9-1-1 Outage Reporting and Notification Form
THIS FORM IS FOR PHONE COMPANY USE TO REPORT 9-1-1 OUTAGES ONLY. IF YOU HAVE A POWER OUTAGE TO REPORT, PLEASE REPORT TO THE POWER COMPANY. IF YOU HAVE AN ELECTRICAL INCIDENT TO REPORT TO THE PUC, PLEASE CALL 303-894-2528. 
This form is for initial notification and final reporting to the Public Utilities Commission of 9-1-1 outages pursuant to 4 C.C.R. 2143 (g). If you have any questions, concerns, or suggestions regarding this form, please contact dora_911program@state.co.us. If you would prefer, you may also report your outage via our outage reporting voice mail line at 303-894-2528.

Form updated 5/26/20
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Email *
Name of Entity Reporting *
Name of Your Company
Type of Entity Reporting *
Reporting Individual *
Name of person completing this form
Call Back Number *
What is a good call back number for the reporting individual?
Ticket Number *
If there is a ticket number for this incident, enter it here, otherwise enter "none".
Report Type *
Affected Geographic Area *
Or "unknown"
Date and Time of Outage Beginning *
Or "unknown"
Date and Time of Outage Ending *
If ongoing, enter the expected duration of the outage, or "ongoing, expected duration unknown".
Number of End Service Users Affected *
Or "unknown". If estimated, enter the number and "estimated".
Description of the Services Affected *
Example: "Toll and 911 isolated", "ALI outage only". If unknown, enter "unknown".
Description of the issue
Example: "Fiber Cut", "Equipment Failure", "Poor audio quality",
PSAPs Notified *
State which PSAPs were notified of this outage. If none, select the first option. There is also an "other" option at the end of the list if for any reason the PSAPs notified aren't on this list.
Required
At what time was the PSAP notified? *
Contingency Plans Activated *
Describe any contingency plans activated to mitigate the outage, such as conditional routing of 911 calls to a 7-digit number. If none, enter "none".
Suspected Cause *
Or "unknown"
If this was a cable/fiber cut, were locates requested?
Clear selection
If this was a cable/fiber cut, what person or company caused the cut to occur?
Action Currently Being Taken to Investigate or Resolve the Outage *
For final reports only: State whether 9-1-1 callback numbers and/or location information that could not be delivered to a PSAP due to this event existed and were provided to the PSAP following restoration of service.
A copy of your responses will be emailed to the address you provided.
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