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Pre-Excavation Check-List
Please complete below before beginning excavation.
Instrucciones en espanol?
Si
IN THE EVENT OF DAMAGE • Notify One Call and your supervisor • Begin Completing Incident Report • Photograph entire area and damage location PHOTOGRAPHY TIPS • U
se a Hit Kit to properly document where the locates are in reference to where the strike occurred
• Photograph the excavation itself (damage location)
• Take photos from multiple vantage points and of surrounding area (360 degrees)
• There is a 35Mb total size limit or total of 10, whichever comes first.
Complete a continuación antes de comenzar la excavación
En el evento de estropear
•
Notifique One Call y al supervisor
•
Empieze a completar el reporte de incindente
•
Tome fotografias de toda el area y la locacion perjudicada
Consejos de fotografia
•
Tome fotografias de la excavacion. (El area perjudicada)
•
Tome fotos de diferentes puntos y de la area alrededor
•
35Mb limite de tamano
Submitter/Remitente
Submitter is/Remitente es:
Employee/Empleado
Not an Employee/No Empleado
Employee Submitter/Empleado Remitente
Your Name/Nombre
Submitters ID
Your Title/Titulo (Read Only)
Your Email Address/Direccion de Correo Electronico (Read Only)
Alternative Email Address (if desired)/Direccion de Correo Electronico Alternativo
Non-Employee Submitter
Your Name/Nombre
Your Title/Titulo
Your Email Address/Direccion de Correo Electronico
Is this Pre-Ex for In-House or Subcontractor?/Es esto para pre excavacion dentro de la empresa o subcontratista?
In-House/dentro de la empresa
Subcontractor/subcontratista
In House
Drill Operator Name/Equipment Operator/Nombre del operador de perforación
Drill Operator/Equipment Operator ID
Drill Operator/Equipment Operator Title (Read Only)/Título del operador de perforación
Locator/Spotter Name/Nombre del localizador
Locator/Spotter ID
Locator/Spotter Title (Read Only)/Título del localizador
Crew Foreman's Name/Nombre de Crew Forman
Foreman's ID
Crew Foreman's Title (Read Only)/
Título
de Crew Forman
Subcontractor/Subcontratista
Subcontractor Company Name/Nombre de la empresa del subcontratista
Subcontractor ID
Sub's Name not in above database? (Add name manually)/ el nombre del subcontratista no está en la base de datos?
Yes
No
Input Subcontractor Name (Full Legal Name)/ Ingrese el nombre del subcontratista (nombre legal completo)
Address Line 1/Direccion 1
Address Line 2/
Direccion 2
City
Country
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
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Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
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Canada
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Chile
China
Christmas Island
Cocos ( Keeling ) Islands
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Cook Islands
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Côte d ' Ivoire
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Cuba
Cyprus
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Denmark
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Dominica
Dominican Republic
East Timor
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El Salvador
Equatorial Guinea
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Falkland Islands ( Islas Malvinas )
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French Polynesia
French Southern and Antarctic Lands
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Germany
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Grenada
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Guyana
Haiti
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Hungary
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Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
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Kenya
Kiribati
Korea
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Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
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Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
State/Ciudad
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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New Hampshire
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Texas
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Provinces
Please select...
Alberta
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Newfoundland
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Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
State/Province
Postal Code/Codigo postal
Locate Ticket#/Ticket de localizar
For example, One-Call or DigAlert
Please attach Copy/Picture of Locate Ticket
Permit Number/NTP/Numero de permiso
Job Number/Numero de trabajo
NFID/FCC
Office/Oficina
Office associated with this job.
Office Address (read only)/Direccion de la oficina
If this is blank, then the Office was not selected correctly--click on it to select.
Office ID
Customer/Cliente
Please select...
AT&T
Beanfield Metroconnect
Bell Canada
Comcast
Cogeco
Cogeco Peer 1
Cox
Google
Henkels & McCoy
Lumen
MCI
MNSI
Municipalities
Rise
Rogers
Start
Telus
Time Warner
Toronto Hydro
Verizon
Other
Pre-Excavation Check-List/
Lista de verificacion de pre-excavar
1)
Verify that the One-Call ticket covers the "Scope of work" and "Work to begin" date
/ Verifique que One Call ticket cubra el alcance del trabajo y la fecha de cuando empieza el trabajo
I have verified the One-Call ticket covers the "Scope of work"/
Yo verifique que One Call ticket cubre el alcance del trabajo
I have verified the One-Call ticket ‘Work to begin’ date/
Yo verifique que One Call ticket tiene la fecha de empezar el trabajo
White paint has been laid to indicate our pathway/ P
intura blanca indica nuestro camino
Are there any stacked utilities in or around our pathway?/
Hay utilidades apiladas en nuestro camino?
Yes/Si
No/No
If yes, the stacked utilities are properly marked/
Si es así, las utilidades apiladas están marcadas correctamente
2) What marked utilities did you observe?/Que utilidades marcadas observaste?*
Gas (Yellow)/Gas Natural (Amarillo)
Electric (Red)/Electricidad (Rojo)
Telecommunications (Orange)/Telecomunicaciones (Naranja)
Sewer (Green)/Alcantarilla (Verde)
Water (Blue)/Agua (Azul)
None/Nada
3) Based on visual observation, did you see signs of any unmarked utilities?/Basado en tu observacion visual, has visto senales de utilidades sin marcar?*
Gas (Yellow)/Gas Natural (Amarillo)
Electric (Red)/Electricidad (Rojo)
Telecommunications (Orange)/Telecomunicaciones (Naranja)
Sewer (Green)/Alcantarilla (Verde)
Water (Blue)/Agua (Azul)
None/Nada
4) Photograph the entire proposed work area, including all locate marks/Fotografiar toda el area de trabajo, las areas marcadas
Photo 1/Foto 1
Photo 2/Foto 2
Photo 3/Foto 3
Photo 4/Foto4
Photo 5/Foto 5
Add another picture?/Agregar otra fotografia?
Yes/Si
Photo 6/Foto 6
Add another picture?
Yes
Photo 7/Foto 7
Add another picture?
Yes
Photo 8/Foto 8
Add another picture?
Yes
Photo 9/Foto 9
Add another picture?
Yes
Photo 10/Foto 10
I have photographed the entire site prior to excavation/
Yo tome fotografias de toda el area antes de excavar
I have photographed existing locate/markings/
Yo tome fotografias de las areas marcadas
5) Advise your crew members of the following: if they have to cross a marked Utility they must HAND DIG ONLY within 18" of the locate marks plus half the diameter of the buried facility.
Asesorar a los miembros de mi equipo: si ellos tienen que cruzar utilidad marcada tienen que excavar a mano dentro de 18 pulgadas de las marcas de localizacion mas medio diametro de la instalacion enterrada.
RESPECT THE MARKS! Oregon: 24" Missouri: 24" Kansas: 24" Oklahoma 24" Texas: 18"
I have advised my crew of the hand dig rule above/
He informado a mi equipo de la regla de excavacion manual.
6) Will you be using a directional drill?/Estara usted utilizando un taladro direccional?*
Yes/Si
No/No
If Yes, has the beacon been calibrated properly, as directed by the manufacturer?/
Si la respuesta es si, ha sido la balide localizacion calibrada apropiadamente como lo indica el fabricante?
Yes/Si
Need link to upload oversize files?
Yes
Link to Upload Oversize Files
Comments/Comentarios
Contact Information