FLORIDA PSC

ELECTRIC ACCIDENT REPORT

Narrative of Incident:
Location of Incident:
Description of Injury:
Date:	Time:	County:
Facilities Involved
Voltage:	Constructed After 7/1/1986? (Y/N):
Overhead: (Y/N)	Underground: (Y/N)
Parallel To:	Parallel To:
Crossing Over:	Crossing Under:
Vertical Clearance: ft. in.	Pad Mounted Equipment:
Horizontal Clearance: ft. in.	Burial Depth: in.
Was Line Marked (Y/N):

If Yes, Interval of Markings: ft.
Was Company Given Advance Notification Of Work? (Y/N):
Electric Utility:	Reported By:
Date Reported:	Time Reported:
Number Of Fatalities:	Number Of Injuries:

Description of Electric Accident Report Fields

Constructed After 7/1/1986?: Was the power line/equipment involved in the accident constructed after July 1, 1986?

Overhead: Did the accident involve an above ground power line(Y/N).

Underground: Did the accident involve an underground power line(Y/N).

Parallel To: Does the power line in question (in the vicinity of the accident) run parallel to a street, highway or other suitable landmark. If yes, enter the name of the street, highway or landmark. Example, Highway 301, rear lot line, drainage canal, Wachovia Bank Building, etc.

Crossing Over: Does the overhead power line in question (in the vicinity of the accident) cross over a street, highway or other suitable landmark. If yes, enter the name of the street, highway or landmark. Example, billboard sign, rooftop, balcony, lake, etc.

Crossing Under: Does the underground power line in question (in the vicinity of the accident) cross under a street, highway or other suitable landmark. If yes, enter the name of the street, highway or landmark. Example, driveway, Highway 301, fence, etc.

Vertical Clearance: Depending on the circumstances of the accident, the vertical clearance of the power line from a roadway, rooftop, scaffold, platform, etc.

Pad Mounted Equipment: Did the accident involve a pad mounted transformer, switchgear or other pad mounted device. If so, identify the device.

Horizontal Clearance: Similar to Vertical Clearance but for lateral measurements.

Burial Depth: If power line is underground, depth to which it is buried.

Was Line Marked: Was the location of the underground power line marked or identified by flags, stakes, painted hash marks, etc.

If Yes, Interval of Markings: What was the interval of the markings. Example, every 3 feet, every 7 feet, etc.

Was Company Given Advance Notification Of Work? (Y/N): If the accident involved non-utility workers working in close proximity to the power line, was the utility given advance notification of the work to be performed?

ELECTRIC ACCIDENT REPORT

AVELAZQU

2006-02-02

Tony Velazquez

Florida Public Service Commission