Construction Site Case Notes Form
Use this form to document construction site incidents, observations, safety concerns, impacts, and follow-up actions.
Case Identification
Date of Note
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Note
*
Hour Minutes
AM
PM
AM/PM Option
Site / Project Name
*
Site Address or Location Area
*
Reporter Name / Role
*
Incident or Observation Details
Note Type
*
Safety Incident
Near Miss
Damage/Property Issue
Quality Issue
Progress Blocker
Equipment Issue
Environmental Issue
Other
Detailed Description
*
Exact Location on Site
*
Date/Time Incident Occurred
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Was Work Stopped or Affected?
*
Yes
No
People and Equipment Involved
People Involved or Witnesses
Contractor, Subcontractor, or Company Involved
Equipment or Materials Involved
Number of People Affected or Present
Safety Impact and Immediate Actions
Injury or hazard present
*
No injury or hazard
Hazard only
Minor injury
Serious injury
Property damage only
Immediate action taken
*
PPE used or missing
Hard hat
Safety vest
Gloves
Safety boots
Eye protection
Hearing protection
Fall protection
None
Other
Area secured or access restricted
*
Yes
No
Who was notified
Supervisor
Safety officer
Site manager
Client
Emergency services
Other
Follow-Up, Resolution, and Attachments
Required Follow-Up Actions
*
Responsible Person or Team
*
Target Completion Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Status
*
Open
In Progress
Resolved
Monitoring
Attachments
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Additional Comments
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