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pdfNOTICE: This report is required by 49 CFR Part 195. Failure to report can result in a civil penalty not to exceed
$100,000 for each violation for each day that such violation persists except that the maximum civil penalty shall not
exceed $1,000,000 as provided in 49 USC 60122.
OMB NO: 2137-0047
EXPIRATION DATE: 7/31/2015
Report Date
ACCIDENT REPORT – HAZARDOUS LIQUID
PIPELINE SYSTEMS
U.S. Department of Transportation
Pipeline and Hazardous Materials
Safety Administration
No.
(DOT Use Only)
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure
to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information
displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2137-0047. Public reporting for this
collection of information is estimated to be approximately 10 hours per response, including the time for reviewing instructions, gathering the
data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:
Information Collection Clearance Officer, PHMSA, Office of Pipeline Safety (PHP-30) 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
INSTRUCTIONS
Important:
Please read the separate instructions for completing this form before you begin. They clarify the
information requested and provide specific examples. If you do not have a copy of the instructions, you can obtain
one from the PHMSA Pipeline Safety Community Web Page at http://www.phmsa.dot.gov/pipeline/library/forms.
PART A – KEY REPORT INFORMATION
Report Type: (select all that apply) Original Supplemental Final
1. Operator’s OPS-issued Operator Identification Number (OPID):
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2. Name of Operator: ______________________________________________________________________________________
3. Address of Operator:
3.a _______________________________________________________________________
(Street Address)
3.b ___________________________________________________
(City)
3.c State: /
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3.d Zip Code: /
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4. Local time (24-hr clock) and date of the Accident:
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Hour
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Month
5. Location of Accident:
Latitude:
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Longitude: - / / / / . /
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6. National Response Center Report Number (if applicable):
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Year
7. Local time (24-hr clock) and date of initial telephonic report to the
National Response Center (if applicable):
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7a. Local time (24-hr clock) and date of confirmed discovery
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Hour
Month
Day
Year
8. Commodity released: (select only one, based on predominant volume released)
Crude Oil
Refined and/or Petroleum Product (non-HVL) which is a Liquid at Ambient Conditions
Gasoline (non-Ethanol)
Diesel, Fuel Oil, Kerosene, Jet Fuel
Mixture of Refined Products (transmix or other mixture)
Other Name: __________________________________
HVL or Other Flammable or Toxic Fluid which is a Gas at Ambient Conditions
Anhydrous Ammonia
LPG (Liquefied Petroleum Gas) / NGL (Natural Gas Liquid)
Other HVL Name: _______________________________
CO 2 (Carbon Dioxide)
Biofuel / Alternative Fuel (including ethanol blends)
Fuel Grade Ethanol
Biodiesel Blend (e.g. B2, B20, B100): B/___/___/___/
9.
Estimated volume of commodity released unintentionally:
Ethanol Blend % Ethanol: /___/___/
Other Name: _______________________
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/ Barrels
10. Estimated volume of intentional and/or controlled release/blowdown:
(only reported for HVL and CO 2 Commodities)
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/./
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/ Barrels
11. Estimated volume of commodity recovered:
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/ Barrels
Form PHMSA F 7000-1 (rev 7-2014)
Page 1 of 17
Reproduction of this form is permitted
12. Were there fatalities? Yes No
If Yes, specify the number in each category:
13. Were there injuries requiring inpatient hospitalization?
If Yes, specify the number in each category:
Yes No
12.a Operator employees
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13.a Operator employees
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12.b Contractor employees
working for the Operator
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13.b Contractor employees
working for the Operator
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12.c Non-Operator
emergency responders
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13.c Non-Operator
emergency responders
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12.d Workers working on the
right-of-way, but NOT
associated with this Operator
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13.d Workers working on the
right-of-way, but NOT
associated with this Operator
12.e General public
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13.e General public
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12.f Total fatalities (sum of above)
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13.f Total injuries (sum of above)
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14. Was the pipeline/facility shut down due to the Accident?
Yes No Explain: ______________________________________________________________________________
If Yes, complete Questions 14.a and 14.b: (use local time, 24-hr clock)
14.a Local time and date of shutdown
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Hour
14.b Local time pipeline/facility restarted
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Hour
15. Did the commodity ignite?
Yes
No
16. Did the commodity explode?
Yes
No
17. Number of general public evacuated: /
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Month
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Year
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Day
Still shut down*
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(*Supplemental Report required)
Year
18. Time sequence: (use local time, 24-hour clock)
18.a Local time Operator identified failure
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Hour
18.b Local time Operator resources arrived on site
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Month
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Month
Form PHMSA F 7000-1 (rev 7-2014)
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Page 2 of 17
Reproduction of this form is permitted
PART B – ADDITIONAL LOCATION INFORMATION
*1. Was the origin of the Accident onshore?
Yes (Complete Questions 2-12)
No (Complete Questions 13-15)
If Onshore:
2. State: /
If Offshore:
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3. Zip Code: /
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13. Approximate water depth (ft.) at the point of the Accident:
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/ - /
4._______________________
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5_______________________
City
County or Parish
6. Operator-designated location: (select only one)
Milepost/Valve Station (specify in shaded area below)
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Area: ___________________
Block/Tract #: /___/___/___/___/
Nearest County/Parish: ________________
On the Outer Continental Shelf (OCS)
8. Segment name/ID: __________________________________
Specify: Area: ___________________
9. Was Accident on Federal land, other than the Outer Continental
Shelf (OCS)?
