal number will indicate the organization. The remaining digit(s) will begin with "1" and continue. It will not be necessary to add zeros to this number.

Organization Managers may authorize a maximum of two employees to sign the DOT-104. Their signatures are certification that the invoices attached to the transmittal are correct and proper for payment. Signature cards for these employees will be placed in a file in Transportation Finance.

All invoices attached to a given DOT-104 must be of the same type and, if applicable, the same Small Purchase Class. Invoices are to be sorted by type and date of purchase, then attached to the DOT-104. All Small Purchase Authorization invoices received at the organizational level will be batched and transmitted to Transportation Finance daily. SCO's will have the original DOT-5's master batched to the DOT-104, forwarded to the organization’s financial officer for review and approval, and then transmitted to Transportation Finance. RPO/ECO/EPO/DPO's are treated like SCO's. The organization should retain a copy of the document package, including the DOT-104.

SPECIAL INFORMATION: For transmittals of Purchasing Card Statements, clearly stamp the front of Form DOT-104 with "P-CARD."

Effective 10/1/97

APPLICATION: The DOT-105 is used for administrative control and receipt documentation of one-time purchases of commodities and one-time, non-recurrent services which require only one payment. It may also be used for Class 4 (exempt) purchases which require only one payment, with no dollar limitations. It is used singularly in a purchase to the amount of $1000 and with a DOT-105B (to record verbal bids) in amounts from $1000 to $5,000. The DOT-105 can accommodate requisition and receipt of up to six different items, with variable accounting upon receipt, from a single vendor. Additional DOT-105s can be used if over six items are involved.

Purchases using the DOT-105 may be initiated at any level. Once the DOT-105 is completed, it will be reviewed and the appropriate Supervisor may sign the DOT-105 at the "I certify that the materials/services listed above are authorized purchases" statement. At this point, the appropriate organization storekeeper for the type of purchase being made is contacted for approval. Organization processing of the "105" may vary. The purchasing organization will provide the appropriate storekeeper with an explanation of the proposed purchase and all the information required to complete the Small Purchase Authorization Control Log (DOT-2), or the Cardholders Log for purchasing card procurements (DOT-2C). If approved, a purchase order number will be assigned to the DOT-105.

A copy of the DOT-105 may be sent to the vendor, if the purchase is not by Purchasing Card. The receiving organization normally retains the original DOT-105 for record, but organization management may require a copy be sent with the transmittal of invoices (if not by Purchasing Card) or for additional administrative reasons.

SPECIAL INFORMATION: If any freight charges are involved, the original freight ticket(s) must be forwarded with the DOT-105.

The guidance for coding "Unclassified" purchases in REMIS recognizes the addition to the "PMS Standards File" of specific inventory classification for "Unclassified" and are as follows. For unclassified Equipment Parts, enter Class 508. For all other unclassified purchases, enter the Class that most accurately identifies the purchase item. If the purchase is unrelated to inventory, use "999." For unclassified Equipment Parts, enter the Type listed for the Class 508 item selected. For all other unclassified items, enter the Type that most accurately reflects the commodity/service. If the Type cannot be determined or the purchase is unrelated to inventory, use "999." For unclassified and items unrelated to inventory, use "999999." for the Subcode.

Effective 10/1/97

APPLICATION: The DOT-105F is for facsimile (Fax) orders only. It is primarily used for one-time purchases of commodities and one-time, non-recurrent services which require only one payment. It may also be used for Class 4 (exempt) purchases which require only one payment, with no dollar limitations. It is used singularly in a purchase to the amount of $1000 and with a DOT-105B (to record verbal bids) in amounts from $1000 to $5,000.

When a "fax" order is made with the Purchasing Card, the card number and expiration date must be included.

Effective 12/15/98

APPLICATION: The DOT-12 Daily Work Report records labor, equipment, and inventory usage on a given date. It is prepared in an original only. A maximum of four work assignments can be recorded on one DOT-12 (more than four work assignments must be recorded on another DOT-12). It assigns related costs to various accounting functions and provides space for comments to document extraordinary situations (such as injuries). It captures all information necessary to make daily REMIS "DR" computer entries and provides a complete record of the date's work efforts. It is filled out by designated clerical personnel, supervisor, foreman, section chief or mechanic, depending on the context of the information being reported. This "initiator" will then sign the DOT-12 and forward to the manager of the organization. The manager will review the DOT-12 and sign it to signify approval. The DOT-12 will then be passed to the Computer Entry Clerk for assignment of a document number and logging (DOT-1), followed by entry in the REMIS system and filing.

