Report Investigator:
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Prepared by:
Customer Information:
Customer Information:
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Customer Name:
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Address:
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Contact Number:
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Date of Complaint:
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Date of Work Performed:
Jobsite Information:
Jobsite Information:
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Crew was peforming work for:
- CPA North
- CPA South
- CPA Construction
- CPA O and M
- Peoples Natural Gas
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Jobsite Foreman:
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Crew members involved:
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Any Witnesses?
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Name of Witness:
Complaint Investigation:
Complaint Investigation
Customer Statement:
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Emplain What happened in your own words:
Pre Job Pictures
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Were Pre Job Pictures taken?
Post Job Pictures
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Were Post Job Pictures taken?
Tools and Equipment:
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If tools or equipment resulted in the damages, what tools and equipment were involved?
Root Cause Investigation
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1. What happened?
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2. Why did this complaint happen?
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3. What was the Root Cause of the complaint?
Corrective Actions
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What can we do to correct the complaint from happening in the future?
Complaint Pictures
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