MAD-Occurrence Report

TYPE OF OCCURRENCE

• Select Delay Scope Change Damages Code Violation Warranty Violation Quality Control Other

  • Delay
  • Scope Change
  • Damages
  • Code Violation
  • Warranty Violation
  • Quality Control
  • Other

RELATED TO:

• Select Engineering / Code Detailing Fabrication Unrecoverable Scope Change Installation Other

  • Engineering / Code
  • Detailing
  • Fabrication
  • Unrecoverable Scope Change
  • Installation
  • Other

CAUSED OR DIRECTED BY:

• Select General Contractor Architect / Engineer Owner Inspector Supplier Southland Industries Other

  • General Contractor
  • Architect / Engineer
  • Owner
  • Inspector
  • Supplier
  • Southland Industries
  • Other

• Specify (Type here or use Sign function to write):

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

• Add signature

  Sign

IMPACTS:

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

  • 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):

• Add signature

  Sign

• Daily time turned in?

  Yes

  No

• Note on record drawings?

  Yes

  No

NOTIFICATIONS:

• Company:

• Reported to:

• Southland

• Reported by: