GCL - Utility Strike Investigation - duplicate

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• Site Conducted:

  Select

• Conducted On:

  Date

• Prepared By:

• Location:
  Address

• Job Ref:

• Provide Pictures of The Damaged Utility & The Surrounding Area:

  Media

• Exact Time Utility Was Damaged:

  Date

• Have The Glenevin SHE Department Been Notified?

  Yes

  No

• Has The Utility Provider Been Informed? (Include Reference Number)

  Yes

  No

• List Involved Operatives & Their Role:

• Were Involved Operatives Trained & Competent To Be Carrying Out Their Duties?

  Yes

  No

• What Type of Service Was Damaged?

  Select

• What Size Was The Service?

  Select

• Depth (in mm) of Damaged Utility (Provide Picture If Safe)

• Were There Visual Markers Highlighting The Service? e.g.(Marker Tape, Tiles, Change In Soil Type, Meter Boxes, Scarring on Pavement)

  Yes

  No

  N/A

• Ground Conditions Around The Damaged Utility: (Stone, Clay, Concrete etc.)

• How Was The Utility Damaged?

• Were All Plans Available on Site? (Provide Picture of Damaged Utilities Plan)

  Yes

  No

  N/A

• Were The Plans Clear & Accurate?

  Yes

  No

• Was a Cat & Genny Used Fully & In Conjunction With The Utility Plans?

  Yes

  No

  N/A

• Cat Serial Number & Next Calibration Date: (Provide Picture)

• Genny Serial Number & Next Calibration Date: (Provide Picture)

• Where All Located Services Marked Prior To Commencing Excavation?

  Yes

  No

• Were Sufficient Trial Holes Excavated? (Provide Picture)

  Yes

  No

  N/A

• Was The Damaged Utility Exposed In Any Trial Holes?

  Yes

  No

• Additional Photos:

  Media

Gang Lead Statement:

• Please fully describe events from when you arrived on site, to the when the incident happened.

• Add signature

  Sign

Supervisor Statement:

• Provide A Statement of Your Observations After Attending The Incident:

• What Do You Think Caused The Strike?

• How Do You Think The Strike Could Have Been Prevented?

• Add signature

  Sign

• (Clients) Utility Strike Reference:

• Investigation Findings:

• Immediate Cause:

• Root Cause:

• Has There Been Any Previous Audits performed on This Gang Recently

  Yes

  No

• Following The Investigation: The Gang Are Found To Be:

  Accountable

  Unaccountable

• Details of Actions To Be Taken Following The Utility Strike:

• Additional Documentation

  Media