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DIRT- Damage Information Reporting Tool
Please fill out this form as soon as possible after any damage occurs.
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Contractor/Excavator
Your answer
Company
Your answer
Email
Your answer
Phone
Your answer
Name of person providing this information
Your answer
Type of contractor
Construction Manager
General Contractor
Site Excavator
Municipality
College staff
Utility provider
Other:
Date of event
MM
/
DD
/
YYYY
Time of event
Time
:
AM
PM
Location of damage (fill out address or precise location in Other)
City street
State highway
County road
Public-other
College property
Private property
Other:
What type of facility operation was affected?
Cable
Television
Electric
Natural Gas
Network/telecommunications
Sewer (Sanitary Sewer)
Steam
Water
Other:
Type of excavation equipment
Auger Backhoe/Trackhoe
Boring Drilling/Directional Drilling
Hand Tools
Probing Device
Other:
Type of work performed
Curb/Sidewalk
Bldg. Construction
Bldg. Demolition
Drainage
Driveway
Electric Engineering/Survey
Electrical
Fencing
Grading
Landscaping
Natural Gas
Network/telecommunication
Road Work
Sanitary Sewer
Site Development
Steam
Storm Drain/Culvert
Traffic Signal/Traffic Sign
Utility Pole/streetlight
Water
Williams facilities contact person
Your answer
Additional information (At a minimum, please supply; contact info for individual responsible for damage, site/damage details, and whatever other information you feel is pertinent.)
Your answer
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