SERVICE STRIKE REPORT

• Site conducted

  Select

• Date and Time Report Started

  Date

• Date and Time Strike(s) Occurred

  Date

• Road name ref

• Gang

  Select

• Initially notified immediately by text/email to whom on H&S Team

• Report prepared by

  Select
• Location (including house No. & full postcode)
  Address

General Information

• Service Type

  Select GAS WATER CCTV CABLE ELECTRIC STREETLIGHT ELECTRIC CABLE HV ELECTRIC CABLE LV TELECOMMUNICATIONS - Copper SEWER TELECOMMUNICATIONS - Fibre

  • GAS
  • WATER
  • CCTV CABLE
  • ELECTRIC STREETLIGHT
  • ELECTRIC CABLE HV
  • ELECTRIC CABLE LV
  • TELECOMMUNICATIONS - Copper
  • SEWER
  • TELECOMMUNICATIONS - Fibre

• Describe briefly how the site was made safe

• Date & Time Strike Reported to Service Owner

  Date

• Date and Time Repaired (you must email it through to HS team once known if not included in this report)

  Date

• Activity when Strike occurred

• Damaged Service Depth

• Recommended Depth

• Surface Type

• Name of Operative responsible for damage

• Name of Foreman

• If a subcontractor, name which

• Was any person(s) injured (IF SO, NOTIFY H&S TEAM IMMEDIATELY)

• Brief Injury Description, if any

Evidence Required

• NOTE: for each of the following a CLEAR and sufficiently detailed photo(s) must be taken

  Drawing

• 1. Generic Street Works Risk Assessment available? (usually on Tablet - Copy or Photo Required)

  YES

  NO

  N/A

  Photo

• 2. Dynamic risk assessment (POWRA) completed Copy & Photo FRONT AND BACK

  YES

  NO

  N/A

  Photo

• F91 FORM COMPLETED ? (PHOTO FRONT AND BACK)

  YES

  NO

  N/A

  Photo

• 3. Service drawings on site and checked (usually on Tablet - Copy & Photos Required)

  YES

  NO

  N/A

  Photo

• Open up and photo evidence service prints of utility damaged.

  YES

  NO

  N/A

  Photo

• 4. Services marked up (Photo Required)

  YES

  NO

  N/A

  Photo

• 9.CAT & Genny Calibration Due Date (provide photo of both showing cal dates and cat in 3 phases)

• 11. Visual Signs- eg. Surface Scars, Furniture or Property (Photo Required)

  YES

  NO

  N/A

  Photo

• 12. Trial/Pilot Holes (Photos Required)

  YES

  NO

  N/A

  Photo

• 14. Utility Observer (banksman)

  YES

  NO

  N/A

• 16. Is at least one Operative in the Gang NRSWA Qualified (Photo of card front and back required & ticket No)

  YES

  NO

  N/A

  Photo

• 17. Excavator operated by qualified person (Photo of Card Required)

  YES

  NO

  N/A

  Photo

• 19. What type of equipment damaged the service

  Select Excavator Floor Saw Stihl Saw Breaker Graft Shovel Other (specify)

  • Excavator
  • Floor Saw
  • Stihl Saw
  • Breaker
  • Graft
  • Shovel
  • Other (specify)

• As soon as a strike is known it must be reported ASAP to Contract Project Manager and HSEQ Manager

• Please ensure the photographic evidence is as required- Full photos of marking up including property photos and photos of all documents be mindful of glare/reflections off tablet screens. background locations for actual strike area ,measurements etc

• Please provide witness statements

• Person causing damage statement ..

• Name / position

  Sign

• Witness statement....

• Name/position

  Sign

General Comments and Observations

• Please add additional comments and observations which may help in the consideration of the strike ( eg. Ground/ weather conditions, shallow or direction change of service damaged).

Sign Off

• Prepared By Name and Signature

  Sign

• Date and time

  Date

CAUSE OF STRIKE

• Immediate

• Underlying

• Avoidable?

• Count towards strike KPI?

• CHF REFERENCE

CORRECTIVE ACTIONS

• Most relevant action applied

  Select

• Please provide brief description of action taken

• Signature

  Sign

• Date

  Date