Information

  • Document No.

  • Conducted on

  • Employee Name

Reported

  • Date and Time Reported

  • Who received the call?

  • Reported by

  • Phone Number

  • Address
  • Pole Location

  • District

  • Trouble Reported

  • Other

Worked by

  • Assigned to

  • Assigned Time

  • Returned Time

  • Personnel Involved

Trouble/Interruption

  • Caused by

  • Broken conductor

  • Broken pole

  • Broken conductor

  • Broken pole

  • Take picture

  • Added conductor guard

  • Added conductor guard

  • At meter base

  • At transformer

  • At weather head

  • At secondary splice

  • URD

  • Approximate location of the outage.
    Example: 200ft north of dip pole

  • Approximate location

  • Comments

  • Picture

  • Changed KVA

  • Old KVA

  • KVA

  • New KVA

  • KVA

  • Cleared by engineering

  • Time Off

  • Time On

  • Consumers Off

Misc

  • Major Outage

  • Notes

  • Pictures

  • Locate Ticket #

  • Signature

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.