Emergency Verification Form

If you would prefer to fill out your forms manually, you can download and print the blank form here:

Emergency Verification Messages

Automated emergency messages will be delivered by text message or an automated telephone call and can be sent to a maximum of two (2) phone numbers. We will follow up on all emergencies due for work being done within two (2) business hours with an additional automated message (in addition to the actual copy of the ticket) using one of the following methods below:

Text Message (Short Message Service or SMS)

A text message will be sent to the designated number(s) immediately after the request is completed. The text message will include the ticket number, type of ticket, start date and time, contact name and contact phone number, address/nearest intersecting street and city. If no address is provided, a line reading “CALL FOR LOCATION INFO” replaces the address/nearest interacting street and or city. For those using Smartphones, the text message can include a link that will direct the receiver to the complete ticket and map in the phone browser.

Sample text message:

FRM:
SUBJ: TKT 8551111
MSG: EMERGENCY
5/04/07 10:00AM
JOE PUBLIC @ 3167777777
123 MAIN ST
at 1ST ST
WICHITA

Sample smartphone message:

FRM:
SUB: TKT 12345678
MSG: TEST12
Seq No: 1
http://ks.itic.occinc.com/ABCD-123-EF4-5G 6

Automated Call

An automated call will be made to the primary or alternate contact number provided. These numbers must be to a phone number that is answered promptly by an individual who is familiar with the process. Members can choose to use a PIN or not use a PIN for access to the locate information (but use of a PIN must be requested on the attached form). Once a call is answered, the individual will be prompted to press 1 or enter the PIN (if one is assigned). The ticket information will be available once the individual enters the correct response. After collecting the appropriate information, the individual is prompted to confirm receipt of the message so that no further attempts are made for the current ticket. If no contact is made at the primary number, an automated call to the alternate contact number will occur after 5 minutes. After several failed automated call attempts, a live operator will intervene to complete the call process.

Sample automated call:

"Please enter your Kansas 811 pin number." or “Please press 1 to continue.”
User enters correct pin number or presses 1
"Ticket 8551111."
"Press 9 at any time to accept this ticket. Otherwise press 1 to repeat the ticket number, 2 for start time, 3 for contact information, 4 for location of work, 5 for marking instructions, 6 for ticket comments or press 8 for all ticket information.”
User enters 9: "Accepted"
"If you have any questions, please contact Kansas 811 at 800-344-7233. Thank you. "

Regarding receipt of automated emergency verification messages; I acknowledge, understand and agree to the following:

Kansas 811 (KS811) will follow up on all emergencies due for work being done within two (2) business hours with an additional automated message (in addition to the actual copy of the ticket).
Delays and disruptions over third party telecommunications networks, servers or the Internet, all of which are used in providing backup messages, are completely beyond the control of Kansas 811 (KS811) and One Call Concepts, Inc. (OCC). KS811 and OCC do not guarantee the availability or reliability of such networks.
KS811 and OCC shall not be responsible or liable for any loss, damage or expenses incurred directly or indirectly as a result of any difficulties experienced by a third party service provider.
I am the owner or legitimate user, or I have the consent of the owner or the legitimate user, of the phone/cellular phone I am registering for the backup message service. I am responsible for ensuring the method selected is capable of receiving backup messages during the time specified.

Daytime

Select ONE of the following for receipt of your "Daytime" emergency verification messages:

Text message with minimal ticket information onlySmartphone message with link to ticket and mapAutomated Phone Call

Primary Contact *

Primary Phone *

Cell Phone Carrier *Sprint, AT&T, etc

Select a 4-6 digit numeric pin #

Secondary Contact *

Secondary Phone *

Cell Phone Carrier *Sprint, AT&T, etc

Select a 4-6 digit numeric pin #

After Hours

Select ONE of the following for receipt of your "After Hours" emergency verification messages:

Text message with minimal ticket information onlySmartphone message with link to ticket and mapAutomated Phone Call

Primary Contact *

Primary Phone *

Cell Phone Carrier *Sprint, AT&T, etc

Select a 4-6 digit numeric pin #

Secondary Contact *

Secondary Phone *

Cell Phone Carrier *Sprint, AT&T, etc

Select a 4-6 digit numeric pin #

READ, ACKNOWLEDGED AND ACCEPTED:

Company *

Terminal Code(s) *

Name *

Title *

Phone *

Email *

Signature *

Date *

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