Title Page
-
Site conducted
-
Civil Contract audit been carried out on
-
NBU or PN Number required
-
Company Name
- Heneghans
- V25
- Northfield
- C&A
- LDH
- CWB
- ASG Civils
- Comms Installations Ltd
- Perfecta Group
- SL Comms
- Cusack
- Hardwick
- AGM
- Axle
- McLoughlin
-
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
-
Conducted on
-
Actual Time of strike.
-
Supervisor Name
- Marlon Brown
- Bartley Keane
- Dave Bagley
- Daniel Laycock
- Leah Jones
- Andrew Siddons
- Anthony Douglas
- Steven Pegg
- Steven Hewkin
- Steve Kemp
- Kevin Murphy
- Kris Ogilsby
- Des Rogan
- Sean Delaney
- Jamie Ayrton
- Gary Handley
- John Walsh
- Phil Edgell
- Chris Gunn
- John Whitehead
- Bob Morris
- Mick Mcelhinney
- Rob Austin
- Cable Agent 2
- Cable Agent 3
- Ian Molloy
-
Team Leader
Location of Event
-
Address of strike
-
House Number ?
-
where event occurred
-
Public:
Affected Facility Information
-
Was the utilitie owner informed?
-
Time reported to Utility owner
-
Ref Number
Excavation Information
-
Depth of Damage utility
-
please take a photo, more than one can be taken
-
Was a Visual inspection carried out, i.e gas box on building, chambers, toby boxes and any other street furniture
-
please take a photo, more than one can be taken
-
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.
-
please take a photo, more than one can be taken
-
Was all known utilitie marked up.
-
please take a photo, more than one can be taken
-
NRSWA card on-site
-
Please take a photo, more than one can be taken
-
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
-
Please take a photo, more than one can be taken
-
Plant operating Cert
-
please take a photo, more than one can be taken
-
Were utilities Drawings on site and in Date (UTILITY DRAWING VALID PERIOD DAYS - GAS-28 / ELECTRIC-30 / B.T-90 / WATER-90 / VIRGIN-90 ).
-
please take a photo, more than one can be taken
-
Was the utilitie trial-holed dug before excavation?
-
please take a photo, more than one can be taken
-
Was cat & genny used on site and in calibration?
-
Please take a photo, more than one can be taken (Serial Number Required of the Cat)
-
Cat & Genny - Are batteries charged and fit for use (Test both equipment for power & noise indicators)
-
Was warning tape or sand over the utility strike
-
please take a photo, more than one can be taken
-
Is a team member trained / competent in the use of Cat & Genny
-
please take a photo, more than one can be taken
-
As a on site Risk Assessment Been completed by the team
-
please take a photo, more than one can be taken
-
As a Plant Check sheet been completed
-
please take a photo, more than one can be taken
-
Statement required of the utility strike from Team Leader as to what as taken place on Site.
-
Statement requires detail description of what as taken place prior to the strike
Disruption & Injury Information
-
Did the damage cause an interruption in service?
-
If yes, how long was service interrupted?
-
Approximately how many customers were affected?
-
Estimated cost of damage / repair/ restoration?
- Unknown
- £0
- £1-£500
- £500 - £1001
- £1,001-5,000
- £5,001-10,000
- Over £10,000
-
Any injuries occurred from the strike ?
-
How many people injured (YOU must inform H&S Managers Bob Morris / Chris Lockham Immediately)
Description of the Root Cause
-
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
-
Additional Comments from Site Agent:
-
what action is recommended to avoid further strikes
- 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
-
Have you informed Builder manager i.e Virgin Media or City Fibre build manager
-
What time did you inform the Builder Manager
-
Please sign off once completed
-
As all Information Been Entered Correctly
