Damaged Utility Reporting Form

Capture the full record of a utility strike during excavation work, from crew details and equipment used to photo evidence of the damage.

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Customer's Name

First Name

Last Name

Job Number

Address Where the Hit Occurred

Street Address

City

State / Province

ZIP / Postal Code

Foreman's Name

First Name

Last Name

Employee Who Hit the Line

First Name

Last Name

Equipment/Tools Being Used When the Hit Occurred

Date of Hit

Were Facility Marks Visible in the Excavation Area?

Were the Facility Marks Accurate?

What Were the Facilities Marked With?

Do You Have a Signed Waiver from the Customer to Hand Dig?

Were Utility Repairs Completed Onsite Allowing You to Set All Posts?

Foreman's Comments

Person at AFC Notified of the Utility Hit

First Name

Last Name

Are You a Project Manager or Superintendent?

Name of Person Who Contacted 811

First Name

Last Name

Original Ticket Number

Utility Hit Ticket Number

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