Job Info

Job # (or use slider below)

Job # (or fill in above


Nearest address

Dig Safe num


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

Has onsite personnel been notified. List personnel

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

Utility name and representative name

Did utility agree as to fault?

Utility Rep Signature
Photo of utility rep's license plate
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.