Title Page
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Make sure the scene is safe. Once the scene is safe : 1st, take some preliminary pictures; 2nd, make necessary repairs and restore power; 3rd, complete this form and provide pictures of the repairs.
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Pictures of Scene
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Date/Time of Accident
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Map Location/Line Number
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Physical Address
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Weather
- Sunny
- Partly Sunny
- Partly Cloudy
- Cloudy
- Night
- Foggy
- Snow
- Rain
- Ice
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Temperature
- 100 to 110 Degrees
- 90 to 100 Degrees
- 80 to 90 Degrees
- 70 to 80 Degrees
- 60 to 70 Degrees
- 50 to 60 Degrees
- 40 to 50 Degrees
- 30 to 40 Degrees
- 20 to 30 Degrees
- 10 to 20 Degrees
- 0 to 10 Degrees
- -10 to 0 Degrees
- -20 to -10 Degrees
- -30 to -20
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Wind Direction/Speed
- North
- Northeast
- East
- Southeast
- South
- Southwest
- West
- Northwest
- 0 to 10 MPH
- 10 to 20 MPH
- 20 to 30 MPH
- 30 to 40 MPH
- 40 to 50 MPH
- 50+ MPH
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What was damaged?
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What type of vehicle or equipment caused the damage?
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Were there any clearance issues?
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If damaged underground facilities, was JULIE called?
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What was the voltage of the damaged line?
- Secondary 120/240
- Secondary 240/480
- Primary 1 Phase 7.2kv
- Primary 2 Phase 7.2kv
- Primary 3 Phase 7.2kv
- SubTrans. 69kv
- N/A
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Law Enforcement Agency, Officer on Scene and Accident Report Number
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Name, Address and Phone Number of Driver
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Description of the accident/incident
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Provide a diagram of the accident scene, showing road, if pictures are not enough.
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Are follow up repairs needed?
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EIEC employees at scene.
- Jason Kocher-Foreman
- Luke Perzee-Subforeman
- Alex Hubert-Journeyman
- Jonah Carney-1st Apprentice
- Cliff Miller-Serviceman
- Scott McTaggart-Serviceman
- Graham Schmid-Foreman
- Jeremiah Nichols-Journeyman
- Matt Huddleston-3rd Apprentice
- Nick Curry-1st Apprentice
- Rod Blackburn-Serviceman
- Sean Miller-Serviceman
- Mike Batte-Foreman
- Scott Lane-Journeyman
- Drew Schrodt-3rd Apprentice
- Zach Owens-2nd Apprentice
- Jay Eshleman-2nd Apprentice
- Ken Mutchmore-Foreman
- Kevin Dettmering-Subforeman
- Travis Glazik-2nd Apprentice
- Jaxson Coplea-2nd Apprentice
- Jeff Blackford-Serviceman
- Todd Moore-Serviceman
- Tim Kulow-Elec. Sys. Foreman
- Mike Bristle-Elec. Sys. Tech.
- Don Gerdes-Forestry Foreman
- Jr. Price-Journeyman Forrester
- Paul Crutcher-Electrical Engineer
- Bill Hoffschneider-Staking Tech.
- Brad Weisenbarn-Staking Tech.
- Doug Vaughn-Operations and Safety Coordinator
- Brad Smith-VP of O&E
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EIEC vehicles at scene.
- 3 Pickup Truck
- 5 Shop Truck
- 14 Bucket Truck
- 15 Pickup Truck
- 20 Bucket Truck
- 23 Spare Digger Truck
- 26 Bucket Truck
- 28 Pickup Truck
- 30 Shop Tow Truck
- 32 Operations Truck
- 33 Bucket Truck
- 35 Pickup Truck
- 39 Pickup Truck
- 40 Digger Truck
- 44 Spare Bucket Truck
- 46 Spare Bucket Truck
- 50 Pickup Truck
- 53 Pickup Truck
- 59 Bucket Truck
- 60 Bucket Truck
- 62 Tree Bucket Truck
- 68 Bucket Truck
- 70 Bucket Truck
- 71 Digger Truck
- 81 Bucket Truck
- 82 Digger Truck
- 83 Bucket Truck
- 84 Bucket Truck
- 85 Bucket Truck
- 86 Bucket Truck
- 87 Bucket Truck
- 88-DiggerTruck
- 89 Pickup Truck
- 92 Pickup Truck
- 96 Bucket Truck
- 97 Pickup Truck
- 98 Pickup Truck
- 99-Bucket Truck
- B1 Boring Machine
- RC50 Skid Steer
- T6 Small Trencher
- T7 Large Trencher
- T9 Pesotum Trencher
- T10 Gilman Trencher
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Employee Signature
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Ops and Safety Coor. Signature
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VP of O&E Signature
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President/CEO Signature
