Appendix C Sample Forms, Reports, and Releases

During the Common Ground Study, the Reporting and Evaluation Task Team drafted a sample report form (originally referred to as figure 9-1) to demonstrate what may be reported when collecting damage prevention information. The team created this sample form (illustrated on the following page) using the best practices from one call center, regulatory agency, facility, locator, excavator, and industry group report forms. The form was created to enable data collection from all stakeholders involved in the damage prevention process, including facility owners/operators, excavators, and locators.

Appendix C Sample Form

The 9-1 form was the basis for the development of the CGA’s Damage Information Reporting Tool (DIRT) launched in December 2003. The Data Reporting & Evaluation Committee approved minor modifications to the original 9-1 form when creating DIRT. These modifications were later approved by the CGA Best Practices Committee. The approved DIRT form has been included in Appendix C. To review the electronic version and tool, visit 


The following references were used as examples during the Task Team’s discussions and the development of the composite 9-1 reporting form. These sources do not include all stakeholders that may report any of the same information shown on the sample form.

  • Connecticut Department of Public Utility Control/Call Before You Dig, Inc.
  • Consolidated Edison Company of New York, Inc.
  • Florida Sunshine State One Call
  • Massachusetts Department of Telecommunications and Energy
  • National Transportation Safety Board Safety Study: Protecting Public Safety Through Excavation Damage Prevention (NTSB/SS-97-01)
  • New Hampshire Public Utilities Commission
  • Tennessee One Call System, Inc.
  • Tierdael Construction Company—General Contractors
  • Virginia State Corporation Commission


One Call Center One Call Center

Facility Owner Facility Owner

Excavator Excavator

Locator Locator

Project Owner Project Owner

Designer Designer