Gufpa Form-1 - Instructions For Protection Act Complaint Form printable pdf download

Gufpa Form-1 - Instructions For Protection Act Complaint Form

(For Official Use Only) Report No.______Case No._________Date___________

INSTRUCTIONS

For Completing The Georgia Utility Facility

Protection Act Complaint Form

General Instructions: Any person desiring to file a complaint under the Georgia

Utility Facility Protection Act (GUFPA), O.C.G.A.§ 25-9, should complete and

submit this form with all available information. Please use a separate form for

each alleged violator. Please return all pages except the Instruction Sheets.

(Please note that the Complaint Form should be sent c/o Utilities Protection

Center, Inc. (UPC) for administrative purposes only. UPC is not responsible for

any enforcement actions under the GUFPA Advisory Committee.)

Definitions:

Person means any individual, firm, joint venture, partnership, association,

municipality, state, or other governmental unit, authority, department, agency, or

a corporation and shall include any trustee, receiver, assignee, employee, agent

or personal representative thereof.

Complainant means any person desiring to formally lodge a complaint against

another person.

Alleged Violator means any person accused of any “probable violation” of the

GUFPA.

Probable Violation means any accusation or assertion (yet to be proved), that a

person has violated the GUFPA.

Excavator means any person engaged in excavating or blasting in the State of

Georgia.

Facility Owner/Operator means any person or entity that owns, operates or

controls the operation of a utility facility for the purpose of commercial enterprise

in the State of Georgia.

Section I: Complete all available information including name, address and other

contacts for the Complainant and Alleged Violator. Include the name of the

Facility Owner/Operator and their Locate Contractor if applicable.

Section II: Complete all information relating to date, time, location, etc. of any

probable violation.

Section III: Check all probable violations that apply. If “Other” is selected,

provide a detailed explanation in Section V.

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GUFPA Form-1, Revised 08/20/00

Gufpa Form-1 - Instructions For Protection Act Complaint Form