HPU FORM | Damage Report – HPU | Hibbing Public Utilities

Skip to content

WHO WE ARE
my HPU
Outages
- Report A Problem
Commission
Employee Portal

WHO WE ARE
my HPU
Outages
- Report A Problem
Commission
Employee Portal

Submit A Service Request

Employee Dashboard

Hibbing Public Utilities

Damage Report

Download the PDF or Fill out online.

Download PDF Application

Damage Report

Please enable JavaScript in your browser to complete this form.

- Step 1 of 5

Damage Number

Date of Report

Date

Time

Time of Report

Engineer Reporting *

First

Last

Section Divider

Damage Address

Address Line 1

Address Line 2

City

State

Zip Code

Nearest Intersection

Date of Damage

Time of Damage

HPU Notified

Persons Reporting Damage *

Damaged Utility

Electric
Natural Gas
Steam
Water
Sewer
Telephone
Cable TV
Fiber
Unknown/Other

Engineering crews onsite

Type of Facility

Distribution Main
Collection Main
Service/Drop
Unknown/Other

Depth of Damage (Feet)

Depth of Damage (Inches)

Name of Excavator *

Phone No. of Excavator

Address of Excavator

Address Line 1

Address Line 2

City

State

Zip Code

Did the Excavator 'spot' the utility?

Yes
No

Does the Excavator have a One-Call Ticket?

Yes
No

Was the damaged utility marked by HPU?

Yes
No
(NLR-OK)

If YES, provide locate ticket #

#

If YES, what date was utility marked?

GSOC Locate Request Date

Work-To-Begin Date/Time

Date

Time

GSOC Ticket Expiration Date/Time

Date

Time

Locate Requested By *

Work Being Done For *

Type of Work

Are Marks within 24-inches of Damage?

Yes
No

Distance from Marks to Damage (Feet)

Photos of Damage Taken?

Yes
No

Are there pre-excavation photos?

Yes
No

Distance from Marks to Damage (Inches)

Did the Excavator use 'White-Lines'?

Yes
No

Did the locator request an 'extension'?

Yes
No

Was the 'extension' agreed to?

Yes
No

If YES, what date was the extension made to?

Where was the location of the excavation site?

Private Property
Utility Easement
Road Right-Of-Way (ROW)

Does the location correlate with the dig ticket?

Yes
No

Type of Work

Pre-Excavation
Maintenance
Inspection/Survey
Leak Repair
Valve Repair
CP/Anode Work
Main Installation
Main Insertion
Main Repair
Service Installation
Service Insertion
Service Repair
Pavement Work
Restoration
Other:

Type of Material

Cast/Ductile Iron
Steel
Copper
Plastic
Other

Damage Media

Digging Equipment
Grading Equipment
Vacuum Equipment
Hand Equipment
Cutting Equipment
Plowing Equipment
Vertical Boring
Horizontal Boring
Marker/Sign Post
Settlement/Cave-In
Backfilling
Erosion
Stake/Form Pin
Probe Rod/Bar Hole
Other

Root Cause (Excavator at Fault)

No Locate Request/Notice
Insufficient Locate time
No ‘No Response’ Call
Poor Excavation Practices
No Pot-Hole/Hand Dig
Previous Damage
Failure to Support Facility
Unauthorized Tampering
Inadequate Shoring
Outside Locate Area
Failure to Maintain Marks
Expired Locate
Wrong Locate Info Provided
Digging Before Work-To-Begin Time
Failure to White-Line/Stake
Failure to Report Damage
Other

Excavator at Fault (Other)

Root Cause (Locator at Fault)

Failed to Mark
Incorrect Locate
Incomplete Locate
Miscommunication
Poor Signal/Tone
Cannot Locate Facility
Other

Locator at Fault (Other)

Root Cause (Facility Owner at Fault)

Abandoned Facility
Deteriorated Facility
Bad Installation
Depth Issues
Unavoidable
No Records
Other

Facility Owner at Fault (Other)

Was this a Natural Gas Hit?

Yes
No

If YES, was there a release of gas?

Yes
No

If YES, was 911 notified?

Yes
No

Time of 911 notification

Emergency crews onsite

Emergency crews left

HPU Head Dept. Called?

Yes
No

HPU Crew Member In-Charge *

Total # of HPU Onsite

Time of HPU notification?

HPU crews onsite

HPU crews departed

Was anyone injured?

Yes
No

Was there an ignition of gas?

Yes
No

Was there damage to other property?

Yes
No

If YES, please describe

Has a HPU Gas Hit Report been completed?

Yes
No

If YES, who filed hit report *

Date of Gas Hit Report

Has HPU Engineering reviewed the Gas Hit Report?

Yes
No

Was there an interruption of gas service?

Yes
No

Time of interruption

Time of restoral

Total number of customers affected

Was a crew notified of the damage?

Yes
No

Which department was notified?

Linecrew
Heat Dept.
Water Dept.

Who notified the crew *

Time of notification

Was there an interruption of service?

Yes
No

Time of interruption

Time of restoral

Total number of customers affected

HPU Eng. Dept. Called?

Yes
No

HPU Crew Member In-Charge *

Total # of HPU Onsite

Time of HPU Notification

HPU Crews onsite

HPU Crews departed

Was this damage from a HPU crew?

Yes
No

Which department caused the damage?

Linecrew
Heat Dept.
Water Dept.

Was a Damage Report done?

Yes
No

Was a Pre-Excavation done?

Yes
No

Comments

Upload any images of damage scene

Drag & Drop Files, Choose Files to Upload You can upload up to 8 files.

Name *

Signature

Clear Signature

Date

Need Assistance?

Please reach out if you have
any questions or issues with the form.

HAVE A QUESTION? WE HAVE AN ANSWER

In Need Of Assistance?

Garbage & Sewer

DIG SAFELY: Gopher One
Call 811 Before You Dig

Office Hours:
Monday – Friday
7:30 am. to 4:00 pm.

Programs
Careers
Newsroom
Problem Center
Commission
FAQ

Programs
Careers
Newsroom
Problem Center
Commission
FAQ

CONTACT US!

Garbage/Sewer Inquiries:
(218) 262-3486 Ext: 713

After Hours Emergency
(218) 262-7720

Billing Inquiries:
(218) 262-7734 or (218) 262-7730

Service Department:
(218) 262-7712

Customer Meter Reading:
(218) 262-7710

Email:

Accessibility | Privacy Policy

© All rights reserved Hibbing Public Utilities 2022 | Site by FindenMarketing.com