Alabama Underground Damage Prevention Authority Violation Complaint Response Form

If you have multiple filed complaints to respond to, please complete a separate response for each complaint docket number.

* indicates required field
Complaint Docket Number *
Date Response Filed Date Response Filed * / MM / DD YYYY
Respondent Information for Filed Complaint
Company Name for Person Filing Complaint Response *
Name of Contact Name of Contact * First Last
Address of Person Filing Complaint Response Address of Person Filing Complaint Response *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number of Person Filing Complaint Response Phone Number of Person Filing Complaint Response * - ### - ### ####
Email of person Filing Complaint Response *
Were you previously aware of this alleged violation? *

Were you previously aware of this alleged violation? Yes No
Provide details including whom you spoke with
Excavation/Locate Request Information

if applicable
Was a locate request made? *

Was a locate request made? Yes No
If so, Locate Request Number
Did excavation begin prior to the state date/time on the locate request? *

Did excavation begin prior to the state date/time on the locate request? Yes No Unknown
Was the minimum horizontal clearance (tolerance zone) of 18" maintained between the marked facility and the mechanical equipment? *

Was the minimum horizontal clearance (tolerance zone) of 18" maintained between the marked facility and the mechanical equipment? Yes No Unknown
If working in the tolerance zone, were the buried facilities exposed by hand or non invasive equipment used before excavating? *

If working in the tolerance zone, were the buried facilities exposed by hand or non invasive equipment used before excavating? Yes No Unknown
Was the underground facility marked? *

Was the underground facility marked? Yes No
Were the markings completed prior to the legal start time noted on the locate request? *

Were the markings completed prior to the legal start time noted on the locate request? Yes No
Was the excavation pre-marked with white paint noting the proposed area of excavation?

Was the excavation pre-marked with white paint noting the proposed area of excavation? Yes No Unknown
Were the facilities marked accurately within the required tolerance zone? *

Were the facilities marked accurately within the required tolerance zone? Yes No
Was reasonable care used to maintain the facility marks during the life of the project? *

Was reasonable care used to maintain the facility marks during the life of the project? Yes No Unknown
Alleged Violation Response Information
Do you dispute that an alleged violation of the Alabama Underground Damage Prevention statute occurred? *

Do you dispute that an alleged violation of the Alabama Underground Damage Prevention statute occurred? Yes No
If yes, what specifically do you dispute?
Do you believe the statutes listed by the complainant as being violated are correct? *

Do you believe the statutes listed by the complainant as being violated are correct? Yes No
Why or why not?
Damage Information Response
Did damage occur as a result of the alleged violation? *

Did damage occur as a result of the alleged violation? Yes No Unknown
Did the complainant correctly describe the damage that resulted from the alleged violation? *

Did the complainant correctly describe the damage that resulted from the alleged violation? Yes No
if no, provide detail.
If found at fault, describe your plans and procedures to ensure future compliance with the Alabama Underground Damage Prevention requirements. *
Upload any pictures or other relative documents

Attach Files
I verify that the information submitted to the above referenced docket number is correct to the best of my knowledge. *

I verify that the information submitted to the above referenced docket number is correct to the best of my knowledge. Yes

Alabama Underground Damage Prevention Authority Violation Complaint Response Form

Alabama Underground Damage Prevention Authority Violation Complaint Response Form

Respondent Information for Filed Complaint

Excavation/Locate Request Information

Alleged Violation Response Information

Damage Information Response