Yes No
Block #: /___/___/___/___/
15. Area of Accident: (select only one)
10. Location of Accident: (select only one)
Totally contained on Operator-controlled property
Originated on Operator-controlled property, but then flowed
or migrated off the property
Pipeline right-of-way
11. Area of Accident (as found): (select only one)
Tank, including attached appurtenances
Underground Specify: Under soil
Under a building
Under pavement
Exposed due to excavation
In underground enclosed space (e.g., vault)
Other ____________________________
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In State waters
Specify: State: /
/___/___/___/___/___/___/___/___/___/___/___/___/___/
Depth-of-Cover (in): /
/
14. Origin of Accident:
Survey Station No. (specify in shaded area below)
7. Pipeline/Facility name: _______________________________
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Shoreline/Bank crossing or shore approach
Below water, pipe buried or jetted below seabed
Below water, pipe on or above seabed
Splash Zone of riser
Portion of riser outside of Splash Zone, including riser
bend
Platform
/
Aboveground Specify:
Typical aboveground facility piping or appurtenance
Overhead crossing
In or spanning an open ditch
Inside a building
Inside other enclosed space
Other ____________________________
Transition Area Specify: Soil/air interface Wall
sleeve Pipe support or other close contact area
Other _________________________
12. Did Accident occur in a crossing?:
Yes
No
If Yes, specify type below:
Bridge crossing Specify: Cased Uncased
Railroad crossing (select all that apply)
Cased
Uncased
Bored/drilled
Road crossing
(select all that apply)
Cased
Uncased
Bored/drilled
Water crossing
Uncased
Specify: Cased
Name of body of water, if commonly known:
_____________________________________
Approx. water depth (ft) at the point of the Accident:
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(select only one of the following)
Shoreline/Bank crossing
Below water, pipe in bored/drilled crossing
Below water, pipe buried below bottom (NOT in
bored/drilled crossing)
Below water, pipe on or above bottom
Form PHMSA F 7000-1 (rev 7-2014)
Page 3 of 17
Reproduction of this form is permitted
PART C – ADDITIONAL FACILITY INFORMATION
1. Is the pipeline or facility:
Interstate
Intrastate
2. Part of system involved in Accident: (select only one)
Onshore Breakout Tank or Storage Vessel, Including Attached Appurtenances
Atmospheric or Low Pressure
Pressurized
Onshore Terminal/Tank Farm Equipment and Piping
Onshore Equipment and Piping Associated with Belowground Storage
Onshore Pump/Meter Station Equipment and Piping
Onshore Pipeline, Including Valve Sites
Offshore Platform/Deepwater Port, Including Platform-mounted Equipment and Piping
Offshore Pipeline, Including Riser and Riser Bend
3. Item involved in Accident: (select only one)
Pipe Specify:
Pipe Body
Pipe Seam
3.a Nominal diameter of pipe (in):
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3.b Wall thickness (in):
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3.c SMYS (Specified Minimum Yield Strength) of pipe (psi):
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3.d Pipe specification: _____________________________
3.e Pipe Seam
Specify: Longitudinal ERW - High Frequency
Longitudinal ERW - Low Frequency
Longitudinal ERW – Unknown Frequency
Spiral Welded ERW
Spiral Welded SAW
Lap Welded
Seamless
Single SAW
DSAW
Flash Welded
Continuous Welded
Furnace Butt Welded
Spiral Welded DSAW
Other ________________________
3.f Pipe manufacturer: _______________________________
3.g Year of manufacture: /
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3.h Pipeline coating type at point of Accident
Fusion Bonded Epoxy
Specify:
Coal Tar
Asphalt
Polyolefin
Extruded Polyethylene Field Applied Epoxy Cold Applied Tape Paint
Composite
None
Other _______________________________
Weld, including heat-affected zone Specify: Pipe Girth Weld Other Butt Weld Fillet Weld Other_____________
If Pipe Girth Weld is selected, complete items 3.a. through h. above. If the values differ on either side of the girth weld, enter one value in
3.a. through h. and list the different value(s) in Part H - Narrative Description of the Accident.
Valve
Mainline Specify: Butterfly Check Gate Plug
Other __________________________
Ball Globe
3.i Mainline valve manufacturer: ______________________________
3.j Year of manufacture: /
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Relief Valve
Auxiliary or Other Valve
Pump
Meter/Prover
Scraper/Pig Trap
Sump/Separator
Repair Sleeve or Clamp
Hot Tap Equipment
Stopple Fitting
Flange
Relief Line
Auxiliary Piping (e.g. drain lines)
Tubing
Instrumentation
Tank/Vessel Specify: Single Bottom System
Roof/Roof Seal
Appurtenance
Other ___________________________________
4. Year item involved in Accident was installed:
/
/
Double Bottom System
Tank Shell
Chime
Roof Drain System
Mixer
Pressure Vessel Head or Wall
Other ________________________________
/
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/
Form PHMSA F 7000-1 (rev 7-2014)
Page 4 of 17
Reproduction of this form is permitted
5. Material involved in Accident: (select only one)
Carbon Steel
Material other than Carbon Steel Specify: ____________________________________________
6. Type of Accident involved: (select only one)
Mechanical Puncture Approx. size: /__/__/__/__/./__/in. (axial) by /__/__/__/__/./__/in. (circumferential)
Leak Select Type: Pinhole
Crack
Rupture Select Orientation: Circumferential
Connection Failure
Seal or Packing
Other
Longitudinal
Other ________________________________
Approx. size: /__/__/__/__/./__/ in. (widest opening) by /__/__/__/__/__/./__/in. (length circumferentially or axially)
Overfill or Overflow
Other Describe: _______________________________________________________________________________________
PART D – ADDITIONAL CONSEQUENCE INFORMATION
1. Wildlife impact:
Yes No
1.a If Yes, specify all that apply:
Fish/aquatic
Birds
Terrestrial
2. Soil contamination:
Yes No
3. Long term impact assessment performed or planned:
Yes No
4. Anticipated remediation: Yes No (not needed)
4.a If Yes, specify all that apply:
Surface water Groundwater Soil
5. Water contamination:
Yes
Vegetation
(Complete 5.a – 5.c below)
Wildlife
No
5.a Specify all that apply:
Ocean/Seawater
Surface
Groundwater
Drinking water
(Select one or both)
Private Well Public Water Intake
5.b Estimated amount released in or reaching water:
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/___/./___/___/ Barrels
5.c Name of body of water, if commonly known: __________________________________________
6. At the location of this Accident, had the pipeline segment or facility been identified as one that “could affect” a High Consequence Area
(HCA) as determined in the Operator’s Integrity Management Program?
Yes No
7. Did the released commodity reach or occur in one or more High Consequence Area (HCA)?
Yes No
7.a If Yes, specify HCA type(s): (select all that apply)
Commercially Navigable Waterway
Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
Yes No
High Population Area
Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
Yes No
Other Populated Area
Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
Yes No
Unusually Sensitive Area (USA) – Drinking Water
Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
Yes No
Unusually Sensitive Area (USA) – Ecological
Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
Yes No
Form PHMSA F 7000-1 (rev 7-2014)
Page 5 of 17
Reproduction of this form is permitted
8. Estimated Property Damage:
8.a Estimated cost of public and non-Operator private property damage
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8.b Estimated cost of commodity lost
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8.c Estimated cost of Operator’s property damage & repairs
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8.d Estimated cost of Operator’s emergency response
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8.e Estimated cost of Operator’s environmental remediation
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8.f Estimated other costs
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Describe ___________________________________________________
8.g Total estimated property damage (sum of above)
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1. Estimated pressure at the point and time of the Accident (psig):
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2. Maximum Operating Pressure (MOP) at the point and time of the Accident (psig) :
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PART E – ADDITIONAL OPERATING INFORMATION
3. Describe the pressure on the system or facility relating to the Accident: (select only one)
Pressure did not exceed MOP
Pressure exceeded MOP, but did not exceed 110% of MOP
Pressure exceeded 110% of MOP
4. Not including pressure reductions required by PHMSA regulations (such as for repairs and pipe movement), was the system or facility
relating to the Accident operating under an established pressure restriction with pressure limits below those normally allowed by the MOP?
No
Yes
(Complete 4.a and 4.b below)
4.a Did the pressure exceed this established pressure restriction?
