Daily_Report_Form.pdf

DAILY REPORT TO INSPECTOR

DATE

CONTRACT NO. TITLE AND LOCATION REPORT NO.

CONTRACTOR (Prime or Subcontractor) NAME OF SUPERINTENDENT OR FOREMAN

WEATHER TEMPERATURE (�F)

WEATHER EFFECTS

PRIME CONTRACTOR/SUBCONTRACTOR WORKFORCE

(If space provided below is inadequate, use additional sheets)

NUMBER TRADE HOURS EMPLOYER

LOCATION AND DESCRIPTION

OF WORK PERFORMED

TOTAL WORK HOURS ON

JOB SITE THIS DATE

CUMULATIVE TOTAL OF WORK

HOURS FROM PREVIOUS REPORT

TOTAL WORK HOURS FROM

START OF CONSTRUCTION

WERE THERE ANY LOST TIME ACCIDENTS THIS DATE?

� YES � NO

IF “YES”, ATTACH SUMMARY OF INCIDENT OR OSHA REPORT

CONSTRUCTION AND PLANT EQUIPMENT LEFT ON JOB SITE UNTIL USE IS COMPLETED

DESCRIPTION DATE FIRST ON JOB

(First time only)

HOURS WORKED

THIS DATE

HOURS IDLED DATE OF FINAL

REMOVAL FROM JOB SITE

CONSTRUCTION AND PLANT EQUIPMENT NOT LEFT ON JOB SITE PERMANENTLY

(This will include pickup truck and mobile mounted items, such as compressor, that are also used for transportation to and from the job)

DESCRIPTION HOURS WORKED HOURS IDLED

SPEC. PARA.

AND/OR DRAWING NO.

LOCATION AND DESCRIPTION OF DEFICIENCIES

(Materials, Equipment, Safety, and/or Workmanship) ACTION TAKEN OR TO BE TAKEN

REFERENCE

DEFICIENCIES CORRECTED THIS DATE REPORT NO. COMPLIANCE

NOTICE NO.

INSPECTION AND/OR TESTING

PERFORMED TODAY-FOLLOW WITH REPORT

LOCATION AND/OR

ELEMENT OF WORK

REMARKS

RESULTS OF

INSPECTION/TESTING

SPEC. PARA.

AND/OR DRAWING NO.

EQUIPMENT RECEIVED TODAY TO BE INCORPORATED IN JOB

(Description, Sizes, Quantity)

SUBMITTAL NO.

OR CERTIFICATION

DATE

APP.

REMARKS (Include directions received from CEU, visitors, compliance notes received, errors and/or omission in P/S; pertinent information)

Note: Form must be forwarded to On-Site CONTRACTOR/SUPERINTENDENT DATE inspector by 10:00 A.M. the following day.

ON-SITE INSPECTOR’S REMARKS AND/OR EXCEPTIONS TO THIS REPORT

ON-SITE INSPECTOR DATE