Template

Utility Damage Report Form

by Alan Milford, from the Community

Use this Utility Damage Report Form to record utility strikes in the field and standardize incident investigations. Log dates and times, location and site address, team members, and the utility owner. Capture what happened when the asset was struck, injuries and environmental impact, and the type of utility affected such as LV, HV, service, or main. Verify plans, CAT and Genny use, safe digging practices, air lancing, and trial holes. List equipment, document immediate causes, conclusions, and attach risk assessments, photos, and additional notes. Export reports to PDF for compliance and lessons learned.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Eltel UK Utility Damage Report
Use this Eltel UK Utility Damage Report to record and investigate utility strikes on site. Capture incident date and time, job details, location, utility type and depth, pressure or voltage, photos, and cause. Document team information, qualifications, and a full narrative of what happened. Verify plans on site, risk assessments, and CAT/Genny availability, calibration, and survey steps before and during excavation. Record excavation methods, PPE used, and whether the damage was avoidable. Add corrective and preventive actions, owners, due dates, and attach plans, photographs, and signatures.
by Mike Ritchie, from the Community
Downloads: 0
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Template
Crawford Utility Damage Report
This Utility Damage Report template helps construction and civil crews document and investigate utility strikes during excavation and roadwork. Record job and location details, Miss Dig ticket information, date and time of damage, utility owner, and attach photos of the location, markings, and the damage. Include sketches, note whether utilities were properly marked or potholed, and measure distance from flags. Log crew members, equipment involved (e.g., excavator, trencher, hydro vac), and the type of work performed. Identify root causes such as inaccurate or disturbed markings or digging before marks. Capture utility representative details and signatures to support incident review, corrective actions, and claims.
by Brandy Prosch, from the Community
Downloads: 30+
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Template
Hen - SF03 - Utility Strike Report
Use this Utility Strike Report to record any known or unknown strikes during excavation or civil works. Capture site details, date and time, supervisor and team, location and the asset struck such as gas, electric, telecoms, water, sewer or fibre, and whether the utility owner was informed. Log excavation depth, photos, markings, NRSWA card, equipment used, drawings validity, trial holes, CAT and Genny calibration and competency, and warning markers. Document service interruption, affected customers, costs, injuries, and a detailed root cause analysis. Add corrective actions, training needs, manager notifications, and sign off to prevent recurrence.
by Heneghans 01, from the Community
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Template
Strike Investigation Form
This Strike Investigation Form helps teams document and investigate utility strikes that occur during excavation, cabling, or related site works. Record incident time, location, work details, weather, ground and surface conditions, plant and equipment involved, and type of utility damaged such as electric, gas, water, sewer, fibre, or telecoms. Capture service position, diameter, depth, material, and protection, and note utility status. Verify risk management controls including permits to dig, point of work assessments, use and calibration of CAT and Genny, utility plans, service mark ups, trial pits, and protective measures. Attach photos and supporting notes to create a complete investigation record and aid corrective actions.
by Gillian Huppler, from the Community
Downloads: 10+
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Utility Damage Report Form

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Eltel UK Utility Damage Report

Crawford Utility Damage Report

Hen - SF03 - Utility Strike Report

Strike Investigation Form

You might also like

Eltel UK Utility Damage Report

Crawford Utility Damage Report

Hen - SF03 - Utility Strike Report

Strike Investigation Form