Alabama Underground Damage Prevention Authority Violation Complaint Form

Date Date / MM / DD YYYY
* indicates required field
Complaint is for INFORMATION ONLY - Not subject to enforcement provisions *

Complaint is for INFORMATION ONLY - Not subject to enforcement provisions Yes No
Information on Person Filing Complaint
Company Name for Person Filing Complaint *
Name of Person Filing Complaint Name of Person Filing Complaint * First Last
Address of Person Filing Complaint Address of Person Filing Complaint *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number of Person Filing Complaint Phone Number of Person Filing Complaint * - ### - ### ####
Email of person Filing Complaint *
Affiliation for Person Filing Complaint
Alleged Violator Information
Alleged Violator Company Name *

If business name is not known, enter "Unknown"
Name of Alleged Violator if known Name of Alleged Violator if known First Last
Supervisor on job (if known) Supervisor on job (if known) First Last
Address of Alleged Violator Address of Alleged Violator *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number of Alleged Violator Phone Number of Alleged Violator * - ### - ### ####
Email of Alleged Violator
Was the alleged violator performing subcontracted services at the time the damage occurred?

Was the alleged violator performing subcontracted services at the time the damage occurred? Yes No Unknown
Utility/Operator Information
Name of Utility/Operator damaged or involved in alleged violation *
Damaged Utility/Operator Contact Person
When did you or your organization become aware of the damage/alleged violation? When did you or your organization become aware of the damage/alleged violation? * / MM / DD YYYY
* : HH MM AM/PM
Damage/Alleged Violation Information
When did the damage or alleged violation occur? When did the damage or alleged violation occur? * / MM / DD YYYY
* : HH MM AM/PM
Type of Alleged Violation/Root Cause *

Type of Alleged Violation/Root Cause 37-15-4:Excavation/Demolition without a valid locate request 37-15-4:Excavation/Demolition before locate request was valid 37-15-4:Excavation/Demolition beyond the 20 day expiration without an updated locate request 37-15-4:Excavation/Demolition outside the requested locate area 37-15-8:Use of mechanized equipment within the marked tolerance zone 37-15-8:Failure to use reasonable care within the tolerance/safety zone 37-15-7:Reporting a false emergency for a locate request 37-15-6:Facility was not located or marked 37-15-6:Did not locate within the required amount of time 37-15-5:Failure to join the 811 Center and utilize the services of the 811 Notification System 37-15-9:Not reporting damage to the underground facility owner 37-15-9:No notification of 911/emergency responders when required Other (describe below) Other (describe below)
If Other is selected, please provide a description of the alleged violation.
If known, please provide the section of the Alabama Underground Damage Prevention Law that was violated (Alabama Code Title 37: Public Utilities and Public Transportation § 37-15)
Alabama 811 Locate Request number (if known)
Did damage occur as a result of the violation? *

Did damage occur as a result of the violation? Yes No Unknown
Type of Facility Operation Damaged

Type of Facility Operation Damaged Gas Cable TV Electric Pipeline Sewer Telecom Water Other

Check all that apply
Type of Facility Damaged

Type of Facility Damaged Distribution Service line/Drop Transmission Other Unknown

Check all that apply
What is the address or location of the alleged violation? What is the address or location of the alleged violation? *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Provide any additional information relative to the damage or alleged violation
Upload any pictures or other relative documents

Attach Files

Alabama Underground Damage Prevention Authority Violation Complaint Form

Alabama Underground Damage Prevention Authority Violation Complaint Form

Information on Person Filing Complaint

Alleged Violator Information

Utility/Operator Information

Damage/Alleged Violation Information