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Home
About Us
Board of Directors
Contact
TempMonitor
Excavators
Brochure
Calendar
Center Holidays
Color Code
Contact Us
E-Ticket
Enforcement Board
How 811 Works
Law
Positive Response
Remote Ticket Entry
When To Call
White Paint Law
HomeOwners
Brochure
Calendar Events
Center Holidays
Color Code
Contact Us
E-Ticket
How 811 Works
Locate Projects Near Me
Law
Positive Response
When To Call
White Paint Law
Member Utilities
Brochure
Calendar Events
Center Holidays
Change of Information
Credit Card ACH
Color Code
Damage Reporting Form
DIRT
E-Ticket
Enforcement Board
Fees For Membership Explained
Kor-Web
Law
Logos
Member Transmissions
MSAM
Membership Application Forms
Positive Response
Remote Ticket Entry
White Paint Law
Quick Links
DIRT
E-Ticket
MSAM
Law
P.I.P.E.
Positive Response (NEW)
Positive Response (Previous Before 11-07-17)
Ticket Search (Previous)
Ticket Search (NEW)
Always Call 811 Before You Dig!! It's free, it's easy, and it's the law!
Call 811, or (800) 351-1111, or (615) 366-1987
Damage Reporting Form
The following form should be used by utility companies to report damages of their facilities to Tennessee One-Call.
Click here for the Alternate PDF version that can be faxed or mailed to TOCS.
Fax - 615-366-5021
Mailing Address:
Tennessee One Call System, Inc.
1850 Elm Hill Pike
Nashville, TN 37210
You may also fill in the form below and submit:
Utility Damage Reporting Form
Who is providing the information?
Excavator
Public Works
Telecommunications
Liquid Pipeline
Railroad
Electric
Locator
Road Builders
Unknown/Other
Engineer/Design
Natural Gas
Equipment Manufacturer
Private Water
Federal / State Regulator
Name of Person providing the information:
---------------------------------------------------------------------------------------------------------------------------------------------------------
Type of Event (DIRT EVENT):
Underground Damage
Underground Near Miss
Type of Event (NON-DIRT EVENT):
Above Grade
Aerial
Natural Cause
Submarine
Date of Damage to Underground Facility
City & County where damage occurred:
Address where damage occurred:
Nearest Intersection:
Select Right-Of-Way where damage occurred:
City Street
State Highway
County Road
Interstate Highway
Public-Other
Private Business
Private LandOwner
Private Easement
Pipeline
Power / Transmission Line
Dedicated Public Utility Easement
Federal Land
Railroad
Unknown / Other
---------------------------------------------------------------------------------------------------------------------------------------------------------
What Type of Facility Operation was Affected?
Cable Television
Electric
Liquid Pipeline
Natural Gas
Sewer
Steam
Telecommunications
Water
Unknown / Other
What Type of Facility was Affected?
Distribution
Gathering
Service/Drop
Transmission
Unknown/Other
Was the facility part of a joint trench?
Yes
No
Did this event involve a Cross Bore?
Yes
No
Was the facility owner an 811 member?
Yes
No
Unknown
If No, is the facility owner exempt from 811 membership?
Yes
No
Unknown
Measured depth from grade?
Embedded in concrete/asphalt pavement
18" - 35" / 46 - 91 cm
<18" / 46 cm
>36" / 91 cm
---------------------------------------------------------------------------------------------------------------------------------------------------------
Type of Excavator:
Contractor
Occupant
County
Railroad
Developer
State
Farmer
Utility
Municipality
Unknown/Other
Type of Excavation Equipment:
Auger
Backhoe/Trackhoe
Boring
Bulldozer
Drilling
Directional Drilling
Explosives
Farm Equipment
Grader/Scraper
Hand Tools
Milling Equipment
Probing Device
Trencher
Vacuum Equipment
Unknown/Other
Type of Work Performed:
Agriculture
Bldg. Construction
Bldg. Demolition
Cable TV
Curb/Sidewalk
Drainage
Driveway
Electric
Engineering/Survey
Fencing
Grading
Irrigation
Landscaping
Liquid Pipeline
Milling
Natural Gas
Pole
Public Transit Auth.
Railroad
Road Work
Sewer
Site Development
Steam
Storm Drain/Culvert
Street Light
Telecommunication
Traffic Signal
Traffic Sign
Water
Waterway Improvement
Unknown/Other
---------------------------------------------------------------------------------------------------------------------------------------------------------
Was the 811 Center notified?
Yes
No
If YES, what was the ticket number?
If YES, type of Locator:
Facility Owner
Contract Locator
Unknown/Other
If NO, is excavation activity and/or excavator type exempt from notification?
Yes
No
Unknown
Was work area white-lined?
Yes
No
Unknown
---------------------------------------------------------------------------------------------------------------------------------------------------------
Did Excavator incur downtime?
Yes
No
If YES, how much time?
<1hour
1 to 2 hours
2 to 3 hours
3+ hours
Estimated cost of downtime?
$0
$1-1000
$1,001-$5,000
$5,001-$25,000
$25,001-$50,000
> $50,000
---------------------------------------------------------------------------------------------------------------------------------------------------------
Did damage cause an interruption in service?
Yes
No
Unknown
If YES, duration of interruption:
<1hr
1-6hrs
6-12hrs
12-24hrs
24-48hrs
48+hrs
How many customers were affected?
Unknown
0
1
2-10
11-50
51+
Estimated cost of damage/repair/restoration:
$0
$1-1,000
$1,000-$5,000
$5,000-$25,000
$25,000-$50,000
> $50,000
Unknown
---------------------------------------------------------------------------------------------------------------------------------------------------------
Root Cause:
No notification made to 811 Center
Excavator dug outside area described on ticket
Excavator dug prior to valid start date/time
Excavator dug after valid ticket expired
Excavator provided incorrect notification info
Excavator dug prior to verifying marks by test-hole(pothole)
Excavator failed to maintain clearance after verifying marks
Excavator failed to protect/shore support facilities
Improper backfilling practices
Marks faded or not maintained
Improper excavation practice not listed above
Locating issue - Facility not marked due to Abandoned facility
Locating issue - Facility not marked due to Incorrect facility records/maps
Locating issue - Facility not marked due to Locator error
Locating issue - Facility not marked due to No response from operator/contract locator
Locating issue - Facility not marked due to Tracer wire issue
Locating issue - Facility not marked due to Unlocatable facility
Locating issue - Facility marked inaccurately due to Abandoned facility
Locating issue - Facility marked inaccurately due to Incorrect facility records/maps
Locating issue - Facility marked inaccurately due to Locator error
Locating issue - Facility marked inaccurately due to Tracer wire issue
Miscellaneous Root Causes
Deteriorated facility
811 Call Center Error
Previous damage
Root Cause not listed
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