J-0200000-06 DigSafe Request.pdf

PWD-ME DIG SAFE UTILITY LOCATE REQUEST FORM

A Utility Locate Form shall be submitted to PWD-ME DSC at least fourteen (14) calendar days prior to excavation, ground penetrating or concrete slab cutting, coring or drilling activity either inside or outside of a building which will penetrate more than 3". A Utility Locate Form is required for ANY excavation, ground penetrating or concrete slab cutting, coring or drilling on the Shipyard by Shipyard Employees, Contractors or other personnel unless the excavation is an emergency.

Part I – To be completed by Contractor or Shipyard Personnel performing the Excavation

Today’s Date: ______/______/______ DIGSAFE Ticket #: (1-888-344-7233) ___________________________________

Requested by: ______________________________ Phone #: ____________________________________________

Code # / Company: __________________________ E-mail: ______________________________________________

Contract #: ________________________ Project Title:____________________________________________________

Shipyard Project Manager ______________________________________ Phone # ___________________________

Excavation Location: __________________________________ Area Pre-Marked: YES_____ NO_____

Type of work: ______________________________________________________________________________

Depth: (ft) _______ Anticipated Excavation Date: _____/_____/______ Time: (military) __________________

Attach a map or the contract drawings of the excavation area.

PWD-ME Contractors: Complete Part 1 and Submit Form to PWD-ME CM or ET Shipyard Personnel: Complete Parts 1 & 2 and Submit Form to PWD-ME DSC Other Contractors: Complete Part 1 and Submit Form to Project Manager

Part 2 – To be completed by PROJECT MANAGER (If Shipyard work, Part 2 must be completed by Applicant)

Date: _____/_____/______ Name: _____________________________________ Phone # ______________________

Locate Priority: Routine(> 14 days) ______; Urgent(< 14 days) _______; Emergency(<2 days)____________ (PM&E Approval Req.)

Part 1 Reviewed and Complete: YES_____ NO_______ Initial:____________________

Submit Completed Form to PWD-ME DSC

Part 3 – To be completed by Utility Locating Company

Approved by: Initials _________________

Date Utilities marked in the field: _____/_____/______ Name:____________________________________________

Comments: ___________________________________________________________________________________________

Yard Plate Discrepancies Noted: YES ______ NO _______ CADD Dept. Updated: YES ______ NO _______

Comments: ___________________________________________________________________________________________

Submit to PWD-ME DSC

Part 4 – To be completed by PWD-ME DSC

Date ____/______/______ Logged Into Database: YES ______ NO _______ # ________________________

Yard Plate Discrepancies: YES ______ NO _______ CADD Dept. Notified: YES ______ NO _______

Comments:____________________________________________________________________________

PWD-ME DSC to return to Project Manager or Shipyard Personnel

Revision Date 2/2019

DigSafe Request