• Utility Strike Incident Report

    Use this form to document a utility strike incident, including location, timing, utility affected, circumstances, impacts, immediate response, witnesses, and follow-up.

  • Incident Details

  • Incident Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Incident Time*
  • Report Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Report Time*
  • Utility Type Affected*
  • Strike Type*
  • Were emergency services contacted?*

  • Location and Site Information

  • Site Type*
  • Work Area Type*

  • Reporter and Organization Details

  • Format: (000) 000-0000.
  • Reporter Relationship to Site*
  • Format: (000) 000-0000.

  • Utility Strike Circumstances

  • Was the operator trained and authorized?*
  • Were utility locate markings present?*
  • Was a locate request made?*
  • Condition of visible markings
  • Were as-built plans or maps consulted?

  • Damage, Hazards, and Immediate Response

  • Observed Damage Severity*
  • Observed Hazards
  • Any Injuries or Medical Attention Needed?*
  • Was the Area Evacuated or the Site Shut Down?*
  • Was the Utility Owner/Operator Notified?*
  • Notification Time

  • Witnesses, Attachments, and Follow-Up

  • Format: (000) 000-0000.
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  • Preferred Follow-Up Action*
  • Should be Empty:
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