SPECIAL INSTRUCTIONS:

DATE -- The work day being reported must be entered with two digits for the month, day and year (Example: January 1, 1999 would be "01 01 99").

DOCUMENT NUMBER & TYPE -- Document numbering begins with 00001 on July 1st of each year with subsequent DOT-12s numbered in sequence. Document Type is filled with either "FR" (Foreman's Report), "CR" (Clerk's Report) or "MR" (Mechanic's Report).

ROUTE NUMBER -- (If used) Four fields of information must be entered. Field one has two character spaces for CO - County, US - United States, DE - Delta or WV - West Virginia. Field Two consists of three numerical characters and represents the Route Number. Field Three has two digits for a supplemental route designation. Field four has two character spaces for AL - Alternate, BU - Business, CN -Connector, LP - Loop, SP - Spur, TR - Truck Route, BP - Bypass, North, South, East, West (Example: WV Rt.119/04 Spur would be "WV 119 04 SP").

BEG. MILE POST & END MILE POST -- (If used) An entry must be made to both.

MAINT.: UNITS ACCOMPLISHED/WORK ORDER -- Highway Maintenance work requires entry as of the number of work units performed as defined for the maintenance "Activity No." reported. Equipment repair work requires entry of the number assigned the "Work Order" performed by the mechanic being reported.

MAINT.: UNITS OF MEASURE/TYPE OF WORK -- Highway maintenance work requires entry of the specific unit designated for the maintenance "Activity No." reported. Equipment repair work requires entry of "999."

EQUIPMENT DESCRIPTION -- The type of vehicle being reported and the day's ending meter reading and meter status ("O" for operational and "N" for non-) are entered.

E.D.No. Information -- List the unique identification number assigned to the equipment being reported. Due to the fact that dashes cannot be entered, O will be entered for the dash. EXAMPLE: 221-323 is reported as 2210323.

END. METER & STATUS -- The day's ending meter reading and meter status ("O" for operational and "N" for non-) are entered.

Inventory Org. No. -- The usage of inventory must be reported for the two digit inventory location assigned the storage site.

COMMENTS -- Use of the reverse side of the form is recommended to document any particular problem encountered (such as: disciplinary, injuries, etc.) for the reported day. Also, documentation of special reporting of work hours unreported within a work week is required in this section.

Effective 10/15/96

APPLICATION: The Request for Payroll Correction form is used to correct labor errors made on the DOT-12. It is to be completed by the appropriate supervisor. These corrections must be coordinated with the Transportation Finance Division. The form consists of three sections: employee information, the error and the corrective entries and a brief explanation/ authorization section. The form is a four-part form and should be routed as follows: one copy will be retained by the originating organization, one copy forwarded to the organization’s financial officer, and the original and one copy forwarded to the Payroll Section of Finance Division.

DOT-12LE

Daily Work Report [Labor and Equipment Exclusive]

Effective 12/15/98

APPLICATION: The DOT-12LE Daily Work Report records labor and equipment usage on a given date. Labor exclusive DOT-12LE is used by organizations that nre not required to account for inventory. It is prepared by the designated clerical personnel, supervisor, foreman, section chief or mechanic. This person signs the DOT-12LE and forwards it to the organization manager. The manager reviews the DOT-12L and signs it to signify approval. The DOT-12LE is then issued to the Data Entry Clerk for assignment of a document number and logging (DOT-1), followed by entry in the REMIS system and filling.

SPECIAL INSTRUCTIONS:

DATE -- The day being reported must be entered with 2 digits for the month, day and year (Example:January 1, 1999 is "01 01 99").

DOCUMENT NUMBER & TYPE -- Document numbering begins with 00001 on July 1st of each year with subsequent DOT-12s numbered in sequence. Document Type is filled with either "FR" (Foreman's Report), "CR" (Clerk's Report) or "MR" (Mechanic's Report).

ROUTE NUMBER -- (If used) Four fields of information must be entered. Field one has two character spaces for CO - County, US - United States, DE - Delta or WV - West Virginia. Field Tow consists of three numerical characters and represents the Route Number. Field Three has two digits for a supplemental route designation. Field four has two character spaces for AL - Alternate, BU - Business, CN -Connector, LP - Loop, SP - Spur, TR - Truck Route, BP - Bypass, North, South, East, West (Example: WV Rt.119/04 Spur would be "WV 119 04 SP").

