Encore Excavating Spill Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Job Info

• Job # (or use slider below)

• Job # (or fill in above

• Town

• Nearest address

• Dig Safe num

spill

• Describe the situation

• Enter the spill amount in litres

• Describe the confinement and clean up and clean up details

• Is Alberta environment needed to be notified

  Yes

  No

  N/A

• Has onsite personnel been notified. List personnel

  Yes

  No

  N/A

• Get signature of site personnel that clean up is satisfactory and all appropriate personnel have be notified

  Sign

Representative

• Utility name and representative name

• Did utility agree as to fault?

  Yes

  No

  N/A

• Utility Rep Signature

  Sign

• Photo of utility rep's license plate

  Media