Service strike Report form

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Which service(s) have been hit

  Electric

  Gas

  Water

  Telecoms

  Other

• What type of service has been struck

• Has a permit to dig been issued

  Yes

  No

• Why not?

• Enter details and photo of the permit issued

  Media

• Was the correct detector equipment used before a permit was issued? (Cat and Genny)

  Yes

  No

• What Mode did the locator pick up the underground plant in ........

  Power Mode

  Radio Mode

  Genny Mode

• Enter details of the detector equipment used

Service identification

• Do the operatives have marking / spray paint?

  Yes

  No

• Is there evidence at the incident location showing the ground had been marked out?

  Yes

  No

Plans

• Have plans utility plans been issued?

  Yes

  No

• Are the plans accurate

  Yes

  No

• Were trial holes dug?

  Yes

  No

Utility location / situation

• How was the plant /utility located

  Select Encased in concrete Under concrete Under tarmac In a bed of sand (50mm above and below cable) In a suitable duct or pipe

  • Encased in concrete
  • Under concrete
  • Under tarmac
  • In a bed of sand (50mm above and below cable)
  • In a suitable duct or pipe

• Depth of underground plant damaged (in mm)

  Yes

  No

• Were there any visible marks above or below ground to assist in location of plant?

  Yes

  No

• If Yes, what were they?

  Marker Tape

  Tiles

  Warning Notice

• Did we require assistance from utility company before excavating?

  Yes

  No

• Details of who attended and assisted

  Yes

  No

• Tool used while excavating

  Select Mechanical Plant Power hand tools Non powered hand tools Other

  • Mechanical Plant
  • Power hand tools
  • Non powered hand tools
  • Other

• Provide details

• Was the damage caused by an excavator?

  Yes

  No

• Details of the contractor involved. Name, address, phone number etc.

• What steps are to be taken if not already done so to prevent a re-occurrence?

• Signature of person completing this form

  Sign