Network Damage Report – OLNW Webforms

Form used to access the damage done to OnlineNW's network by outside contractors.

Date*
MM slash DD slash YYYY
Event Occurrence Time*

: Hours

Minutes

AM/PM
Assessment Submitted by:*
First & Last Name
Your E-mail*
Event Details
Locates Status*
- Locates called in / Locates Completed
- Locates called in / Locates NOT Completed
- Locates NOT called in
Locate Request Ticket #
Reason Locates were NOT completed*
- Missed / Mistake
- Work began prior to 48 hour due date
- Located incorrectly
- Misunderstanding regarding desired location
Approximate Address of Damage
Street Address City State ZIP Code
External Party damage caused by:
Contact Name Company
External Party's Contact Phone
Damage Specifics
Damage Description*
Describe what work 3rd party was doing that resulted in the damage
OnlineNW Network Impacted
What portion of OnlineNW's network was damaged?
Action Taken / Response*
How did we respond to this event? What actions were taken? Who was notified? How did we notify them? What was done in order to get network repaired?
Additional Notes
What other points should be mentioned regarding this event?
Take pictures of site noting the following things:
Proof of all Visible Locate markings
The distance between markings and the actual strike
Image of locate markings present onsite*
Max. file size: 12 MB.
Photo or Video Upload #1
Max. file size: 12 MB.
Photo or Video Upload #2
Max. file size: 12 MB.
Photo or Video Upload #3
Max. file size: 12 MB.
Photo or Video Upload #4
Max. file size: 12 MB.
Photo or Video Upload #5
Max. file size: 12 MB.

Save and Continue Later

Event Details