BEG. MILE POST & END MILE POST -- (If used) An entry must be made to both.

MAINT.: UNITS OF MEASURE/TYPE OF WORK --Highway Maintenance work requires entry as of the number of work units performed as defined for the maintenance "Activity No." reported. Equipment repair work requires entry of the number assigned the "Work Order" performed by the mechanic being reported.

EQUIPMENT DESCRIPTION -- The type of vehicle being reported is entered.

END. METER & STATUS -- The day's ending meter reading and meter status ("O" for operational and "N" for non-) are entered.

COMMENTS -- Use of the reverse side of the form is recommended to document any particular problem encountered (such as: disciplinary, injuries, etc.) for the reported day. Also, documentation of special reporting of work hours unreported within a work week is required in this section.

Effective 8/1/97

APPLICATION: The DOT-2 Special Purchase Authorization Control Log is used in "105" and "SPO" purchases. The DOT-2 reduces the chance of duplicate payments and provides a quick summary reference to past purchases. It is maintained by each organization utilizing the Small Purchase Authorization process.

For the "105" purchase process the DOT-2 is used to collect and document specific information required to evaluate the purchase (prior to approval) and to ensure that a unique "Document (Purchase) Number" is assigned to each DOT-105 upon approval. The logged data are later used in the audit process for "105" invoices being transmitted for payment. The information logged on the DOT-2 is also used to establish a Purchase System Master Record in REMIS.

Only one DOT-2 log per organization is required. However, two separate logs will typically be maintained in Division of Highways district and some DOH division operations; one for equipment-related purchases and another for other purchases.

"SPO" purchases may be logged on the same DOT-2 or on a separate one, as preferred. The DOT-2 is used to ensure a unique document number is assigned to the SPO and is also used to provide for logging basic purchase details. The DOT-2 is used, as in the "105" purchase process, to establish the Purchase Master.

SPECIAL INSTRUCTIONS: Document/Purchase Numbers will be five-digit sequential numbers, in ascending order, beginning with 00001 at the beginning of each fiscal year for each organization (that makes "105" and "SPO" purchases). Numbers 50000 or higher, however, will not be used for Document/Purchase Numbers, as this would conflict with the Form DOT-5 (receipt) numbering scheme which uses numbers 50001 and up. The maintenance of multiple

DOT-2 logs will necessitate separation or "blocking" of the sequential numbering series to prevent the issuance of duplicate numbers (example: Maintenance/overhead related purchases -

00001-05000; Equipment related purchases - 05001-10000).

Effective 2/15/98

APPLICATION: The DOT-25 Business Card Order Form is used, in lieu of a memo directed to Office Services Division, for the proper coordination and approval for ordering employee DOT Business Cards.

Effective 10/1/97

APPLICATION: The DOT-35 Purchasing Requisition and Code Sheet is used in several DOT purchase processes. The "SPB" consists of one-time purchases over $5,000 and up to $10,000. Written bids are required. The DOT-35 is part of an "SPB" Requisition Package (DOT-35, DOT-35A) which can be initiated at any organizational level. Typically this will be the organization headquarters level. The DOT-35 documents what materials or services are required, by whom, in what quantities, and what accounting will be charged. The "SPB" purchase process is initiated with a DOT-35. Following the DOT-35's completion, the organization manager grants approval to begin soliciting bids. Use of the DOT-35 is not required, but controlling purchases and the documentation of REMIS Purchase Master establishment must be maintained.

The DOT-35 also supports the preparation of the DOT-35A Purchasing Requisition. Upon completion and approval (organization manager) of the "Requisition Package", it is then logged in to the DOT-3 log and assigned a Requisition or Purchase Number.

When the purchase process has progressed to the point where the Purchase Master and Line Item Masters must be established in the REMIS System, the DOT-35 is used as a source document for those entries. Following the REMIS entries, the Requisition Package, which includes the DOT-35, is sent to Transportation Procurement Division. Copies of the Requisition Package, including the DOT-35, should be retained on file at organization headquarters.

