Excavator Alleged Noncompliance Report

Excavator Name *

First Name

Last Name

Excavator Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Excavator Phone

(###)

###

####

Excavation Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Equipment Used (check all that apply)

Auger

Backhoe

Hand Tool

Directional Bore

Trencher

Other

Noncompliance Information (Check all that apply) *

No Ticket

Failure to white line when dig site cannot be described per s.556.105(1)(a)

Failure to begin work within the 30-day ticket life

Excavation outside of ticket scope

Ticket renewed but no work done

Digging before legal

Expired Ticket

False emergency ticket

Failure to follow low-impact marking practices

Failure to provide date and time of excavation to member after receiving positive response code 2C

Failure to use extra caution while digging in the tolerance zone

Was there damage to underground facilities? *

Note: If this report of alleged noncompliance is due to a damage, please report to Florida DIRT.

No

Yes - reported to Florida DIRT

Yes - NOT reported to Florida DIRT

Is this issue resolved?

Yes

No

Date Noncompliant Event Was Discovered (Events older than 30 calendar days will not be processed.) *

MM

DD

YYYY

Name of Submitter *

First Name

Last Name

Submitter's Phone

(###)

###

####

Submitter's Cell

(###)

###

####

Submitter's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country