Mad-occurrence Report Checklist

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Audit

TYPE OF OCCURRENCE

Delay
Scope Change
Damages
Code Violation
Warranty Violation
Quality Control
Other

RELATED TO:

Engineering / Code
Detailing
Fabrication
Unrecoverable Scope Change
Installation
Other

CAUSED OR DIRECTED BY:

General Contractor
Architect / Engineer
Owner
Inspector
Supplier
Southland Industries
Other

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IMPACTS:

Extra Labor Cost
Extra Metal Cost
Overtime
Schedule
Move Crew
Acceleration
Extra Equipment Cost
Out of Sequence

CORRECTIVE ACTION REQUIRED:

Describe (Type here or use Sign function to write):

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Daily time turned in?

Note on record drawings?

NOTIFICATIONS:

Company:

Reported to:

Southland

Reported by:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.