Photos show mis-marked areas with Yes if no, explain why? a measuring device? No Yes Photos show date of damage? if no, explain why? No Yes Did you get witness statements? if no, explain why? No Down Time Details Name and of all crew members on site: All Equipment, Vehicles and trailers on site: Amount of time delay: did we assist in the repair in any way? Yes No If yes, explain: Report Preparer report prepared by: (print name) job title: phone number: date prepared: preparer signature:
Photos show mis-marked areas with a measuring device? Yes No if no, explain why? Photos show date of damage? Yes No if no, explain why? Did you get witness statements? Yes No if no, explain why? Down Time Details Name and of all crew members on site: All Equipment, Vehicles and trailers on site: Amount of time delay: did we assist in the repair in any way? Yes No If yes, explain: Report Preparer report prepared by: (print name) job title: phone number: date prepared: preparer signature:
Utilty-Damage-Report.docx