Mike Ellis

APOLLO UTILITY DAMAGE REPORT

Utility Strikes

Use this Template

Print as PDF

Use this Template

Information

Project Name
Job No.
Client / Site
Conducted on
Prepared by
Whitnesses

Superintendent name
KeySupervisor
Operators Name
Location
Type of Utility Hit
- Electric power, cables, conduit
- Potable Water
- Sewer and Drains
- Communication, alarm or signals
- Gas, oil, steam
- Reclaimed Water, Irrigation
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

Mike Ellis

APOLLO UTILITY DAMAGE REPORT

Utility Strikes

Use this Template

Print as PDF

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