Title Page
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Site conducted
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Civil Contract audit been carried out on
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NBU or PN Number required
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Company Name
- C & J
- NUS
- Heneghans
- V25
- Northfield
- C&A
- LDH
- CWB
- ASG Civils
- Comms Installations Ltd
- Perfecta Group
- SL Comms
- Cusack
- AGM
- Axle
- McLoughlin
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Utility Strike name
- Gas House Service
- Street Light cable
- Electric House service
- B.T House Service
- Water House Service
- Feeder Pillar
- Electric Main
- Gas Main
- B.T Main
- Water Main
- Virgin Fibre
- City fibre
- Sewer
- Unknown/ Other
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Conducted on
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Actual Time of strike.
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Person carrying out Strike Audit
- Andy Abbott
- Anthony Green
- Brendan Townsley
- Paul Hanrahan
- Karl Hicks
- Courtney Easy
- Tony Williams
- Stephen Hall
- Mark Duty
- Marlon Brown
- Zayd Bedford
- Bartley Keane
- Dave Bagley
- Daniel Laycock
- Steven Hewkin
- Steve Kemp
- Kevin Murphy
- Sean Delaney
- James Nairne
- John Walsh
- Chris Gunn
- John Whitehead
- Bob Morris
- Mick Mcelhinney
- Rob Austin
- Cable Agent 2
- Cable Agent 3
- Ian Molloy
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Team Leader
Location of Event
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Address of strike
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House Number ?
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where event occurred
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Public:
Affected Facility Information
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Was the utilitie owner informed?
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Time reported to Utility owner
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Ref Number
Excavation Information
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Depth of Damage utility
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please take a photo, more than one can be taken
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Was a Visual inspection carried out, i.e gas box on building, chambers, toby boxes and any other street furniture
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please take a photo, more than one can be taken
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Have YOU take photo's of surrounding area of damage utility i.e stand back so you can pick up potential - location, entry point, scaring, Boxes and any other street furniture which will help you complete the form correctly.
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please take a photo, more than one can be taken
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Was all known utilitie marked up.
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please take a photo, more than one can be taken
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NRSWA card on-site
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Please take a photo, more than one can be taken
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Type of Excavation Equipment Used?
- Road Saw
- Mini Excavator
- Stihl Saw
- Hand Tools
- Trencher
- Machine Pecker
- Hand Breaker
- Unknown/Other
- Directional Drilling
- Moleing
- Vacuum Equipment
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Please take a photo, more than one can be taken
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Plant operating Cert
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please take a photo, more than one can be taken
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Were utilities Drawings on site and in Date (UTILITY DRAWING VALID PERIOD DAYS - GAS-28 / ELECTRIC-30 / B.T-90 / WATER-90 / VIRGIN-90 ).
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please take a photo, more than one can be taken
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Was the utilitie trial-holed dug before excavation?
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please take a photo, more than one can be taken
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Was cat & genny used on site and in calibration?
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Please take a photo, more than one can be taken (Serial Number Required of the Cat)
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Cat & Genny - Are batteries charged and fit for use (Test both equipment for power & noise indicators)
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Was warning tape or sand over the utility strike
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please take a photo, more than one can be taken
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Is a team member trained / competent in the use of Cat & Genny
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please take a photo, more than one can be taken
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As a on site Risk Assessment Been completed by the team
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please take a photo, more than one can be taken
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As a Plant Check sheet been completed
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please take a photo, more than one can be taken
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Statement required of the utility strike from Team Leader as to what as taken place on Site.
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Statement requires detail description of what as taken place prior to the strike
Disruption & Injury Information
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Did the damage cause an interruption in service?
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If yes, how long was service interrupted?
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Approximately how many customers were affected?
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Estimated cost of damage / repair/ restoration?
- Unknown
- £0
- £1-£500
- £500 - £1001
- £1,001-5,000
- £5,001-10,000
- Over £10,000
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Any injuries occurred from the strike ?
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How many people injured (YOU must inform H&S Managers Bob Morris / Chris Lockham Immediately)
Description of the Root Cause
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Root Cause of Strike
- Failure to carry out cat and genny scan of site
- Failure to complete / carry out a visual inspection
- Failure to follow HSG47 Safe dig Practices
- Failure to maintain marks
- Failure to use hand tools when required
- Failure to dig a trial hole
- Failure to maintain clearance
- Other insufficient excavation practices
- Other Failures i.e services not shown on Plans and pooly laid exsisting services
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Additional Comments from Site Agent:
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what action is recommended to avoid further strikes
- Team to be stood down until further investigation
- Team requires refresher training on the use of cat and genny, course to be arranged asap
- Team Requires refresher training on HSG47 Safe dig Technique
- Team require toolbok talk on inportance of marking out the work zone, and marking up all known services
- Team requires toolbox talk on maintaining all service spray marks
- No Further Action required
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Have you informed Both Heneghans Health & Safety Department & Your Line Manager ?.
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What time did you inform the Builder Manager
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Please sign off once completed
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As all Information Been Entered Correctly
