Forms & Useful Lists

Following are forms and worksheets for local agencies to use when applying for funding and doing other needed tasks for their Emergency Relief funded projects.  Forms without links are “coming soon” and, in the meantime, may be obtained by contacting your DLAE.

Accessibility Assistance: Caltrans makes every attempt to ensure our documents are accessible. Due to variances between assistive technologies, some large PDFs posted on the following websites are not ADA compliant. Should you need additional assistance, please contact ada.compliance.office@dot.ca.gov or (916) 324-8378.

Forms

• Emergency Notification Form
• Initial Damage Estimate (IDE) Form (Excel)
• Damage Assessment Form (DAF) Cover Sheet (PDF) (Disaster CA26-5 and earlier)
• Damage Assessment Form (DAF) Cover Sheet (PDF) (Disaster CA27-1 and later)
• Emergency Relief Program Forms and Training Videos
• DAF Sketch, Photos, Narrative Sheet (PDF)
• Betterment Benefit-Cost (B/C) Analysis and Justification Form (Excel)
• Emergency Relief (ER) Project Log Sheet (PDF)
• Request For Authorization (RFA) to Proceed with Preliminary Engineering (PE) (Word)
• Request For Authorization (RFA) to Proceed with Right of Way (RW) (Word)
• Request For Authorization (RFA) to Proceed with Utility Relocation (UTIL) (Word)
• Request For Authorization (RFA) to Proceed with Construction (CON) (Word)
• Request For Authorization (RFA) to Proceed Data Sheet (Word)
• Emergency Relief (ER) Finance Letter (Excel)  
• Permanent Repairs Using Emergency Opening (a.k.a. PR under EO) Procedures Certification Sample (Word)
• Permanent Repairs Using Emergency Opening (a.k.a. PR under EO) Procedures Economic Analysis (Excel)
• Exhibit 11-M: Preliminary Estimate of Cost (Word)
• Exhibit 11-N: PS&E Certification (Word)

Other useful information (worksheets, templates, and lists)

• List of City Codes (Alphabetic)(Word)
• List of County Codes (Alphabetic)Word)