The DOT-35 is also used in the "SCO" process in the initiation of agency contracts (Requisition Package - WV-35, DOT-35). The "Agency Contract Requisition" developed using this documentation package establishes minimum performance requirements and capabilities, proper justification, projected cost savings, etc. Approved by the organization manager, this package is forwarded to Transportation Procurement Division, where they and the Business Manager will examine and approve the Requisition Package. Distribution to the DOA follows and they provide Transportation Procurement Division with a Notice of Contract Award. Transportation Procurement Division distributes copies of the Notice of Contract Award to the affected organizations.

The "SCO" purchase process for purchasing against a Statewide Open End or Agency Contract begins with a telephone call that relates the relevant information to the organization Storekeeper, who fills out a DOT-35, or the organization manager is sent a completed DOT-35 from the originating organization. If a lower level organization initiates the purchase, the form is submitted to that organization’s supervisor, the first recommending individual, who signs and dates the form. From there it is sent to the organization’s headquarters. Once there, the appropriate Storekeeper will review and provide any further information for completion. At this point a Purchase Order Number will be assigned to the DOT-35 from the DOT-3 log.

After the Storekeeper gives the recommendation, by signing and dating, the form is passed to the organization’s chief financial officer or other designated manager.

After a review, the form is signed and dated again. The WV-39 is prepared from the information on the DOT-35. The WV-39 is reviewed by the organization’s chief financial officer or other designated manager for accuracy against the DOT-35 and then submitted to the organization manager. He reviews the documents and approves them by signing and dating the documents.

The package is returned to the chief financial officer, or designee, who will provide the vendor with an original WV-39 and a copy of the DOT-35. A copy is also sent to Transportation Procurement Divison. The original DOT-35 will remain at the organization headquarters, where it is forwarded to the data entry clerk, who will enter it into the REMIS System through the Purchase System (PS) transaction, and then filed with the WV-39.

The purchasing process for "RPO, ECO, EPO and DPO" purchases using the DOT-35 are essentially alike. The organization headquarters is the point of origination of a purchase requisition. After review at that level, the organization manager approves the requitition package, the REMIS Purchase System entries are made, and the documents are sent to Transportation Procurement Division. Three copies of the DOT-35 are to be prepared, one for the point of origination, one for the organization headquarters (if not the point of origination), and one to accompany the document package.

SPECIAL INFORMATION: State Contract No - For "SPB" purchases, enter the appropriate Small Purchase Code. A Direct Charged equipment parts purchase, required to repair a unit of equipment to which an E.D. Number has been assigned, that necessitates the expenditure of $1000 or more, must be coordinated with the Director of the Equipment Division or his designee. Purchasing organizations will annotate the DOT-35 to reflect coordination with Equipment Division. The DOT-35 initiates a change order as part of the change order document package (DOT-35, WV-39).

Effective 7/1/97

APPLICATION: The DOT-35A Purchasing Requisition is used in the "SPB" purchase function primarily for purchase of commodities over $5,000 to $10,000. It may also be used for competitive services which require no formal agreement within the same dollar range.

The Small Purchase Bids Attached process may be initiated at any DOT organizational level by completion of a requisition package which includes the DOT-35A. The organization management level will typically perform this function, with initial approval to pursue the "SPB" purchase resting with the organization manager. When the DOT-35 is completed and approved by proper organization management, initiation of the DOT-35A can begin. The DOT-35A is actually two forms:

1. DOT-35A Purchasing Requisition and
2. DOH-35A Request for Quotations. (Since there is only one "Request for Quotations" and a minimum of three bids are necessary, this portion of the DOH-35A will have to be copied.)

Following preparation of this package (DOT-35/ DOT-35A) the organization manager or designee must approve the package before the process can be continued. Upon approval, a requisition or purchase number must be assigned and the appropriate information entered in the organization’s Purchase Order Control Log, DOT-3. The DOT-35A may then be mailed to potential vendors to solicit bids.

Once an award has been determined and the REMIS Purchase System Master Record/Line Item Master Record(s) are established, the "Bids Attached" package, containing originals from the DOT-35/DOT-35A and other documentation, will be transmitted to Transportation Procurement Division on a DOT-19. Copies of the "Bids Attached" package must be retained and filed by the initiating organization. After final approval, Transportation Procurement Division will issue the purchase order to the chosen vendor. The initiating organization will be alerted to final approval of the purchase through the "Date Approved" field in the REMIS Purchase Tracking Screen.

SPECIAL INFORMATION: When a commmodity or service is only available from two sources, bids should be obtained from both vendors. Notation of this fact should be made in the "For Justification of Suggested Vendor" section of the DOT-35A. Notation should also be made in the case where the vendor is a sole source of supply.

