The form must be filed not later than the 15^th of the month following the incident.  Filers should file as soon as possible after the incident, but no later than the 15^th of the following month.

Check the appropriate block to indicate whether or not there were damages to facilities.  The form is also used to report violations of regulations, whether or not damage occurred.

I.          Provide information as indicated describing the Date of Report, Utility filing, with contact name,    mailing address and Email address.

II.        Provide information identifying the Excavator involved in the incident with mailing address, contact person, phone and Email address, if known.

III.      Provide information on Date & Time of incident, CBYD Ticket #,
          Location of incident.

A thru E  --  Specify type of Utility affected.

F and G  --   Specify “Main” or “Service”.  “Main” could mean  
                   “Electric primary” or “communication  
                    multi-cable”. “Service” could mean electric,
                    communication, or sewer connection to a single
                    building.

H and I  --   Specify the location; Public right-of-way is usually a
                  road; Private right-of-way is off the road.

M thru Z  --  Fill in Only if Damage occurred.
                  Select the Primary or Root Cause of the DAMAGE,
                   i.e., what one item contributed most to the damage.

M   No notice was given by the excavator; no CBYD Ticket # was
      obtained.

N   The facility was not located due to an error or omission by the markout person, e.g., the markout person ignored the facility, or marked it incorrectly, or incorrectly stated that there was no facility in the excavation area.

O   The facility was not located because the excavator did not allow two full working days between the time of the notice and actual excavation.  Include in “COMMENTS” whether the excavation was necessitated by an emergency.  An emergency includes situations involving danger to life, health or property, the interruption of operation of a major industrial plant, or the continuity of public utility service.

S    The facility was not located because the notice by the
       excavator to CBYD was incorrect or incomplete.

V   The facility was not located because the facility records were
      incorrect.

U   No record of the facility existed, resulting in no location or incorrect location.  In some cases, a markout person may have no record of a facility, but may see other indications that a facility may exist (such as a meter at a building), and attempt to locate without benefit of a record.

P    The excavator did not maintain the markings, or removed pavement containing marks, or allowed construction activity to obliterate marks.  It is the responsibility of the excavator to maintain the markings.

Q   Excavator failed to hand dig.  For facilities containing combustible or hazardous fluids or gases, an excavator may use mechanical equipment solely for the purpose for removing the bituminous and concrete road surface otherwise, an excavator must employ hand digging only.

R   Excavator failed to exercise “reasonable care” to protect facilities.  Because “reasonable care” can be defined in many ways, an explanation in the COMMENTS section is required.  Examples of reasonable care include:  proper support, shoring and backfill methods and techniques; selection of equipment to minimize reasonable likelihood of disturbance to underground facilities; adequate supervision; proper understanding by the personnel on the job site so that prompt action can be taken in the event of contact with underground facilities; adequate training of employees in protection of utility facilities and the public; maintaining necessary liaison with owners of underground facilities; sponsoring pre-planning and pre-construction meetings as necessary.

X    Excavator did not stay within the proposed work area.

W    The facility was located incorrectly by the markout person
        because of an incorrect record of the facility.

Z    The facility was located incorrectly because the markout person made a mistake or otherwise failed to mark a known facility. 

VIOLATIONS OF THE REGULATIONS  ---  ITEMS 1 THROUGH 17

Enter in the block provided ALL violations from the numbered table.  Each of these items is a requirement of the DPUC Regulations §16-345.  Many duplications of the lettered items in the table above are included for reports of violations which did not result in damage.  However, violations may also apply in incidents where there was damage

1    No Notice by the excavator; no CBYD Ticket was obtained.  This is a violation of the regulations whether or not damage occurred.

2    Excavator commenced work without waiting two full working days after obtaining a CBYD ticket.

3    The excavator did not give a description of the location of the proposed excavation sufficient to permit marking of the facilities.

4    The excavator failed to renew a notice.  CBYD notifications “expire” after 30 days.  A notice renewal is required.

5    Failure to mark the proposed area of excavation with white marks.  The marking allows facility owners to mark facilities more efficiently, thereby improving response times to all CBYD notices.

6    The excavator declared an emergency when one did not exist.  An emergency includes situations involving danger to life, health or property, the interruption of operation of a major industrial plant, or the continuity of public utility service.

7    Whether or not damage resulted, failure to hand dig near facilities containing combustible or hazardous fluids or gases should be reported, including the total thickness of bituminous and/or concrete pavement, and the cover over the facility.  These measurements are necessary to reasonably judge if the damage occurred during pavement removal.

8    It is the responsibility of the excavator to maintain the markings by avoiding the covering or removing of surface markings or stakes during construction activity.

9    It is the responsibility of the excavator to adequately support underground facilities until proper backfill, including proper compaction, is complete.

10  Excavators are required to report both damages and contacts with underground facilities.  Often, contacts which appear insignificant, can lead to facility failure.  It is in the interest of all parties to address these contacts as soon as possible.

11  Excavators are not knowledgeable of the operation of utility facilities in the work area.  Even well-intentioned actions have led to disastrous results.

12  Excavator failed to exercise “reasonable care” to protect facilities.  Because “reasonable care” can be defined in many ways, an explanation in the COMMENTS section is required.  Examples of reasonable care include:  proper support, shoring and backfill methods and techniques; selection of equipment to minimize reasonable likelihood of disturbance to underground facilities; adequate supervision; proper understanding by the personnel on the job site so that prompt action can be taken in the event of contact with underground facilities; adequate training of employees in protection of utility facilities and the public; maintaining necessary liaison with owners of underground facilities; sponsoring pre-planning and pre-construction meetings as necessary.

13  Facility owner/operator did not mark facilities either because there was no record of the facilities, or because an incorrect record led the markout person to conclude that no facility existed.

14  Facility owner/operator did not mark facilities because of an error or omission of the markout person.

15   Facility owner/operator did not mark facilities because of some other reason.  For example, the notification was mishandled, no one was dispatched to mark, or other error.

16   Facility owner/operator attempted to mark facilities, but marked inaccurately because there was no record, or an incorrect record led to the inaccurate mark.

17   Facility owner/operator DID mark facilities, but did so inaccurately because of an error or omission of the markout person. 

COMMENTS

Include any information which would be useful in clarifying the incident, either to further explain the cause or identify any unusual circumstances involved.  Attach additional sheets if that would be helpful.

IV.       Indicate if utility service was interrupted, the time, duration, and number of affected customers.  Specify number of fatalities, personal injuries (requiring professional medical attention) and/or persons evacuated. 

V.        Indicate whether the excavator will be billed by the facility 
            owner/operator.

Affix signature of person approving, date of approval, printed name and title and telephone number where the person can be contacted for further information, if necessary.