RHODE ISLAND DIVISION OF PUBLIC UTILITIES AND CARRIERS
     REPORT OF DIG-SAFE PROBABLE VIOLATIONS AND/OR DAMAGE TO UNDERGROUND
                               FACILITIES


REPORT DATE________________VIOLATION/INCIDENT DATE___________________________________
REPORTING COMPANY____________________________________________________________________
MAILING ADDRESS______________________________________________________________________
PHONE__________________PERSON REPORTING______________________________________________
OPERATOR OF UNDERGROUND FACILITY_____________________________________________________

LOCATION OF VIOLATION/DAMAGE
STREET______________________________CITY/TOWN________________________________________
PUBLIC WAY_____PRIVATE PROPERTY______RIGHT OF WAY______EASEMENT______

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FACILITY DAMAGED (Include type, size material, pressure/voltage)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
ESTIMATE OF DAMAGE___________________________________________________________________
INJURY OCCURRED  (   ) YES    (   ) NO  IF SO, DESCRIBE______________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
DESCRIPTION OF ACTIVITY CAUSING DAMAGE, CITING ANY LACK OF PRECAUTION
_____________________________________________________________________________________
_____________________________________________________________________________________
CONTRACTOR__________________________WORKING FOR______________________________________
ADDRESS_________________________________________________PHONE________________________
TYPE OF EQUIPMENT____________________________________________________________________
DEPARTMENT OF LABOR LICENSE NO.______________________________________________________
DIG-SAFE NO.____________________________
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                    ALLEGED VIOLATIONS(S) OF DIG-SAFE (PLEASE CHECK)

1. ___ 	39-1.2-5 Notice of excavation location was not given to the operator(s) of 
        underground facilities or Dig Safe System, Inc.  At least forty-eight (48)
        hours (exclusive of Saturday, Sunday and holidays) but not more than thirty
        (30) calendar days before the proposed excavation.

2. ___	39-1.2-5 If blasting was employed, the initial notification or subsequent
        notification did not indicate the date and specific location of the blasting.

3. ___ 	39-1.2-7 The underground facility was not marked or was inadequately marked
        by the Operator of the facility.

4. ___ 	39-1.2-10 Excavation was not performed with precaution to prevent weakening
        of support to pipes, mains, wires or conduits or damage to the protective
        coating thereof and/or severance of any such pipe, main, wire or conduit.
        Attach support of allegations.

5. ___	39-1.2-11 Damage occurred to underground facility and operator thereof was
        not contacted by excavator.

6. ___	39-1.2-12 The marking of the underground facilities was lost or not maintained
        and remarking was not requested at least twenty-four (24) hours before the
        excavation began or continued.

(NAME & TITLE)______________________________________________________________________
DATE_____________________________________

SEND TO: Division of Public Utilities, Gas Engineering Section, 89 Jefferson Blvd. Warwick, RI 02888

* MAY BE SUBMITTED BY UTILITY COMPANIES AND PERSONS AS DEFINED IN 39-1.2-1(a)