Yes
No
4.b Was this pressure restriction mandated by PHMSA or the State?
PHMSA
State
Not mandated
5. Was “Onshore Pipeline, Including Valve Sites” OR “Offshore Pipeline, Including Riser and Riser Bend” selected in PART C, Question 2?
No
Yes
(Complete 5.a – 5.e below)
5.a Type of upstream valve used to initially isolate release source:
Manual
Automatic
Remotely Controlled
5.b Type of downstream valve used to initially isolate release source:
Manual Automatic
Check Valve
Remotely Controlled
5.c Length of segment initially isolated between valves (ft):
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5.d Is the pipeline configured to accommodate internal inspection tools?
Yes
No Which physical features limit tool accommodation? (select all that apply)
Changes in line pipe diameter
Presence of unsuitable mainline valves
Tight or mitered pipe bends
Other passage restrictions (i.e. unbarred tee’s, projecting instrumentation, etc.)
Extra thick pipe wall (applicable only for magnetic flux leakage internal inspection tools)
Other Describe:__________________________________________________________________
5.e For this pipeline, are there operational factors which significantly complicate the execution of an internal inspection tool run?
No
Yes
Which operational factors complicate execution?
(select all that apply)
Excessive debris or scale, wax, or other wall build-up
Low operating pressure(s)
Low flow or absence of flow
Incompatible commodity
Other Describe:__________________________________________________________________
5.f Function of pipeline system: (select only one)
> 20% SMYS Regulated Trunkline/Transmission
≤ 20% SMYS Regulated Trunkline/Transmission
> 20% SMYS Regulated Gathering
≤ 20% SMYS Regulated Gathering
Form PHMSA F 7000-1 (rev 7-2014)
Page 6 of 17
Reproduction of this form is permitted
6. Was a Supervisory Control and Data Acquisition (SCADA)-based system in place on the pipeline or facility involved in the Accident?
No
Yes 6.a Was it operating at the time of the Accident?
Yes
No
Yes
No
6.b Was it fully functional at the time of the Accident?
6.c Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist with the
detection of the Accident?
Yes
No
6.d Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist with the
confirmation of the Accident?
Yes
No
7. Was a CPM leak detection system in place on the pipeline or facility involved in the Accident?
No
Yes
7.a Was it operating at the time of the Accident?
Yes
No
Yes
No
7.b Was it fully functional at the time of the Accident?
7.c Did CPM leak detection system information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist
with the detection of the Accident?
Yes
No
7.d Did CPM leak detection system information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist
with the confirmation of the Accident?
Yes
No
8. How was the Accident initially identified for the Operator? (select only one)
CPM leak detection system or SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations)
Static Shut-in Test or Other Pressure or Leak Test
Controller
Local Operating Personnel, including contractors
Air Patrol
Ground Patrol by Operator or its contractor
Notification from Public
Notification from Emergency Responder
Notification from Third Party that caused the Accident
Other _________________________________________________
8.a If “Controller”, “Local Operating Personnel, including contractors”, “Air Patrol”, or “Ground Patrol by Operator or its contractor” is
selected in Question 8, specify the following: (select only one)
Operator employee
Contractor working for the Operator
9. Was an investigation initiated into whether or not the controller(s) or control room issues were the cause of or a contributing factor to the
Accident? (select only one)
Yes, but the investigation of the control room and/or controller actions has not yet been completed by the Operator (Supplemental
Report required)
No, the facility was not monitored by a controller(s) at the time of the Accident
No, the Operator did not find that an investigation of the controller(s) actions or control room issues was necessary due to:
(provide an explanation for why the Operator did not investigate)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Yes, specify investigation result(s): (select all that apply)
Investigation reviewed work schedule rotations, continuous hours of service (while working for the Operator) and other
factors associated with fatigue
Investigation did NOT review work schedule rotations, continuous hours of service (while working for the Operator) and
other factors associated with fatigue (provide an explanation for why not)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Investigation identified no control room issues
Investigation identified no controller issues
Investigation identified incorrect controller action or controller error
Investigation identified that fatigue may have affected the controller(s) involved or impacted the involved controller(s)
response
Investigation identified incorrect procedures
Investigation identified incorrect control room equipment operation
Investigation identified maintenance activities that affected control room operations, procedures, and/or controller
response
Investigation identified areas other than those above Describe: ___________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Form PHMSA F 7000-1 (rev 7-2014)
Page 7 of 17
Reproduction of this form is permitted
PART F – DRUG & ALCOHOL TESTING INFORMATION
1. As a result of this Accident, were any Operator employees tested under the post-accident drug and alcohol testing requirements of DOT’s
Drug & Alcohol Testing regulations?
No
Yes
*1.a Specify how many were tested:
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*1.b Specify how many failed:
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2. As a result of this Accident, were any Operator contractor employees tested under the post-accident drug and alcohol testing requirements
of DOT’s Drug & Alcohol Testing regulations?
No
Yes
*2.a Specify how many were tested:
*2.b Specify how many failed:
PART G – APPARENT CAUSE
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Select only one box from PART G in the shaded column on the left representing the
APPARENT Cause of the Accident, and answer the questions on the right. Describe
secondary, contributing, or root causes of the Accident in the narrative (PART H).
G1 - Corrosion Failure – *only one sub-cause can be picked from shaded left-hand column
External Corrosion
1. Results of visual examination:
Localized Pitting General Corrosion
Other _______________________________________________
2. Type of corrosion: (select all that apply)
Galvanic Atmospheric Stray Current Microbiological
Other ________________________________________________
Selective Seam
3. The type(s) of corrosion selected in Question 2 is based on the following: (select all that
apply)
Field examination
Determined by metallurgical analysis
Other _____________________________________________________________
4. Was the failed item buried under the ground?
Yes 4.a Was failed item considered to be under cathodic protection at the time of
the Accident?
Yes Year protection started: / / / / /
No
4.b Was shielding, tenting, or disbonding of coating evident at the point of
the Accident?
Yes No
4.c Has one or more Cathodic Protection Survey been conducted at
the point of the Accident?
Yes, CP Annual Survey Most recent year conducted:
/ / /
Yes, Close Interval Survey Most recent year conducted: /
Yes, Other CP Survey Most recent year conducted:
/
No
No
4.d Was the failed item externally coated or painted?
