California Public Utilities Commission
California Major Telephone Service Interruption Reporting Template
General Order 133-C
Date Filed: ______________________ Media Attention State of Emergency Declaration
Company: ________________________________________ U#: _____________ OCN: __________________
Date and Time Service Interruption (Start date and time): _______________________ (pst)
Service Restoration (Estimated date and time): _______________________ (pst)
Service Restoration (Actual date and time): _______________________ (pst)
Duration: ______________________ (minutes)
Explanation of Outage Duration: ________________________________________________________________
Area(s) Affected by the Outage
Count(ies): ______________________ Cit(ies): ___________________
Location(s) of the Facility affected by the Outage
Count(ies): ______________________ Cit(ies): ___________________
Service(s) Affected *
E911 circuit Wireline Other(s), please specify: _______________________
Service(s) Affected for Wireline Users
No Dial Tone Toll Isolation Loss of 911 Other(s), please specify: _____________________
Number of Potentially Affected
Total Number of Assigned Wireline Phone Numbers: ______________ (enter "0" if none affected)
Total Number of Blocked Calls: ________________
Description of Incident: _________________________________________________________________________
_____________________________________________________________________________________________
Description of Cause(s) of the Outage
Cable damage Diversity Failure Hardware Failure Power Failure
Insufficient Data Simplex Conditioning Traffic System/ Overload Other/Unknown
Design (select one) Environmental (select one) Procedural (select one)
Firmware External Other Vendor
Hardware Internal Service Provider
Software System Vendor
Name and Type of Equipment that Failed: _________________________________________________________
Method(s) used to restore service: _______________________________________________________________
Steps taken to restore service: __________________________________________________________________
Steps taken to prevent reoccurrence: _____________________________________________________________
Remarks/Comments: ___________________________________________________________________________
Primary Utility Contact Information
Name: ________________________________ Phone: ____________________ E-mail: ______________________
