CGA DIRT Field Submission Form

Field submission form for Common Ground Alliance DIRT damage reporting, capturing excavator details, incident context, root cause, facility type, and corrective actions for industry submission.

Submission Notice

• Submission purpose
  This form captures excavation damage details for CGA DIRT reporting and damage prevention analysis.
• I confirm the information provided is accurate to the best of my knowledge
• PII notice
  Collect only minimum necessary information. Avoid entering sensitive personal data unless required for the report.

Incident Summary

• Date of damage event
• Time of damage event
• Incident location
  Enter the worksite or nearest address where the damage occurred.
• State or province
• Incident type

Excavator Information

• Excavator company or organization
• Excavator type
• Type of work being performed
• Excavator contact name
  Optional contact for follow-up. Do not enter unnecessary personal data.

Facility and Damage Details

• Facility type
• Facility owner/operator
• Damage description
  Describe what was damaged, how it was damaged, and any immediate impacts.
• Damage severity
• Was emergency response required?

Root Cause and Contributing Factors

• Root cause
• If other, describe the root cause
• Contributing factors
• If other, describe contributing factors

Corrective Actions and Follow-Up

• Immediate actions taken
  Include notifications, site controls, repairs, and any safety measures taken after the event.
• Recommended preventive actions
• Is follow-up required?
• Follow-up notes