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Utility Damage Report Form

by Alan Milford, from the Community

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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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About author

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.