Jobsite Damage or Breakage Report

Form Name

Full Name *

Email *

Supervisor: *

Date: *

Foreman *

Date and Time of Accident: *

What was broken or damaged and how? State who the property belonged to, such as CPS, City Water Board, R.L. Jones etc. Please explain in detail: *

Jobsite Name *

Job #: *

Job Phase *

Jobsite Address: *

Operator: *

Equipment Operating *

Was operator told of whatever he broke or damaged in his area? *

Yes

No

If no, state why:

Who did you tell to call the locators? *

On what day did they call to set up location? *

What was the date they came to locate? *

Name of company that came to locate: *

Name of person that came to locate: *

Were there any markers on this jobsite as to where these lines, cables, mains etc. were located? *

Yes

No

State the reason why this accident occurred: *

Upload photos of the accident *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

18225 FM 2252 - SAN ANTONIO, TEXAS 78266 - 210/561-6860 - FAX # 651-5435