Reporting Complaint Form

Alleged Violations of Wyoming State Statute 37-2-301 through 37-12-307

Date Date / MM / DD YYYY
1. Name 1. Name First Last
Phone Phone - ### - ### ####
Email
2. Business Name and Address
(N/A if not aplicable)
3a. Which stakeholder group do you represent while reporting this alleged violation of Wyoming State Law?
Are you the...

3a. Which stakeholder group do you represent while reporting this alleged violation of Wyoming State Law?
Are you the... Excavator Underground Facility Owner/Operator Utility Locator Homeowner
3b. Which stakeholder group is the alleged reporting violation against (Who is the complaint about)?
Is it the…

3b. Which stakeholder group is the alleged reporting violation against (Who is the complaint about)?
Is it the… Excavator Underground Facility Owner/Operator Utility Locator Homeowner
3c. Enter Name, phone number and any other contact information of the alleged violator.
4. If you are the reporting underground utility owner/operator, please select the utility you represent.

4. If you are the reporting underground utility owner/operator, please select the utility you represent. Gas Electrical Water Sewer Communications N/A
5. Please describe, in detail, the alleged violation(s) of Wyoming State Law you are reporting today.
6. Did the excavator request an emergency locate ticket, when an emergency request was unnecessary?

6. Did the excavator request an emergency locate ticket, when an emergency request was unnecessary? Yes No N/A
7. Please provide any locate ticket numbers associated with the alleged violation of Wyoming State Law that you are reporting. (If none or unknown, please indicate)

7. Please provide any locate ticket numbers associated with the alleged violation of Wyoming State Law that you are reporting. (If none or unknown, please indicate) None Unknown Ticket Number(s) Ticket Number(s)
8. Did damage occur to an underground utility?

8. Did damage occur to an underground utility? Yes No N/A
9. If you answered yes to question 8, please enter the date the damage occurred.
(Please indicate N/A if not applicable)
10. If you answered yes to question 8, please provide the address where the underground utility damage occurred. (Please indicate N/A if not applicable)
11. If the damage was to an underground utility that released hazardous gas and or materials, was a call placed to 911 for emergency responders?

11. If the damage was to an underground utility that released hazardous gas and or materials, was a call placed to 911 for emergency responders? Yes No N/A
12. If damage occurred to an underground utility, did the excavator immediately notify the underground utility owner/operator?

12. If damage occurred to an underground utility, did the excavator immediately notify the underground utility owner/operator? Yes No N/A
13. If damage occurred to an underground utility, did the excavator immediately notify the Facility Notification Center, creating a damage ticket?

13. If damage occurred to an underground utility, did the excavator immediately notify the Facility Notification Center, creating a damage ticket? Yes No N/A
14. Did the excavator place the locate request for the intended excavation activity at least 2 (two) full business days, but not more than 14 (fourteen) business days prior to excavation?

14. Did the excavator place the locate request for the intended excavation activity at least 2 (two) full business days, but not more than 14 (fourteen) business days prior to excavation? Yes No N/A
15. Did the excavator provide a specific location for their intended exavation?

15. Did the excavator provide a specific location for their intended exavation? Yes No N/A
16. Did the excavator provide a description for their intended excavation?

16. Did the excavator provide a description for their intended excavation? Yes No N/A
17. Did the excavator mark out (white line, physically or digitally) their area or path for the intended excavation prior to the underground utility's arrival?

17. Did the excavator mark out (white line, physically or digitally) their area or path for the intended excavation prior to the underground utility's arrival? Yes No N/A
18. Was hand digging or soft digging methods used to expose the underground utilities?

18. Was hand digging or soft digging methods used to expose the underground utilities? Yes No N/A
19. Did the excavator cooperate with the underground utility owner/operator to mitigate the damage?
(1-star rating being the least cooperative while a 3-star rating being the most cooperative)

19. Did the excavator cooperate with the underground utility owner/operator to mitigate the damage?
(1-star rating being the least cooperative while a 3-star rating being the most cooperative)
1 2 3
20 Did the excavator conceal or attempt to conceal the underground utility damage?

20 Did the excavator conceal or attempt to conceal the underground utility damage? Yes No N/A
21. Did the excavator repair or attempt to repair the damage without the underground utility owner/operators permission?

21. Did the excavator repair or attempt to repair the damage without the underground utility owner/operators permission? Yes No N/A
22. Was the underground utility listed on the locate ticket request?

22. Was the underground utility listed on the locate ticket request? Yes No N/A
23. To your knowledge, has the underground utility registered and filed their underground utility with the Facility Notification Center? (One-Call of Wyoming, Inc)

23. To your knowledge, has the underground utility registered and filed their underground utility with the Facility Notification Center? (One-Call of Wyoming, Inc) Yes No N/A
24. Did the underground utility owner/operator respond to the locate request within 2 (two) full business days?

24. Did the underground utility owner/operator respond to the locate request within 2 (two) full business days? Yes No N/A
25. If the underground utility owner/operator did not mark the utility within 2 (two) full business days, was another time mutually agreed upon?

25. If the underground utility owner/operator did not mark the utility within 2 (two) full business days, was another time mutually agreed upon? Yes No N/A
26. Please describe the mutually agreed upon time and reasoning that deviated from the 2 (two) full business days for marking the utility. (Please indicate N/A if not applicable)
27. Did the underground utility owner/operator mark their underground utility in the areas defined by the excavator for the proposed excavation on the locate ticket?

27. Did the underground utility owner/operator mark their underground utility in the areas defined by the excavator for the proposed excavation on the locate ticket? Yes No N/A
28. If you answered NO to question 27, please describe where the underground utility owner/operator was supposed to mark as opposed to where they actually marked. (Please indicate N/A if not applicable)
29. Did the underground utility owner/operator mark the location using...
(please select at most 3 options)

29. Did the underground utility owner/operator mark the location using...
(please select at most 3 options) Paint Flags Stakes Whiskers Other clearly identifiable markings N/A
30. If you have any documentation such as; photographs, emails, locate tickets and the like, please upload as attachments here.

Attach Files
For the status of this complaint please contact the
Wyoming Public Service Commission at 307-777-7427.

Reporting Complaint Form

Reporting Complaint Form

For the status of this complaint please contact the Wyoming Public Service Commission at 307-777-7427.

For the status of this complaint please contact the
Wyoming Public Service Commission at 307-777-7427.