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Yes No
5. Was there observable damage to the coating or paint in the vicinity of the corrosion?
Yes No
Form PHMSA F 7000-1 (rev 7-2014)
Page 8 of 17
Reproduction of this form is permitted
Internal Corrosion
6. Results of visual examination:
Localized Pitting
General Corrosion
Not cut open
Other _______________________________________________
7. Cause of corrosion: (select all that apply)
Corrosive Commodity Water drop-out/Acid Microbiological
Other ________________________________________________
Erosion
8. The cause(s) of corrosion selected in Question 7 is based on the following: (select all that
apply)
Field examination
Determined by metallurgical analysis
Other _____________________________________________
9. Location of corrosion: (select all that apply)
Low point in pipe Elbow
Other_____________________________________
10. Was the commodity treated with corrosion inhibitors or biocides?
11. Was the interior coated or lined with protective coating?
Yes No
Yes No
12. Were cleaning/dewatering pigs (or other operations) routinely utilized?
Not applicable - Not mainline pipe
Yes
No
13. Were corrosion coupons routinely utilized?
Not applicable - Not mainline pipe
Yes
No
Complete the following if any Corrosion Failure sub-cause is selected AND the “Item Involved in Accident” (from PART C, Question 3) is
Tank/Vessel.
14. List the year of the most recent inspections:
14.a API Std 653 Out-of-Service Inspection
14.b API Std 653 In-Service Inspection
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No Out-of-Service Inspection completed
No In-Service Inspection completed
Complete the following if any Corrosion Failure sub-cause is selected AND the “Item Involved in Accident” (from PART C, Question 3) is
Pipe or Weld.
15. Has one or more internal inspection tool collected data at the point of the Accident?
Yes No
15.a. If Yes, for each tool used, select type of internal inspection tool and indicate most recent year run:
Magnetic Flux Leakage Tool
Ultrasonic
Geometry
Caliper
Crack
Hard Spot
Combination Tool
Transverse Field/Triaxial
Other __________________________
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/
16. Has one or more hydrotest or other pressure test been conducted since original construction at the point of the Accident?
Yes Most recent year tested: / / / / /
Test pressure (psig): /
/
/
/
/
/
No
17. Has one or more Direct Assessment been conducted on this segment?
Yes, and an investigative dig was conducted at the point of the Accident
Yes, but the point of the Accident was not identified as a dig site
No
Most recent year conducted:
Most recent year conducted:
/
/
/
/
/
/
/
/
/
/
18. Has one or more non-destructive examination been conducted at the point of the Accident since January 1, 2002?
Yes No
18.a If Yes, for each examination conducted since January 1, 2002, select type of non-destructive examination and indicate most recent
year the examination was conducted:
Radiography
Guided Wave Ultrasonic
Handheld Ultrasonic Tool
Wet Magnetic Particle Test
Dry Magnetic Particle Test
Other __________________________
/
/
/
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/
Form PHMSA F 7000-1 (rev 7-2014)
Page 9 of 17
Reproduction of this form is permitted
G2 - Natural Force Damage - *only one sub-cause can be picked from shaded left-hand column
Earth Movement, NOT due to
1. Specify:
Earthquake Subsidence Landslide
Other ____________________
Heavy Rains/Floods
2. Specify:
Washout/Scouring Flotation Mudslide Other _________________
Lightning
3. Specify:
Direct hit
Temperature
4. Specify:
Thermal Stress
Frozen Components
Heavy Rains/Floods
Secondary impact such as resulting nearby fires
Frost Heave
Other ________________________________
High Winds
Other Natural Force Damage
5. Describe: _________________________________________________
Complete the following if any Natural Force Damage sub-cause is selected.
6. Were the natural forces causing the Accident generated in conjunction with an extreme weather event?
6.a If Yes, specify: (select all that apply)
Yes
No
Hurricane
Tropical Storm
Tornado
Other ______________________________
G3 – Excavation Damage - *only one sub-cause can be picked from shaded left-hand column
Excavation Damage by Operator
(First Party)
Excavation Damage by Operator’s
Contractor (Second Party)
Excavation Damage by Third Party
Previous Damage due to Excavation
Activity
Complete Questions 1-5 ONLY IF the “Item Involved in Accident” (from PART C,
Question 3) is Pipe or Weld.
1. Has one or more internal inspection tool collected data at the point of the Accident?
Yes No
1.a If Yes, for each tool used, select type of internal inspection tool and indicate most
recent year run:
Magnetic Flux Leakage
Ultrasonic
Geometry
Caliper
Crack
Hard Spot
Combination Tool
Transverse Field/Triaxial
Other _____________________
/
/
/
/
/
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/
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/
/
/
2. Do you have reason to believe that the internal inspection was completed BEFORE the
damage was sustained? Yes No
3. Has one or more hydrotest or other pressure test been conducted since original construction
at the point of the Accident?
Yes
Most recent year tested:
Test pressure (psig):
/
/
/
/
/
/, /
/
/
/
/
/
No
4. Has one or more Direct Assessment been conducted on the pipeline segment?
Yes, and an investigative dig was conducted at the point of the Accident
Most recent year conducted: / / / / /
Yes, but the point of the Accident was not identified as a dig site
Most recent year conducted: / / / / /
No
Form PHMSA F 7000-1 (rev 7-2014)
Page 10 of 17
Reproduction of this form is permitted
5. Has one or more non-destructive examination been conducted at the point of the Accident
since January 1, 2002?
Yes No
5.a If Yes, for each examination conducted since January 1, 2002, select type of nondestructive examination and indicate most recent year the examination was conducted:
Radiography
Guided Wave Ultrasonic
Handheld Ultrasonic Tool
Wet Magnetic Particle Test
Dry Magnetic Particle Test
Other __________________________
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
Complete the following if Excavation Damage by Third Party is selected as the sub-cause.
6. Did the Operator get prior notification of the excavation activity?
6.a If Yes, Notification received from: (select all that apply)
Yes No
One-Call System
Excavator
Contractor
Landowner
Complete the following mandatory CGA-DIRT Program questions if any Excavation Damage sub-cause is selected.
Yes
7. Do you want PHMSA to upload the following information to CGA-DIRT (www.cga-dirt.com)?
No
8. Right-of-Way where event occurred: (select all that apply)
Public Specify: City Street State Highway County Road Interstate Highway
Private Specify: Private Landowner Private Business Private Easement
Pipeline Property/Easement
Power/Transmission Line
Railroad
Dedicated Public Utility Easement
Federal Land
Data not collected
Unknown/Other
Other
9. Type of excavator: (select only one)
Contractor
Railroad
County
State
Developer
Utility
Farmer
Municipality
Data not collected
Occupant
Unknown/Other
10. Type of excavation equipment: (select only one)
Auger
Explosives
Probing Device
Backhoe/Trackhoe
Farm Equipment
Trencher
Boring
Grader/Scraper
Vacuum Equipment
Drilling
Directional Drilling
Hand Tools
Milling Equipment
Data not collected Unknown/Other
11. Type of work performed: (select only one)
Agriculture
Drainage
Grading
Natural Gas
Sewer (Sanitary/Storm)
