Hit/Cut Report

• Type of Hit

  Gas

  Power

  Cable

  Other
• Address/Location
  Address

• Locate Ticket #

• Job #

• Date of Incident:

  Date

• Time:

  Date

• Employee Name:

• Crew:

• Investigation Performed on Site

  Yes

  No

  N/A

• Attach Pictures here

  Media

• Description of how the incident occurred:

• Results of Investigation:

• Corrective Action Taken:

• Were Locators called back to the site:

  Yes

  No

  N/A

• Locators Name:

NOTE: Filling out an Underground Cut Report is not an admission of guilt, but rather a proven method to identify future problems

• Supervisor’s Signature

  Sign

• Date:

  Date