Effective 4/1/2001

APPLICATION: Form DOT-506 (GL-6) is to be completed by new employees, with assistance from the hiring organization's personnel/payroll clerk (if necessary). After completion, it is to be submitted (along with other "new hire" documentation) to Human Resources Division for entry into the Personnel Data Processing System.

DOT-6

Inventory Usage or Transfer

Effective 2/1/97

APPLICATION: The DOT-6 Inventory Usage or Transfer is used to initiate and document transfer or usage of inventory. For usage, the DOT-6 will be utilized for all classified inventory materials under the direct control of the Storeroom Clerk. Transfer of classified inventory materials on the DOT-6 may occur in any one of the following situations:

1. Transfer from one inventory site to another inventory site within the same organization (use of DOT-6 is optional)
2. Transfer from one organization to another organization. The transfer can involve a movement of inventory materials from among counties, districts and divisions that maintain an inventory.

A transfer can only occur when the receiving organization maintains an inventory under its control. Transfer of inventory materials to an organization that does not maintain inventory or to an outside agency is not possible; this particular transaction is considered a usage.

Other functions possible with a DOT-6 are "Inventory Adjustment" and "Uncertified Materials Usage". "Inventory Adjustment" is used to correct inventory shortages and is used to write off damaged or unusable materials.

"Uncertified Materials Usage" is used to denote materials requiring certification by the Materials Control, Soils and Testing Division that have an expiration date, require written justification, are signed by the organization manager and are approved by Finance Division. The Inventory Adjustment cannot be made until the approval of the Business Manager has been received.

A DOT-6 is prepared in an original and three copies and may be used for a maximum of ten entries, provided that adherence to the rules listed below are followed:

1. Multiple inventory codes may be used, provided that all of the accounting data are the same, that the Authorization or E.D. and Work Order (if used) are the same and that all transactions are of one category - either transfer or usage. Variations can not be combined on one DOT-6; a second DOT-6 must be initiated.
2. The same date of materials use or transfer must apply to all items listed on the DOT-6.

Information on the DOT-6 will be prepared and entered into the system daily or upon receipt, whichever is sooner.

The processing of DOT-6 is basically the same at all organization levels.

1. Requestor - the requestor (receiving organization) presents the completed DOT-6 to the organization’s Storeroom Clerk.
2. Storeroom Clerk - The Storeroom Clerk will review the request and enter the necessary information as the Issuing Organization. A document number is obtained from the organizational clerk who controls the Document Log.

The Storeroom Clerk will enter the document number on the DOT-6. Any changes made will be noted on the form. After the issue, the Storeroom Clerk returns a copy of the DOT-6 to the requestor, keeps one copy for the files and forwards the original and one copy to the appropriate clerk for the organization.

3. Organization Clerk - The organization clerk enters the information into the REMIS System and files the original DOT-6.

SPECIAL INFORMATION: If the inventory was charged or sold to an outside agency, a BF-38 must be prepared and processed with a copy of the DOT-6 to Transportation Finance Division. The original DOT-6 is filed by the organization clerk with a copy of the BF-38.

Request for Inventory Write-Off

Effective 2/15/2010

APPLICATION: The DOT-6a Request for Inventory Write-Off is used to document and justify inventory write-offs (shrinkage). The original and copies are prepared at the organization having the inventory write-off and submitted to the District Comptroller and District Engineer/Manager for joint approval of the write-off. The DOT-6a form may only be used for individual inventory items.

It is imperative that ALL inventory write-off requests have a complete and acceptable justification prior to approval of the write-off. Insufficient or incomplete justifications shall be grounds for rejection of the write-off request. The Division of Highways has a zero tolerance for theft/fraud. Inventory theft/fraud must be handled by district management as soon as it is identified or reported.

Fuel write-off requests, as a result of the monthly fuel inventory verifications, must be submitted to the District Comptroller by the second day of the new month. Refer to the Division of Highways Fuel and Lube Inventory Operating Procedures for additional details regarding fuel requests for write-off.

Requests for Inventory Write-Off whether rejected or approved must be transmitted to the Finance and Administration Division, Procurement Section. The Procurement Section will maintain all DOT-6a, Request for Inventory Write-Off Forms for a period of three (3) years.

