California Utility Emergency Association
                 Office of Emergency Services/Utilities Branch

                 UTILITIES OUTAGE and RESTORATION STATUS REPORT

1. Event Name: 	                      2. Event Date: 

3. OES Region:                        4. As Of: (date/time)

5. Utility Name:

6. Utility Type: (Gas/Electric/Telcom/Wireless/Water/Wastewater/Pipeline)

7. Utility Point of Contact Information:

a. Contact Name:                       b. Title:
	
c. Phone Number:                       d. Fax Number:
	
e. Cell Phone Number:                  f. Pager Number:
	
g. E-Mail Address:                     h. Alt Phone:
	
8. Alternate Utility Point of Contact Information:

a. Contact Name:                       b. Title:
	
c. Phone Number:                       d. Fax Number:
	
e. Cell Phone Number:                  f. Pager Number:
	
g. E-Mail Address:                     h. Alt Phone:
	

I. OVERALL SITUATION

OA (County)  | Utilitiy    |# Cust | % Sys |  Est.   |       Comments
             | Geo. Area   |out of |out of |date/time|
             | Description |service|service|of repair|
------------------------------------------------------------------------------
1.           |             |       |      %|         |		
             |             |       |       |         |
2.           |             |       |      %|         |		
             |             |       |       |         |              
3.           |             |       |      %|         | 		
             |             |       |       |         | 
4.           |             |       |      %|         | 
             |             |       |       |         | 
5.           |             |       |      %|         |		
             |             |       |       |         | 
6.           |             |       |      %|         |		
             |             |       |       |         |
7.           |             |       |      %|         |		
             |             |       |       |         |              
8.           |             |       |      %|         | 		
             |             |       |       |         | 
9.           |             |       |      %|         | 
             |             |       |       |         | 
10.          |             |       |      %|         |
             |             |       |       |         | 
Total        |             |     0 |       |         |		

Total out of service considered        Difference Between Current and
Normal for that time of year for       Normal                                0
Utility GEO. affected		     0 

II. Major Utility Infrastructure Damaged or At Risk Cause(s) if known:

    Type         Description

    (Select Correct Keyword From List At Bottom Of Form - Then Delete List)

III. Current Situation: (No Change/Worsening/Improving)

IV. Information Needed by Utilities

V. Information Needed from Utilities

State Mutual Aid Requested/Offered

Providing Agency    | Type of Aid         | Expected Duration
------------------------------------------------------------------------------
                    |                     | 
                    |                     |

Utility Mutual Aid Requested/Offered

Providing Utility   | Type of Aid         | Expected Duration
------------------------------------------------------------------------------
                    |                     |
                    |                     |

Type              | Description
------------------------------------------------------------------------------
Medical Help      | 
                  |
Site Access       |
                  |
Law               |
                  |
CHP               |
                  |
Fire              |
                  |
Cal Trans         |
                  |
Hazmat            |
                  |
Emergency Permits |
                  |
Other (identify)  |
                  |

Other Types of Utility Support Needed:

Type	          |  Description
------------------------------------------------------------------------------
Gas               |
                  |
Electric          |
                  |
Pipelines         |
                  |
Telecom-Wireline  |
                  |
Telecom-Wireless  |
                  |
Wastewater        | 
                  |
Water             |
                  |
Other (identify)  |
                  |

Report Prepared by:                    Company Name:
	
UOC/REOC Contact Number:               Normal Work Number:
	

                  KEYWORD LIST - DELETE AFTER MAKING SELECTION  

Electric - Generstion                  Telecom - Local Distribution
         - Interconnections                    - Interoffice Facilities
         - Transmission Lines                  - Local and Interexchange 
         - Distribution Subststion/              Carrier
           Feeder                      
         - Underground Systems         Wireless - Switch
                                                - Cell Sites
Gas - Wells
    - Storage                          Water - Treatment Plants
    - High Pressure Transmission             - Storage Resevoirs
      Lines                                  - Distribution Pipelines
    - Distribution                           - Pump Stations
    - Regular Station                        - Wells
    - Compressor Stations
                                       Wastewater - Collection System
Pipeline - Gathering Line                           Trunklines
         - Input Station                          - Collection System
         - Booster Pump Station                     Pump Station
         - Terminal Station                       - Treatment Plants
         - Storage Capacity                       - Outfalls
         - Loading Facility