Utility Damage Report

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Date of Investigation Date of Investigation / MM / DD YYYY
Crew Leader

Crew Leader Marty Armer Kirk Barrows Richard Colf Cody Cagle Kenny Howerton Cody Finch Joe Goins Jason Brown Thomas Harris Other Other
Dig Operator During Time of Damage
Job Name
Address or Location of Damage
Owner of Utility
Type of Utility
Service/Main
Size of Utility (If Known)

i.e., 25 pair, 2", 4", etc.
One Call Number
Second Request Number (If Applicable)
One Call Start Date One Call Start Date / MM / DD YYYY

2 Working Days After Called In
One Call End Date One Call End Date / MM / DD YYYY

20 Working Days After Date Called In
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