Telecommunications
Data not collected
Cable TV
Curb/Sidewalk
Driveway
Electric
Irrigation
Landscaping
Pole
Public Transit Authority
Site Development
Steam
Traffic Signal
Traffic Sign
Unknown/Other
12. Was the One-Call Center notified?
Yes
*12.a If Yes, specify ticket number: /
/
Building Construction
Engineering/Surveying
Liquid Pipeline
Railroad Maintenance
Storm Drain/Culvert
Water
Building Demolition
Fencing
Milling
Road Work
Street Light
Waterway Improvement
No
/
/
/
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/
/
/
/
/
/
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/
/
/
/
/
/
*12.b If this is a State where more than a single One-Call Center exists, list the name of the One-Call Center notified:
_____________________________________________________________
13. Type of Locator:
Utility Owner
Contract Locator
Data not collected
Unknown/Other
No
Data not collected
Unknown/Other
14. Were facility locate marks visible in the area of excavation?
No
15. Were facilities marked correctly?
16. Did the damage cause an interruption in service?
16.a If Yes, specify duration of the interruption:
No
Yes
Yes
Yes
Data not collected
Data not collected
Unknown/Other
Unknown/Other
/___/___/___/___/ hours
Form PHMSA F 7000-1 (rev 7-2014)
Page 11 of 17
Reproduction of this form is permitted
17. Description of the CGA-DIRT Root Cause (select only the one predominant first level CGA-DIRT Root Cause and then, where available
as a choice, the one predominant second level CGA-DIRT Root Cause as well):
One-Call Notification Practices Not Sufficient: (select only one)
No notification made to the One-Call Center
Notification to One-Call Center made, but not sufficient
Wrong information provided
Locating Practices Not Sufficient: (select only one)
Facility could not be found/located
Facility marking or location not sufficient
Facility was not located or marked
Incorrect facility records/maps
Excavation Practices Not Sufficient: (select only one)
Excavation practices not sufficient (other)
Failure to maintain clearance
Failure to maintain the marks
Failure to support exposed facilities
Failure to use hand tools where required
Failure to verify location by test-hole (pot-holing)
Improper backfilling
One-Call Notification Center Error
Abandoned Facility
Deteriorated Facility
Previous Damage
Data Not Collected
Other / None of the Above (explain)____________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Form PHMSA F 7000-1 (rev 7-2014)
Page 12 of 17
Reproduction of this form is permitted
G4 - Other Outside Force Damage - *only one sub-cause can be picked from shaded left-hand column
Nearby Industrial, Man-made, or
Other Fire/Explosion as Primary
Cause of Accident
Damage by Car, Truck, or Other
Motorized Vehicle/Equipment NOT
Engaged in Excavation
Damage by Boats, Barges, Drilling
Rigs, or Other Maritime Equipment or
Vessels Set Adrift or Which Have
Otherwise Lost Their Mooring
1. Vehicle/Equipment operated by: (select only one)
Operator
Operator’s Contractor
Third Party
2. Select one or more of the following IF an extreme weather event was a factor:
Hurricane
Tropical Storm
Tornado
Heavy Rains/Flood
Other ______________________________
Routine or Normal Fishing or Other
Maritime Activity NOT Engaged in
Excavation
Electrical Arcing from Other
Equipment or Facility
Previous Mechanical Damage NOT
Related to Excavation
Complete Questions 3-7 ONLY IF the “Item Involved in Accident” (from PART C,
Question 3) is Pipe or Weld.
3. Has one or more internal inspection tool collected data at the point of the Accident?
Yes No
3.a If Yes, for each tool used, select type of internal inspection tool and indicate most
recent year run:
Magnetic Flux Leakage
Ultrasonic
Geometry
Caliper
Crack
Hard Spot
Combination Tool
Transverse Field/Triaxial
Other _____________________
/
/
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/
/
4. Do you have reason to believe that the internal inspection was completed BEFORE the
damage was sustained? Yes No
5. Has one or more hydrotest or other pressure test been conducted since original construction
at the point of the Accident?
Yes
Most recent year tested:
Test pressure (psig):
/
/
/
/
/
/, /
/
/
/
/
/
No
6. Has one or more Direct Assessment been conducted on the pipeline segment?
Yes, and an investigative dig was conducted at the point of the Accident
Most recent year conducted: / / / / /
Yes, but the point of the Accident was not identified as a dig site
Most recent year conducted: / / / / /
No
(This section continued on next page with Question 7.)
7. Has one or more non-destructive examination been conducted at the point of the Accident
Form PHMSA F 7000-1 (rev 7-2014)
Page 13 of 17
Reproduction of this form is permitted
since January 1, 2002?
Yes No
7.a If Yes, for each examination conducted since January 1, 2002, select type of nondestructive examination and indicate most recent year the examination was conducted:
/
/
/
/
/
Radiography
Guided Wave Ultrasonic
/
/
/
/
/
Handheld Ultrasonic Tool
/
/
/
/
/
Wet Magnetic Particle Test
/
/
/
/
/
Dry Magnetic Particle Test
/
/
/
/
/
Other __________________________
/
/
/
/
/
Intentional Damage
8. Specify:
Other Outside Force Damage
9. Describe: _________________________________________________________
Vandalism
Terrorism
Theft of transported commodity Theft of equipment
Other ________________________________________
G5 - Material Failure of Pipe or Weld
Use this section to report material failures ONLY IF the “Item Involved in
Accident” (from PART C, Question 3) is “Pipe” or “Weld.”
*Only one sub-cause can be picked from shaded left-hand column
1. The sub-cause selected below is based on the following: (select all that apply)
Field Examination
Determined by Metallurgical Analysis
Other Analysis__________________________
Sub-cause is Tentative or Suspected; Still Under Investigation (Supplemental Report required)
Construction-, Installation-, or
Fabrication-related
Original Manufacturing-related
(NOT girth weld or other welds
formed in the field)
Environmental Cracking-related
2. List contributing factors: (select all that apply)
Fatigue- or Vibration-related:
Mechanically-induced prior to installation (such as during transport of pipe)
Mechanical Vibration
Pressure-related
Thermal
Other __________________________________
Mechanical Stress
Other __________________________________
3. Specify: Stress Corrosion Cracking
Sulfide Stress Cracking
Hydrogen Stress Cracking
Other ______________________________
Complete the following if any Material Failure of Pipe or Weld sub-cause is selected.
4. Additional factors: (select all that apply) Dent Gouge Pipe Bend
Lamination
Buckle
Wrinkle
Misalignment
Other __________________________________
Arc Burn Crack
Burnt Steel
5. Has one or more internal inspection tool collected data at the point of the Accident?
Yes
Lack of Fusion
No
5.a If Yes, for each tool used, select type of internal inspection tool and indicate most recent year run:
Magnetic Flux Leakage Tool
/
/
/
/
/
Ultrasonic
/
/
/
/
/
Geometry
/
/
/
/
/
Caliper
/
/
/
/
/
Crack
/
/
/
/
/
Hard Spot
/
/
/
/
/
Combination Tool
/
/
/
/
/
Transverse Field/Triaxial
/
/
/
/
/
Other __________________________ /
/
/
/
/
6. Has one or more hydrotest or other pressure test been conducted since original construction at the point of the Accident?
