Fields Marked With * Are Required

DATE	*
EXCHANGE OR PHONE NUMBER	*
LOCATION	*
STAKE FOR CONSTRUCTION		YES NO
REPORTED BY	*
SUBSCRIBER NAME
POLE or PEDESTAL #	*
CABLE TYPE	*	BURIED AERIAL
TERMINAL / PED SIZE
APPROXIMATE FOOTAGE
CABLE SIZE	*	CABLE COUNT
NUMBER OF PAIRS IN TROUBLE
NUMBER OF VACANT PAIRS
IN PAIR		OUT PAIR
PROBLEM	*
EQUIPMENT NEEDED	*	BACKHOE PLOW BUCKET TRUCK SKID STEER CONSTRUCTION CREW
DATE DISPATCHED
REPAIRED BY		DATE REPAIRED
NOTES
EMAIL (Send Yourself A Copy)		None Anthony Ferrell Bryan Jenkins Carter Bolin Jason Sargent Jim Phelps Keith Stamper Kevin Brickey Ollie Riggsby Perry Lacy Randy Cantrell Reggie Easterling Roy Burton Steven Gullett Tim Evans