Utility Strike Investigation

Utility Strike Investigation
Initial Details
Client *
Workstream*
Map Group Incident Number
Client Incident Number (If Applicable)
Damaged Utility Provider Reference ID
Company Name*
Lead Operative

First NameLast Name
Lead Operative Role
Operative 2

First NameLast Name
Operative 2 Role
Operative 3

First NameLast Name
Operative 3 Role
Operative 4

First NameLast Name
Operative 4 Role
Contractor Supervisor (If Applicable)

First NameLast Name
Map Group UK Supervisor*

First NameLast Name
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you or have you been on the Map Group UK Permit to Dig Register*
What task was being undertaken*
Location Type*
Date of Strike*

DayMonthYear
Date
Approximate Time of Strike*

Hour Minutes
Was Anyone Injured as a Result of the Strike*
IF STRIKE HAS RESULTED IN AN INJURY, PLEASE CONTACT HSQE DEPARTMENT IMMEDIATLEY.
What Utility was Damaged*
Ground Conditions*
Depth of Damaged Service, in millimetres*
Equipment being utilised at time of strike*
Other Equipment Utilised at Time of Strike*

	Actions required	By Whom	Target close out date	actual close out date
Toolbox talk on HSG47
Toolbox talk on service location avoidance
Permit to Dig
Re-induction required
Equipment replacement
Yellow/Red cards issued
Retraining
Suspended upon further investigation

Initial Details