Yes Most recent year tested: /
/
/
/
/
Test pressure (psig): /
/
/,/
/
/
/
No
7. Has one or more Direct Assessment been conducted on the pipeline segment?
Yes, and an investigative dig was conducted at the point of the Accident Most recent year conducted:
Yes, but the point of the Accident was not identified as a dig site
Most recent year conducted:
No
/
/
/
/
/
/
/
/
/
/
8. Has one or more non-destructive examination(s) been conducted at the point of the Accident since January 1, 2002?
Yes No
8.a If Yes, for each examination conducted since January 1, 2002, select type of non-destructive examination and indicate most recent year the
examination was conducted:
Radiography
/
/
/
/
/
Guided Wave Ultrasonic
/
/
/
/
/
Handheld Ultrasonic Tool
/
/
/
/
/
Wet Magnetic Particle Test
/
/
/
/
/
Dry Magnetic Particle Test
/
/
/
/
/
Other ________________________________ /
/
/
/
/
Form PHMSA F 7000-1 (rev 7-2014)
Page 14 of 17
Reproduction of this form is permitted
G6 - Equipment Failure - *only one sub-cause can be picked from shaded left-hand column
Malfunction of Control/Relief
Equipment
1. Specify: (select all that apply)
Control Valve
Instrumentation
SCADA
Communications Block Valve
Check Valve
Relief Valve
Power Failure
Stopple/Control Fitting
ESD System Failure
Other ________________________________________________________
Pump or Pump-related Equipment
2. Specify: Seal/Packing Failure
Body Failure
Crack in Body
Appurtenance Failure
Other ________________________________________________________
Threaded Connection/Coupling
3. Specify:
Pipe Nipple
Valve Threads
Mechanical Coupling
Threaded Pipe Collar Threaded Fitting
Other ________________________________________________________
4. Specify:
O-Ring
Gasket
Seal (NOT pump seal) or Packing
Other ________________________________________________________
Failure
Non-threaded Connection Failure
Defective or Loose Tubing or Fitting
Failure of Equipment Body (except
Pump), Tank Plate, or other Material
Other Equipment Failure
5. Describe: ___________________________________________________________
_______________________________________________________________________
Complete the following if any Equipment Failure sub-cause is selected.
6. Additional factors that contributed to the equipment failure: (select all that apply)
Excessive vibration
Overpressurization
No support or loss of support
Manufacturing defect
Loss of electricity
Improper installation
Mismatched items (different manufacturer for tubing and tubing fittings)
Dissimilar metals
Breakdown of soft goods due to compatibility issues with transported commodity
Valve vault or valve can contributed to the release
Alarm/status failure
Misalignment
Thermal stress
Other _______________________________________________________
Form PHMSA F 7000-1 (rev 7-2014)
Page 15 of 17
Reproduction of this form is permitted
G7 - Incorrect Operation - *only one sub-cause can be picked from shaded left-hand column
Damage by Operator or Operator’s
Contractor NOT Related to
Excavation and NOT due to
Motorized Vehicle/Equipment
Damage
Tank, Vessel, or Sump/Separator
1. Specify:
Allowed or Caused to Overfill or
Overflow
Valve misalignment
Incorrect reference data/calculation
Miscommunication
Inadequate monitoring
Other ____________________________________
Valve Left or Placed in Wrong
Position, but NOT Resulting in a
Tank, Vessel, or Sump/Separator
Overflow or Facility Overpressure
Pipeline or Equipment
Overpressured
Equipment Not Installed Properly
Wrong Equipment Specified or
Installed
Other Incorrect Operation
2. Describe: __________________________________________________
Complete the following if any Incorrect Operation sub-cause is selected.
3. Was this Accident related to: (select all that apply)
Inadequate procedure
No procedure established
Failure to follow procedure
Other: ______________________________________________________
4. What category type was the activity that caused the Accident:
Construction
Commissioning
Decommissioning
Right-of-Way activities
Routine maintenance
Other maintenance
Normal operating conditions
Non-routine operating conditions (abnormal operations or emergencies)
5. Was the task(s) that led to the Accident identified as a covered task in your Operator Qualification Program? Yes
No
5.a If Yes, were the individuals performing the task(s) qualified for the task(s)?
Yes, they were qualified for the task(s)
No, but they were performing the task(s) under the direction and observation of a qualified individual
No, they were not qualified for the task(s) nor were they performing the task(s) under the direction and observation of a
qualified individual
G8 – Other Accident Cause - *only one sub-cause can be picked from shaded left-hand column
Miscellaneous
1. Describe:
___________________________________________________________________________
___________________________________________________________________________
2. Specify:
Unknown
Investigation complete, cause of Accident unknown
Still under investigation, cause of Accident to be determined*
(*Supplemental Report required)
Form PHMSA F 7000-1 (rev 7-2014)
Page 16 of 17
Reproduction of this form is permitted
PART H – NARRATIVE DESCRIPTION OF THE ACCIDENT
(Attach additional sheets as necessary)
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
PART I – PREPARER AND AUTHORIZED SIGNATURE
Preparer's Name (type or print)
Preparer’s Telephone Number
Preparer's Title (type or print)
Preparer's E-mail Address
Authorized Signer’s Name
Preparer’s Facsimile Number
Date
Authorized Signer Telephone Number
Authorized Signer’s E-mail Address
Authorized Signer’s Title
Form PHMSA F 7000-1 (rev 7-2014)
Page 17 of 17
Reproduction of this form is permitted
Instructions (rev 7-2014) for Form PHMSA F 7000-1 (rev 7-2014)
ACCIDENT REPORT – HAZARDOUS LIQUID PIPELINE SYSTEMS
GENERAL INSTRUCTIONS
Each operator of a hazardous liquid pipeline system shall file Form PHMSA F 7000-1 for
an accident that meets the criteria in 49 CFR §195.50 as soon as practicable but not more
than 30 days after discovery of the accident. Requirements for submitting reports are in
§195.54 and §195.58.
Hazardous liquid releases during maintenance activities are not to be reported if the spill
was less than 5 barrels, not otherwise reportable under 49 CFR §195.50, did not result in
water pollution as described by 49 CFR §195.52(a)(4), was confined to company property
or pipeline right-of-way, and was cleaned up promptly. Any spill of 5 gallons or more to
water during a maintenance activity is required to be reported.
Form
PHMSA
F
7000-1
and
these
instructions
can
be
found
on http://phmsa.dot.gov/pipeline/library/forms. The applicable documents are included in
the section titled Accidents/Incidents/Annual Reporting Forms.
ONLINE REPORTING REQUIREMENTS
Accident Reports must be submitted online through the PHMSA Portal
at https://portal.phmsa.dot.gov/portal, unless an alternate method is approved (see Alternate
Reporting Methods below).
