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Utility Contractors/Excavators Incident Report Form 2026
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- Click ‘Get Form’ to open the Utility Contractors/Excavators Incident Report Form in the editor.
- Begin by indicating whether the incident resulted in damage by checking the appropriate box. This is crucial for categorizing the report.
- Fill in your Company Name, CBYD Contractor Number, and Date at the top of the form. Ensure that all information is accurate to avoid processing delays.
- Provide your Mailing Address and Email for correspondence. This ensures that you receive any follow-up communication regarding the incident.
- Complete the 'Report Prepared By' section with your name and telephone number for accountability.
- Document details about the utility involved, date and time of the incident, and CBYD Ticket Number. This information is essential for tracking purposes.
- Circle the affected utility type and facility location as specified in the form. This helps clarify which services were impacted.
- If damage occurred, select a primary cause from the provided table. Be sure to enter any applicable violation numbers as well.
- In the COMMENTS section, provide any additional context or explanations necessary for clarity regarding the incident.
- Finally, sign and date the form before submitting it to ensure it is officially recorded.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4 Satisfied (52 Votes) |
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Related links
Dec 20, 2021 involved parties are to report the incident to the Office of Environmental Health and Safety at 423-439-7784 or 423-439-7900. EHS and willRead more
This form may also be used to report any near miss not resulting in a utility damage. Part A Please send this information to: Damage Prevention InvestigatorRead more