EXCAVATION FORM

EXCAVATION FORM
DATE AND TECH
Date *

Month Day Year
Technician *
Assistants

CUSTOMER INFO
Customer Name *
Street Address *
City *
State: *
Zip Code

TIME FRAME
Time In: *
AM or PM *

AM PM
Time Out: *
AM or PM *

AM PM
Regular or After Hours *

Regular Hours After Hours (M-F 5:30pm - 6am, weekends, or holidays)

LOCATION & PHOTOS FOR EXCAVATION
Location of Excavation *
Ex. Left side of building
Before Photos of Job *

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Excavation Technical Information
What is the depth? *
What is the size of the pipe? *
What type of pipe are we repairing / replacing? *
What type of pipe are we replacing it with? *
How many technicians are needed for the job? *
Which trucks are needed? *
Ex: Dump Truck, Jetter, Pumper
List equipment and/or tools needed: *
Ex. Kubota, Shoring,Compressor, Jack Hammer etc

PARTS INFORMATION
PARTS NEEDED: *
List parts or upload a written list below. If none, state "none".
Parts - Written List

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CHECKLIST INFORMATION
Did you perform a camera inspection? *

Yes No
Did you mark the area of the repair / replacement? *

Yes No
Are there utilities in the area *

Yes No
If yes - note here:
Is there enough room for a machine to be utilized? *

Yes No

REMOVALS AND REPLACEMENT INFO
Do we need to remove concrete pads *

Yes No
If yes, how many pads and size?
Is there an asphalt removal? *

Yes No
If yes, what is the size of the area?
Do we need to remove tile? *

Yes No

Additional Services
Will we need to contract Commercial Coring for this job? *

Yes No
Is the excavation inside or outside? *

Inside Outside
If it is inside, what is the distance to the closest outside exit?
Is there a water source nearby - if so where/distance?
Are Roadway-Plates needed? *

Yes No
If yes, how many Roadway-Plates?
What are the size of the plates?
Is there a lot of street parking? *

Yes No

Work Order Contract *

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Individual Customer Form

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Ex. American Water, Maintenx, Bed Bath Beyond Cancel of
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