You will not be able to submit reports until you have met all of the Portal registration
requirements –
see http://opsweb.phmsa.dot.gov/portal_message/PHMSA_Portal_Registration.pdf
Completing these registration requirements could take several weeks. Plan ahead and
register well in advance of the report due date.
Use the following procedure for online reporting:
1. Go to the PHMSA Portal at https://portal.phmsa.dot.gov/portal
2. Enter PHMSA Portal Username and Password ; press enter
3. Select OPID; press “continue” button.
4. On the left side menu under “Incident/accident” select “ODES 2.0”
5. Under “Create Reports” on the left side of the screen, select “Hazardous Liquid ”
and proceed with entering your data.
6. Click “Submit” when finished with your data entry to have your report uploaded to
PHMSA’s database as an official submission of an Accident Report; or click
“Save” which doesn’t submit the report to PHMSA but stores it in a draft status to
allow you to come back to complete your data entry and report submission at a later
time. Note: The “Save” feature will allow you to start a report and save a draft of
OMB No. 2137-0047 Expires: 7/31/2015
Page 1 of 32
Instructions (rev 7-2014) for Form PHMSA F 7000-1 (rev 7-2014)
ACCIDENT REPORT – HAZARDOUS LIQUID PIPELINE SYSTEMS
it which you can print out and/or save as a PDF to email to colleagues in order to
gather additional information and then come back to accurately complete your data
entry before submitting it to PHMSA.
7. Once you click “Submit”, the system will check if all applicable portions of the
report have been completed. If portions are incomplete, a listing of these portions
will appear above the row of Parts. If all applicable portions have been completed,
the system will show your Saved Incident/Accident Reports in the top portion of the
screen and your Submitted Incident/Accident Reports in the bottom portion of the
screen. Note: To confirm that your report was successfully submitted to PHMSA,
look for it in the bottom portion of the screen where you can also view a PDF of
what you submitted.
Supplemental Report Filing – Follow Steps 1 through 4 above, and double-click a
submitted report from the Submitted Incident/Accident Reports list. The report will default
to a “Read Only” mode that is pre-populated with the data you submitted previously. To
create a supplemental report, click on “Create Supplemental” found in the upper right
corner of the screen. At this point, you can amend your data and make an official
submission of the report to PHMSA as either a Supplemental Report or as a Supplemental
Report plus Final Report (see “Specific Instructions, PART A, Report Type”), or you can use
the “Save” feature to create a draft of your Supplemental Report to be submitted at some future
date
Alternate Reporting Methods
Operators for whom electronic reporting imposes an undue burden and hardship may submit
a written request for an alternate reporting method. Operators must follow the requirements
in §195.58(d) to request an alternate reporting method and must comply with any conditions
imposed as part of PHMSA’s approval of an alternate reporting method.
RETRACTING A 30-DAY WRITTEN REPORT
An operator who reports an accident in accordance with §195.54 (oftentimes referred to as a
30-day written report) and upon subsequent investigation determines that the event did not
meet the criteria in §195.50 may request that the report be retracted. Requests to retract a
30-day written report are to be emailed to InformationResourcesManager@dot.gov.
Requests are to include the following information:
a. The Report ID (the unique 8-digit identifier assigned by PHMSA)
b. Operator name
c. PHMSA-issued OPID number
d. The number assigned by the National Response Center (NRC) when an
immediate notice was made in accordance with §195.52. If Supplemental
Reports were made to the NRC for the event, list all NRC report numbers
associated with the event.
e. Date of the event
f. Location of the event
g. A brief statement as to why the report should be retracted.
OMB No. 2137-0047 Expires: 7/31/2015
Page 2 of 32
Instructions (rev 7-2014) for Form PHMSA F 7000-1 (rev 7-2014)
ACCIDENT REPORT – HAZARDOUS LIQUID PIPELINE SYSTEMS
Note: PHMSA no longer requests that operators rescind erroneously reported “Immediate
Notices” filed with the NRC in accordance with §195.52 (oftentimes referred to as
“Telephonic Reports”).
SPECIAL INSTRUCTIONS
Certain data fields must be completed before an Original Report will be accepted. An
Original Report will not be able to be submitted online until the required information has
been provided, although your partially completed form can be saved online so that you can
return at a later time to provide the missing information.
1. An entry should be made in each applicable space or check box, unless otherwise
directed by the section instructions.
2. If the data is unavailable, enter “Unknown” for text fields and leave numeric fields and
fields using check boxes or “radio” buttons blank.
3. Estimate data only if necessary. Provide an estimate in lieu of answering a question
with “Unknown” or leaving the field blank. Estimates should be based on bestavailable information and reasonable effort.
4. For unknown or estimated data entries, the operator should file a Supplemental Report
when additional information becomes available.
5. If the question is not applicable, please enter “N/A” for text fields and leave numeric
fields and fields using check boxes or “radio” buttons blank. Do not enter zero unless
this is the actual value being submitted for the data in question.
6. If OTHER is checked for any answer to a question, include an explanation or
description on the line provided, making it clear why “Other” was the necessary
selection.
7. Pay close attention to each question for the phrase:
a. (select all that apply)
b. (select only one)
If the phrase does not exist for a given question, then “select only one” should apply.
“Select only one” means that you should select the single, primary, or most applicable
answer. DO NOT SELECT MORE ANSWERS THAN REQUESTED. “Select all that
apply” requires that all applicable answers (one or more than one) be selected.
8. Date format = mm/dd/yy or for year = /yyyy/
9. Time format: All times are reported as a 24-hour clock:
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Time format Examples:
a. (0000) = midnight =
b. (0800) = 8:00 a.m. =
c. (1200) = Noon
=
d. (1715) = 5:15 p.m. =
e. (2200) = 10:00 p.m. =
/0/0/0/0/
/0/8/0/0/
/1/2/0/0/
/1/7/1/5/
/2/2/0/0/
Local time always refers to time at the site of the accident. Note that time zones at
the accident site may be different than the time zone for the person discovering or
reporting the event. For example, if a release occurs at an gas transmission facility
in Denver, Colorado at 2:00 pm MST, but an individual located in Houston is filing
the report after having been notified at 3:00 pm CST, the time of the accident is to
be reported as 1400 hours based on the time in Denver, which is the physical site of
the accident.
PART A – GENERAL REPORT INFORMATION
Report Type: (select all that apply)
Select the appropriate report box or boxes to indicate the type of report being filed.
Depending on the descriptions below, the following combinations of boxes - and only one
of these combinations - may be selected:
•
•
•
•
Original Report only
Original Report plus Final Report
Supplemental Report only
Supplemental Report plus Final Report
Original Report
Select if this is the FIRST report filed for this accident and you expect that additional or
updated information will be provided later.
Original Report
plus
Final Report
Select both Original Report and Final Report if ALL of the information requested is known
and can be provided at the time the initial report is filed, including final property damage
costs and apparent failure cause information. If new, updated, and/or corrected information
becomes available, you are still able to file a Supplemental Report.