AEXP003 – Authorization for expensing FUEL only write-offs

AEXP004- Authorization for expensing all non-fuel inventory write-offs

Effective 3/1/97

APPLICATION: Form DOT-877's purpose is to document establishment of the Fixed Assets Inventory Master, provide the means to change or correct any information loaded into the Master Record and provide the means to retag an existing inventory item. The DOT-877 will be prepared by the initiating (owning) organization in an original and three copies. The original and one copy will be forwarded to Transportation Procurement Division (or the DOH Equipment Division, if a Fixed Assets Inventory Master is being established for a Support Equipment Item) and one (1) copy forwarded to the appropriate organization headquarters.

Only Transportation Procurement Division (or Equipment Division, in the case of a Support Equipment item) is authorized to perform the initial data entry loading of the Fixed Assets Inventory Master Record utilizing the DOT-877, however the owning organization may make corrections and changes to the inventory record by preparation of the DOT-877. Changes to the inventory concerning transfers are made through the Form DOT-6 process. Transportation Procurement Division serves as the centralized file for the Fixed Assets Inventory System Records which holds all DOT-877s.

Additions to the Fixed Assets Inventory System can occur in four different ways. The DOT-877's role in these additions is described below:

1. Discrete Inventory Units - The initiating organization prepares the DOT-877 in an original and three copies, with the original and one copy transmitted directly to Transportation Procurement Division (or Equipment Division, if a Support Equipment item) via the DOT-19 "Document Transmittal." Transportation Procurement Division (or Equipment Division, in the case of Support Equipment) then reviews the DOT-877, enters the Fixed Assets Inventory Master Record into the REMIS System and annotates the DOT-877 with the date entered into the system. The original DOT-877 will remain on file (or be submitted for filing, if Support Equipment) in Transportation Procurement Division's files with the annotated copies going to the initiating organization and appropriate organization headquarters.
2. Simple Component Build-Up Inventory Unit - In this category, more then one sub-assembly or component must be combined with another or others, with minimal labor, to form one inventoried unit. The total value of all combined components must be entered on the DOT-877 under the section "Breakdown of PM Authorization Charges" and must equal the "Total Cost/Value" block of that form. A detailed accounting of components used in the build-up will be provided by attaching copies of appropriate documents. Processing and distribution is the same as above.
3. Complex Component Build-up Inventory Unit and Fabrications Inventory Unit - Total costs of this type addition must be captured. This includes significant labor costs, parts, components and equipment utilized. This "Total Cost/Value" must be reported in the "Breakdown of PM Authorization Charges" on the DOT-877. Upon completion of the DOT-877, it is sent to Transportation Procurement Division (or Equipment Division, if a Support Equipment item) with related documentation. Processing and distribution will be accomplished as outlined above.

For all equipment without a resale or salvage value, the initiating organization must prepare a DOT-877, with proper annotation in the Retirement Code block. Coupled with a WV-103, the documentation is transmitted to Procurement Division via a DOT-19.

The DOT-877 is also used to retag items that have lost their DOT inventory tags. A DOT-877 is prepared using the "old" tag number, replacing it with the "new" tag number. The "Retag Inventory" function will be entered into REMIS by the owning organization utilizing the DOT-877. The original DOT-877 is sent to Transportation Procurement Division and one copy is retained by the intiating organization. The "MASTER LOADED BY" and "DATE MASTER LOADED" blocks must be completed before submission to Transportation Procurement Division.

Effective 5/1/99

APPLICATION: The purpose of this form is to record a complaint of discrimination by an employee. It may used in the informal discussion stage of a Grievance Procedure, but is required if the complaint proceeds to the written step of the Grievance Procedure. When a written complaint is submitted, a copy of the form must be sent to the organization manager and Transportation Human Resources Division.

APPLICATION: The MS-15 Equipment/Materials Issue Log may be used to document the issuance of DOT property to employees for use in their jobs. The purpose of this documentation is to maintain accountability for the items being issued. The MS-15 may also be used to document the issuance of leased items, as in the case of oxygen and acetylene tanks for welding.

In the case of inventory items, having completed MS-15's on file for items that have been assigned to employees (but not usaged out of inventory) prevents employees from having to take the items out of use and bring them in to an Inventory Location to be counted for physical inventory. However, the MS-15 may also be used for non-inventory items, if organization management needs to maintain accountability of these items. The Form may also be used when items are usaged out of inventory and assigned to employees, if management desires to track issuances to individual employees in this manner.

