Force Account Record Template

Company or Agency Name: [Company Name]
Project Name: [Project Name]
Project Number: [Project Number, if applicable]
Record Date: [Date]
Reference Number: [Reference Number, if applicable]

1. Work Information

Work Location: [Location]
Work Order / Change Order Number: [Number, if applicable]
Supervisor or Foreman: [Full Name]
Prepared By: [Full Name]

Description of force account work performed:

[Describe the work performed]

2. Labor Record

Employee 1 Name: [Full Name]
Classification: [Laborer / Operator / Technician / Other]
Hours Worked: [Number]
Rate: [$Amount]
Labor Cost: [$Amount]

Employee 2 Name: [Full Name]
Classification: [Laborer / Operator / Technician / Other]
Hours Worked: [Number]
Rate: [$Amount]
Labor Cost: [$Amount]

Employee 3 Name: [Full Name]
Classification: [Laborer / Operator / Technician / Other]
Hours Worked: [Number]
Rate: [$Amount]
Labor Cost: [$Amount]

Total Labor Cost: [$Amount]

3. Equipment Record

Equipment 1: [Description]
Equipment ID or Unit Number: [Number]
Hours Used: [Number]
Rate: [$Amount]
Equipment Cost: [$Amount]

Equipment 2: [Description]
Equipment ID or Unit Number: [Number]
Hours Used: [Number]
Rate: [$Amount]
Equipment Cost: [$Amount]

Equipment 3: [Description]
Equipment ID or Unit Number: [Number]
Hours Used: [Number]
Rate: [$Amount]
Equipment Cost: [$Amount]

Total Equipment Cost: [$Amount]

4. Material Record

Material 1: [Description]
Quantity: [Number]
Unit Cost: [$Amount]
Total Cost: [$Amount]

Material 2: [Description]
Quantity: [Number]
Unit Cost: [$Amount]
Total Cost: [$Amount]

Material 3: [Description]
Quantity: [Number]
Unit Cost: [$Amount]
Total Cost: [$Amount]

Total Material Cost: [$Amount]

5. Other Charges

Additional charges, if any:

[Fuel]
[Subcontracted service]
[Delivery]
[Disposal]
[Other]

Amount: [$Amount]

Total Other Charges: [$Amount]

6. Daily or Work Notes

Weather Conditions: [Conditions, if applicable]
Site Conditions: [Conditions, if applicable]

Additional notes regarding delays, access issues, approvals, or work progress:

[Insert notes]

7. Cost Summary

Total Labor Cost: [$Amount]
Total Equipment Cost: [$Amount]
Total Material Cost: [$Amount]
Total Other Charges: [$Amount]

Total Force Account Cost: [$Amount]

8. Attachments

Attached or available supporting documents:

☐ timesheets
☐ equipment logs
☐ receipts or invoices
☐ delivery tickets
☐ photos
☐ daily field notes
☐ other: [Describe]

9. Signatures

Prepared By Signature: __________________________
Name: [Full Name]
Title: [Job Title]
Date: [Date]

Supervisor Signature: __________________________
Name: [Full Name]
Title: [Job Title]
Date: [Date]

Owner / Manager / Authorized Reviewer Signature: __________________________
Name: [Full Name]
Title: [Job Title]
Date: [Date]