Utility Hits Report
CS Construction, Inc.
Employee Name
*
First & Last Name
Job Number
*
Ex: 1346A
Date & Time Incident Occurred
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Time Employee Started Work
*
Hour Minutes
AM
PM
AM/PM Option
Supervisor Name
*
First & Last Name
Witnesses
(If Any)
List The Tools You Were Using To Dig
*
Ex: Shovel, Backhoe, Etc.
Type of Utility Hit
*
Gas
Water
Fiber/Communication
Electrical
Sewer
Other
Utility Company Name
*
Were All Utilities Marked?
*
Yes
No
Was It Blue-Staked?
*
Yes
No
Was The Blue-Staking Correct?
*
Yes
No
Distance In Feet & Inches From Hit To Blue-Stake Marking?
*
Ex: 3ft 4in
Were Photos Taken?
*
Yes
No
Was The Utility Company Notified?
*
Yes
No
How Many People/Trucks Came To Repair
*
Time Utility Company Arrived At Site
*
Hour Minutes
AM
PM
AM/PM Option
Time Utility Company Left The Site
*
Hour Minutes
AM
PM
AM/PM Option
Describe The Incident
*
Details Matter! Please Be Descriptive As Possible.
Employee Written Statement
*
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Report Completed/Received By Supervisor Name
*
First & Last Name
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