It is the responsibility of the organization manager to see that an appropriate employee administers the assignment of equipment and materials and maintains the records associated with the MS-15 (or other log) system according to the DOT Administrative Procedures (Volume V, Chapter 5).

Employees who are being issued items documented on the MS-15 will be required by the issuing individual to initial under the “Check Out” column on the Form listing the issued items. Upon request, a copy of the MS-15 will be issued to each employee receiving items. The original MS-15 is retained by the issuing individual until a new log is issued. When the items are returned, the issuing individual will give the original MS-15 to the employee, who will initial under the respective “Check In” column.

Other requirements associated with the MS-15's use or retainment for particular kinds of property will be accomplished according to the guidance of organization management and of Volume V, Chapter 5 of the DOT Administrative Procedures.

Republished: 11/1/2000

APPLICATION: Form RL-546 is used to record the employee's verification of disciplinary action. It is to be utilized in written reprimands, demotions, suspensions and dismissals. It is to be completed by the employee being disciplined. It is forwarded with other disciplinary documentation to Human Resources Division for retention.

Effective 2/1/2001

APPLICATION: DOT agencies use the Hospitality Documentation form to record purchases associated with providing refreshments and other amenities for meetings, seminars, classes, etc. These forms are retained by the purchasing organization for two years after the purchase.

Effective 2/1/97

APPLICATION: The WV-103 "Surplus Property Form" is employed to obtain approval from the DOA Purchasing Division, Surplus Property Unit to dispose of obsolete, surplus, unneeded or junk equipment. In the Fixed Asset Inventory, if the owning organization determines an item is no longer needed or used and is without resale or salvage value, it is declared to be surplus and retired. The owning organization prepares the WV-103 and transmits it with an appropriately filled-out DOH-877 to Transportation Procurement Division. The owning organization should retain a copy of the WV-103.

SPECIAL INFORMATION: If the inventory is office machines, the inventory is sent to Highways’ Office Services Division, which determines the inventory status and completes the WV-103 and transmits it to Transportation Procurement Division.

Effective 6/15/2006

APPLICATION: The WV-35 Purchasing Requisition is used for purchases of commodities or services when the purchase amount is over $25,000. This is known in the DOT Administrative Procedures as “DPO”, “RPO”, and "EPO" purchases. The assistance of the DOA Purchasing Division is needed for these purchases. Responsibility for preparing the WV-35 lies with the DOT organization’s manager. A copy is to be kept by the originating organization.

When this form is also used to establish an agency contract, a "requisition package" consisting of the WV-35 and the DOT-35 (optionally) is completed. Responsibility for initiating this process and completing the requisition package lies with organization management. Approval of the package must come from the organization manager after review. The package is then forwarded to Transportation Finance Division, Procurement Section, with one of the DOT-35s (if used) and the agency copy of the WV-35 retained at the originating organization (or its management level).

The WV-35 is used in the lease purchase process for purchasing equipment. There are three types of lease purchase agreements:

1. Straight Lease Purchase
2. Two-Step Lease Purchase
3. Non-Competitive Lease Purchase

The WV-35 must be completed and submitted as part of the document package to DOA for all three categories of lease purchases.

Effective 3/1/2007

APPLICATION: The WV-36A Purchasing Continuation Sheet is used when additional space is needed in the preparation of the WV-35, Purchase Requisition, and WV-39, Blanket Release Order, forms. The WV-36A's open format may be substituted with the WV-36's columnar format at anytime.

Effective 9/1/99

APPLICATION: The WV-48 Agreement Form is used when a short-term agreement for professional or consulting services are needed, without having to create complicated legal forms. By utilizing the form, whose content and format have previously been approved, the agency will aid in the prompt processing of the contract.  Division of Highways will not use this form for acquiring engineering consulting services, but will follow previously established procedures.

Effective 9/1/99

APPLICATION: The WV-50 Agreement Questionnaire Form is required with the Agreement form when procuring professional services. The purpose of the questionnaire is to document the scope of the project and to project the results expected to be attained by forming this agreement.  Division of Highways will not use this form for acquiring engineering consulting services, but will follow previously established procedures.

Effective: 9/1/2002

APPLICATION: The WV-96 Agreement Addendum must be used, in conjunction with either the WV-48 Agreement or the vendor's agreement form, whenever the DOT enters into an agreement with a vendor for professional or consulting services (except engineering consulting services for the Division of Highways). The WV-96's purpose is to define legal provisions for the contract.