Information

  • Project Name

  • Job No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Whitnesses

  • Superintendent name

  • KeySupervisor

  • Operators Name

  • Location
  • Type of Utility Hit

  • Date and Time of Damage

  • Locate Called prior to Incident

  • When was Locate Called?

  • Locate Number

  • Owner Rep Notified?

  • Owner of Utility

  • Owner Rep Name And Number

  • Description of Damage

  • Take Pics

  • Locates Off by how many feet?

  • Add Drawing if necessary

  • Additional Comments

  • Completed By and Date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.