Skip to content
HoldPoint

Original worksheet / Practice

Special Inspection Report Template: Facts, Evidence, and Follow-Up

An original blank report worksheet and worked fictional example that separate approved-document requirements, field observations, discrepancies, and follow-up.

Free. No account or email gate. Original preparation aid, not credential or project approval.

Make the observation reproducible

A report needs enough location and source information for another person to find the condition. Record the date, work observed, exact location, document reference and revision, and observation. This is a recordkeeping aid, not a prescribed jurisdictional report.

  • Project and permit identifier
  • Date, time, scope, and location
  • Approved document, detail, and revision
  • Observed condition and supporting record

Separate a discrepancy from its resolution

Identify who was notified and the follow-up needed. Do not mark a discrepancy closed merely because someone promised a correction. Seattle Chapter 17 illustrates local reporting and escalation duties; other jurisdictions and projects may differ.

  • Discrepancy and evidence
  • Person notified and notification time
  • Required follow-up and responsible party
  • Resolution evidence and reviewer

Check the reporting contract

Before using the worksheet on a project, reconcile it with the required agency format, jurisdiction, permit, and statement of special inspections. Do not disclose project records publicly without permission.

  • Required recipients and timing
  • Signatures and supporting attachments
  • Agency and jurisdiction-specific fields
  • Secure project record retention

Worked fictional example

Fictional practice: document conflict

At Grid C/4, the crew has a cropped detail without a revision. The inspection request cites S-201 Rev 2. No authorized reconciliation has been provided.

Reveal the model response

Observed a cropped detail at Grid C/4 with no visible revision. Inspection request references S-201 Rev 2. Controlling approved detail was not available for comparison. Requested the approved detail and documented notification to the project contact; conformance remains unresolved.

This reports an evidence gap. It does not decide a technical acceptance limit or grant stop-work authority.

What the worksheet records

Download the CSV for spreadsheet use, or print this field list. Keep any employee or project data in your own secure records; this page does not collect or save it.

Project/permit
Blank worksheet field
Date/time
Blank worksheet field
Scope/location
Blank worksheet field
Document/detail/revision
Blank worksheet field
Observed condition
Blank worksheet field
Evidence ID
Blank worksheet field
Discrepancy
Blank worksheet field
Notification/recipient/time
Blank worksheet field
Follow-up owner
Blank worksheet field
Resolution evidence
Blank worksheet field
Status
Blank worksheet field
Reviewer
Blank worksheet field

Sources & boundaries

What supports this page

Original HoldPoint editorial guidance. Content updated 2026-10-02. This is not independent expert signoff, an official exam, or a field acceptance standard.

  • 2021 Seattle Building Code, Chapter 17: Special Inspections and Tests

    Supports: Seattle-specific agency approval, inspector registration, reporting, and statement-of-special-inspections provisions; sections 1703 and 1704.

    Limit: A dated jurisdictional example, not a nationwide rule or a determination of the code applicable to your permit. Confirm adopted edition and amendments with SDCI.

    Source checked 2026-10-02

Editorial policy, reviewer status, and correction process