📍 When to use this template
- When a site issue (technical, resource, safety, or contractual) cannot be resolved by the site team within a pre-defined timeframe (e.g., 48 hours).
- Triggered whenever an issue's impact on cost, schedule, or quality becomes critical and requires higher-level intervention.
- Typically filled by the Site Engineer or Project Manager and submitted to the Project Head, PMC, or Client's Representative.
Sections & fields
Preview of the template structure. Download Excel to fill on site.
1Header / Project Information6 fields
Project Name
_____________
Contract / Package No.
_____________
Escalation Form No.
_____________
Date of Escalation
_____________
Prepared By (Name & Designation)
_____________
Approved By (Name & Designation)
_____________
2Issue Identification6 fields
Issue Title / Subject
_____________
Date Issue First Identified
_____________
Location / Chainage / Gridline
_____________
Discipline (Civil, MEP, Finishing, etc.)
_____________
Related Drawing / Specification No.
_____________
Identified By (Name & Agency)
_____________
3Detailed Description of Issue4 fields
Problem Statement (What is the issue?)
_____________
Root Cause Analysis (Why did it happen?)
_____________
Chronology of Events (What has happened so far?)
_____________
Parties Involved (Contractor, PMC, Client, Sub-contractor)
_____________
4Impact Assessment5 fields
Impact on Schedule (in days)
_____________
Impact on Cost (Estimated amount in INR)
_____________
Impact on Quality / Technical Specifications
_____________
Impact on Safety
_____________
Impact on Other Activities / Interfaces
_____________
5Actions Taken So Far4 fields
Attempts to Resolve at Site Level
_____________
Communication References (Meeting MoM No., Letter Ref No.)
_____________
Reason for Failure to Resolve
_____________
Current Status of the Issue
_____________
6Proposed Solution & Support Required4 fields
Recommended Solution(s)
_____________
Resources Required (Manpower, Machinery, Material)
_____________
Decision / Approval Required From
_____________
Requested Date for Decision
_____________
7Management Response & Action Plan5 fields
Decision Made
_____________
Action Assigned To (Name & Designation)
_____________
Target Completion Date
_____________
Remarks / Instructions
_____________
Date of Response
_____________
💡 Sample filled excerpt
Issue Title: Unforeseen Hard Rock Encountered in Foundation Excavation at Tower B
Impact on Schedule: Estimated 15-day delay for foundation works.
Proposed Solution: Deploy rock breakers and revise excavation methodology. Request for Variation Order for additional cost of rock breaking.
Decision Required From: Client's Engineer to approve methodology change and initiate VO process as per contract.
⚖ Compliance notes
- Helps document delays and disruptions, crucial for EOT (Extension of Time) claims under FIDIC Sub-Clause 8.4 or equivalent contract conditions.
- Provides a formal record for dispute resolution or arbitration, demonstrating that the contractor followed due process in notifying the Engineer/Client.
- Fulfills contractual obligations for timely notification of issues that may lead to a change or claim (e.g., FIDIC Sub-Clause 20.1).
- Creates an audit trail for project governance and decision-making, often reviewed during internal or external project audits.