Title Page

  • Conducted on

  • Prepared by

  • Location
  • Date

  • Project #

  • PCO:

Subcontractor Work

  • Name of Subcontractor Doing The Work

  • Description Of The Work Performed

  • Photos Of Work Performed

  • Photo Of T&M Ticket

HCC Work

  • Description Of Work Performed

  • Materials

  • Labor

  • Photos Of Work Performed

  • Photos Of Material Tickets/Receipts

  • Was This An Owner Requested Change

  • Authorized By ?

  • Back Charge To Another Subcontractor

  • Name Of Subcontractor Being Back Charged

  • Reason

  • Was Subcontractor Notified Of The Back Charge

  • Approval Signature

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