LANDSLIDE AND EROSION REPORT FORM
File No: 10670-60 /
FOREST DISTRICT
EVENT NO.
LICENSEE /AGENCY
DATE OF EVENT:
AREA / WATERSHED
FORM COMPLETED BY:
ROAD NAME & km:
AFFILIATION & PHONE #:
CP OR BLOCK No. (if applicable):
ROAD TYPE:
INITIATION ZONE COORDINATES (UTM ):
SNOW AVALANCHE
DESCRIBE EVENT:
KNOWN
ESTIMATED
DATE FORM COMPLETED:
FSR (RUP)
FSR (Wilderness)
OTHER
YEAR ROAD CONSTRUCTED (IF KNOWN):
OPENING No. (if applicable):
ZONE:
NORTHING
EVENT TYPE:
DEBRIS FLOW
REPORTED BY:
RP
AIR PHOTO NUMBER:
NSR
MAP SHEET:
EASTING
DEBRIS AVALANCHE
DEBRIS SLIDE
ROCK SLIDE
SLUMP
WASHOUT
OTHER
ATTACHED:
PHOTOS
MAP
SKETCH
MEASUREMENTS (initiation zone):
LENGTH (m):
WIDTH (m):
INITIATION ZONE:
IN BLOCK
BELOW BLOCK
DEPOSITION AREA:
ROAD
GULLY
CREEK
SUSPECTED CAUSE:
ROAD DRAINAGE
BLOCK
EST. AREA (m2):
DEPTH (m):
ROAD CUT
LAKE
EST. VOLUME TRANSPORTED (m3):
ROAD FILL
< 200 m BELOW ROAD
RIPARIAN
OPEN SLOPE
CUT SLOPE FAILURE
FILL SLOPE FAILURE
FAN
OTHER
OTHER
NATURAL
OTHER
COMMENTS:
IMPACTS/DAMAGE:
(Include area affected (ha), stream impact, property, utilities, estimated cost of repairs)
CONTACTS MADE (indicate name & phone # of contact person):
DISTRICT MoF:
LICENSEE:
REGIONAL MoF:
C/O’S:
WLAP:
MINES:
MoT
OTHER (specify):
IMMEDIATE ACTIONS TAKEN:
PROPOSED FURTHER ACTIONS:
FURTHER GEOTECHNICAL ASSESSMENT
LANDSLIDE AND EROSION CONTROL TEAM INVESTIGATION
SEED MIX APPLICATION
ROAD REPAIR PRESCRIPTION
DRAINAGE PLAN / STUDY
LANDSLIDE REHABILITATION PLAN
SLOPE STABILIZATION
OTHER:
IS THERE POTENTIAL FOR FURTHER DAMAGE? WHAT IS THE RISK TO THE DOWNSLOPE RESOURCES?
HAVE FOLLOW-UP ACTIONS BEEN COMPLETED?
IF YES SIGNATURE AND DATE REQUIRED:
REGIONAL USE:
STATUS:
FS1257 HEN 05/02
Yes
No
LERF Checked
SIGNATURE:
Geotechnical Investigation Completed
DATE:
Monitoring required
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LANDSLIDE AND EROSION REPORT FORM
SKETCH
Notes
Comments:_________________________________________________________________________
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FS1257 HEN 05/02
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