Mark See

Vernon Electric Property Damage/Accident Investigation

Document and Record Damage Occurred on Vernon Electric Cooperative's Electrical System

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Use this Template

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Information

Site conducted
Date/Time
Prepared by
Employee's involved w/Repairs?

Incident Information.

Select date
Location of Incident (Example Pole #/ Map #) Please Include County/Village/City?
Discription of Damaged Facilities?(Attach Pictures)
Attach Pictures
Repairs Made to Make Safe?( Attach Pictures)
Attach Pictures
Follow Up Repairs Needed?

Law Enforcement

Law Enforcement Notified
Officer's Name/Department?
Case #

URD Cable DAMAGED Section

Kohnen Utilities Notified? Abe Vanseth (715) 642-5004 Aaron Klein (715) 642-0023
Contractors Digger Ticket #, Date , Time.

Duration of Damage.

Time Call Received?
Appr. Time Outage Occurred?
Time Outage Ended?

Mark See

Vernon Electric Property Damage/Accident Investigation

Document and Record Damage Occurred on Vernon Electric Cooperative's Electrical System

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.