DAILY LABOR REPORT
DAILY MATERIAL AND EQUIPMENT REPORT FORMCHECKBOX Contractor FORMCHECKBOX SubcontractorProject No. FORMTEXT ?????NOTE:Three copies are required (see Distribution below). Submit original and two copies to the Engineer-in-Charge.Contractor/Subcontractor Name: FORMTEXT ?????Change Order Control No.: (if applicable) FORMTEXT ?????Work Date: FORMTEXT ?????Work Accomplished: FORMTEXT ?????Detailed Description of Material or EquipmentLicense No. orSerial No.Quantity / Operating HoursUnitEICComments FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????On-Site CertificationI certify that the equipment described was used on this work for the hours indicated and that the material was used or turned over to the state on this date.EIC CertificationI certify that the comments I have entered on each line are based on my observation of the work. The comments indicate my agreement or observed differences with the contractor’s submittal.For Subcontractor, if applicableDateFor ContractorDateFor Design and ConstructionDateDistribution:Labor and Materials Submission Copy (White)Engineer-In-Charge (Yellow)Contractor’s File Copy (Pink)Page FORMTEXT ???of FORMTEXT ??? ................
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