Damage Report — TechCom

Project Information

Customer / Market *

Project Name / Number *

Page *

Crew Leader *

Sub Name

Ticket & Location

811 Ticket #

Status of ticket at time of damage *

Was ticket valid? *

Condition of marks on site

Locate renewed if ticket life exceeded?

Yes No N/A

Area white lined?

Yes No N/A

Damage reported to 811?

Yes No N/A

Reason required

If damage was not reported to 811, why?

811 report details

Who made the report to 811?

Date and time of report

811 Damage Ticket

911 contacted?

Yes No N/A

Reason required

If 911 was not contacted, why?

911 call details

Who made the call?

Date and time of call

Utility/property owner contacted?

Yes No N/A

Reason required

If owner was not contacted, why?

Owner / utility contact details

Who made the contact?

Date and time of contact

Date excavation began

Location *

Enter a real full address. The system will try to geocode it for Monday Location.

Incident Information

Date and time of incident *

Type of Damage *

Private property contact

Contact Information

If gas, was gas released?

Did the damage cause an outage?

Yes No Unknown N/A

Property / Utility Owner *

What was damaged? *

Damage Description

Was the crew in the correct work location?

Yes No N/A

Nature of Excavation

Nature of Excavation - Other

Mechanism of damage

Mechanism of damage - Other

Direction of excavation relative to facility

Within tolerance zone?

Yes No N/A

Excavation depth

Facility depth

Distance from mark

Was the utility exposed / potholed?

Yes No N/A

How was the utility exposed / potholed?

How exposed / potholed - Other

Was the utility exposed to the excavation depth?

Yes No N/A

Root Cause

Root Cause - Other

Narrative

Walk through the timeline of events, damage, visible conditions, contributing factors and immediate actions. Include emergency/utility response, statements made, outage impact, injuries, evacuation, and repair/restoration status.

Narrative *

Attachments

Include prewalk video/pictures, JSA, damage investigation photos/videos, screenshots of conversations/call logs, follow-up repair/restoration photos, redline, and bore log.

Photos / Files

Tap to add attachments Multiple files allowed. You can add files more than once before submitting.

No attachments selected.