HPU FORM | After Hours Emergency Callout – HPU

Hibbing Public Utilities

After Hours Emergency Callout

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After Hours and Emergency Call-Out

Date / Time

Date

Time

Crew to be called out

Called out by

Signature

Clear Signature

Time Employee Checked In

Time Employee Checked Out

Time Called Received

Time Service Restored

Customer Name

First

Last

Customer Phone

Customer Issue

Line Time call

Customer Address

Address Line 1

Address Line 2

City

State

Zip Code

Was customer notified of potential callout charges? (minimum $150 per employee)

Does the customer have pets the call out employee needs to be aware of?

Single Line Text

Additional Information

Employee Name & Phone #

Time Employee Was Called

Date

Time

Employee Answer

Employee Available?

Refusal Reason or Hours Worked

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