DATE:	 		
WEATHER:		TEMP HIGH/LOW: 		
WORKING CONDITIONS:		
			
TYPE OF EQUIPMENT:		

			
NAME:	CLASSIFICATION	HRS. WORKED	

			

			

INJURY RECORD & DESCRIPTION OF ACCIDENT:		

VISITORS:			

OWNER FURNISHED MATERIALS RECEIVED:		

			
CONTRACTOR FURNISHED MATERIALS RECEIVED:	

			
AMOUNT OF CONTRACT TIME USED:		
AMOUNT OF CONTRACT TIME LEFT:		
NUMBER OF DAYS OVER CONTRACT TIME:		
WORK BEGAN AT: 		
WORKED STOP AT:		
WORK ACCOMPLISHED TODAY:		

	

	

	

	

	

	

	

	
SUPERINTENDENT'S SIGNATURE: