MWEC URD Damage Report
Date and Location
Name:
*
First Name
Last Name
Email:
*
example@example.com
Today's Date:
*
-
Month
-
Day
Year
Date
Time of Damage:
*
Hour Minutes
AM
PM
AM/PM Option
Date of Damage:
*
-
Month
-
Day
Year
Date
Street Address:
*
Nearest Intersection:
*
Map Location:
*
District
*
Please Select
Williams
Mountrail
Company Information
Name of Company:
*
City:
*
Office Address:
*
Damage Information
Duration of Outage:
*
Type of Cable:
*
Please Select
Primary
Secondary
Size of Cable:
*
Depth of Damaged Facility:
*
Locating and Marking
Was the One-Call Center Notified
*
Please Select
Yes
No
Locate Ticket #:
Were facility marks visible in the area of excavation?
*
Please Select
Yes
No
Were facility marks accurate?
*
Please Select
Yes
No
Were Facility marked with:
*
Paint
Flags
What was the distance between locate marks?
*
Excavation
Type of Excavating Equipment:
*
Please Select
Backhoe/Trackhoe
Boring Machine
Auger
Trencher
Probing Device
Other
Other Type of Excavating Equipment:
Type of Work Performed:
*
Please Select
Installing Gas Pipeline
Installing Electric Cable
Joint Trench
Installing Telephone
Installing Cable TV
Installing Poles
Installing Anchors
Other
Other Type of Work Performed:
Location Dig Site:
*
Please Select
Private Property
Utility Easement
Road Right of Way
Describe How the incident occurred:
*
Electrical System Information
Rotation at Transformer:
Please Select
Clockwise
Counterclockwise
Amperage:
Please Select
A
B
C
Voltage at Meter
Please Select
A
B
C
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