Information
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Project Name
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Job No.
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Client / Site
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Conducted on
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Prepared by
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Whitnesses
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Superintendent name
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KeySupervisor
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Operators Name
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Location
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Type of Utility Hit
- Electric power, cables, conduit
- Potable Water
- Sewer and Drains
- Communication, alarm or signals
- Gas, oil, steam
- Reclaimed Water, Irrigation
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Date and Time of Damage
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Locate Called prior to Incident
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When was Locate Called?
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Locate Number
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Owner Rep Notified?
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Owner of Utility
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Owner Rep Name And Number
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Description of Damage
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Take Pics
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Add Drawing if necessary
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Additional Comments
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Completed By and Date