Supplemental Report
Select only if you have already filed an Original Report AND you are now providing new,
updated, and/or corrected information. Multiple Supplemental Reports are to be submitted,
as necessary, in order to provide new, updated, and/or corrected information when it
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becomes available and, per §195.54(b)15(c), each Supplemental Report containing new,
updated, and/or corrected information is to be filed within 30 days. Submission of new,
updated, and/or corrected information is NOT to be delayed in order to accumulate
“enough” to “warrant” a Supplemental Report, or to complete a Final Report.
Supplemental Reports must be filed within 30 days following the Operator’s awareness of
new, updated, and/or corrected information. Failure to comply with these requirements
can result in enforcement actions, including the assessment of civil penalties not to exceed
$100,000 for each violation for each day that such violation persists up to a maximum of
$1,000,000.
In cases where an accident results in long-term remediation, an operator may cease filing
Supplemental Reports in the following situations and, instead, file a Final Report even when
additional remediation costs and recovery of released commodity are still occurring:
1. When the accident response consists only of long-term remediation
and/or monitoring which is being conducted under the auspices of an
authorized governmental agency or entity.
2. When the estimated final costs and volume of commodity recovered can
be predicted with a reasonable degree of certainty.
3. When the volume of commodity recovered over time is consistently
decreasing to the point where an estimated total volume of commodity
recovered can be predicted with a reasonable degree of accuracy.
4. When the operator can justify (and explain in the Part H – Narrative) that
the continuation of Supplemental Report filings in the future will not
provide any essential information which will be critically different than
that contained in a Final Report filed currently.
In any of these cases, though, if the reported total volume of commodity released or other
previously reported data other than “Estimated cost of Operator’s environmental
remediation” or “Estimated volume of commodity recovered” is found to be inaccurate, a
Supplemental Report is still required.
For Supplemental Reports filed online, all data previously submitted will automatically
populate in the form. Page through the form to make edits and additions where needed.
Supplemental Report
plus
Final Report
If an Original Report has already been filed AND new, updated, and/or corrected
information is now being submitted via a Supplemental Report AND the operator is
reasonably certain that no further information will be forthcoming, then Final Report is to
also be selected along with Supplemental Report.
If you subsequently find that new, updated, and/or corrected information needs to be
provided, submit another Supplemental Report.
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In Part A, answer Questions 1 thru 18 by providing the requested
information or by making the appropriate selection.
1. Operator’s OPS -Issued Operator Identification Number (OPID)
For online entries, the OPID will automatically populate based on the selection you made
when entering the Portal. If you have log-in credentials for multiple OPID, be sure the
report is being created for the appropriate OPID. Contact PHMSA’s Information Resources
Manager at 202-366-8075 if you need assistance with an OPID. Business hours are 8:30
AM to 5:00 PM Eastern Time.
2. Name of Operator
This is the company name associated with the OPID. For online entries, the name will
automatically populate based on the OPID entered in A1. If the name that appears is not
correct, you need to submit an Operator Name Change (Type A) Notification.
3. Address of Operator
This is the headquarters address associated with the OPID. For online entries, the address
will automatically populate based on the OPID entered in A1. If the address that appears is
not correct, you need to change it in the online Contacts module.
4. Local time (24-hour clock) and date of the Accident
Enter the earliest local date/time an accident reporting criteria was met. In some cases, this
date/time must be estimated based on information gathered during the investigation.
See “Special Instructions”, numbers 8 and 9 for examples of Date format and Time
format expressed as a 24-hour clock.
5. Location of Accident
The latitude and longitude of the accident are to be reported as Decimal Degrees with a
minimum of 5 decimal places (e.g. Lat: 38.89664 Long: -77.04327), using the NAD83 or
WGS84 datums.
If you have coordinates in degrees/minutes or degrees/minutes/seconds use the formula
below to convert to decimal degrees:
degrees + (minutes/60) + (seconds/3600) = decimal degrees
e.g. 38° 53' 47.904" = 38 + (53/60) + (47.904/3600) = 38.89664°
All locations in the United States will have a negative longitude coordinate, which has
already been included on the data entry form so that operators do not have to enter
the negative sign.
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If you cannot locate the accident with a GPS or some other means, there are online tools
that may assist you at http://viewer.nationalmap.gov/viewer/. Any questions regarding the
required format, conversion, or how to use the tools noted above can be directed to Amy
Nelson (202-493-0591 or amy.nelson@dot.gov).
6. National Response Center (NRC) Report Number
Accidents meeting the criteria outlined in §195.52 are to be reported directly to the 24-hour
National Response Center (NRC) at 1-800-424-8802 at the earliest practicable moment
(generally within 2 hours). The NRC assigns numbers to each call. The number assigned to
that Immediate Notice (sometimes referred to as the “Telephonic Report”) is to be entered
in Question 6. When there is more than one NRC report for the incident, enter the first
report in this field and remaining NRC report numbers in Part H – Narrative. If a NRC
report was not made, select the option that best describes why: NRC Notification Not
Required, NRC Notification Required But Not Made, Do Not Know NRC Report Number.
7. Local time (24-hr clock) and date of initial telephonic report to the National
Response Center
Enter the time and date of the initial Immediate Notice of the accident to the NRC. The
time is to be shown by 24-hour clock notation in the time zone where the incident occurred.
All NRC Reports are time stamped for the eastern time zone. Be sure to convert to local
time if the accident did not occur in the eastern time zone. (See “Special Instructions”,
numbers 9 and 10.)
7a. Local time (24-hr clock) and date of confirmed discovery
Enter the time and date when you had sufficient information to determine that a reportable
event may have occurred even if an evaluation had not been completed.
8. Commodity Released
Select only one primary description of the commodity and then, where applicable, the
secondary description of the commodity, based on the predominant volume released. Only
releases of transported commodities are reportable.
Crude Oil
Refined and/or Petroleum Product (non-HVL) which is a Liquid at
Ambient Conditions
Refined and/or Petroleum Product includes gasoline, diesel, jet fuel,
kerosene, fuel oils, or other refined or petroleum products which are a
liquid at ambient conditions. They are flammable, toxic, or corrosive
products obtained from distilling or processing of crude oil, unfinished
oils, natural gas liquids, blend stocks, and other miscellaneous
hydrocarbon compounds. For a non-HVL petrochemical feedstock, such
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as propylene, report as “other” and specify the name of the commodity
(e.g., “propylene”) in the space provided.
HVL or Other Flammable or Toxic Fluid which is a Gas at Ambient
Conditions
Highly Volatile Liquids (HVLs) are hazardous liquids or liquid mixtures
which will form a vapor cloud when released to the atmosphere and have
a vapor pressure exceeding 276 kPa at 37.8 C.
Other Flammable or Toxic Fluids are those defined under 49 CFR
173.120 Class 3—Definitions
Other flammable or toxic fluids which fall under this category include
gases at ambient conditions, such as anhydrous ammonia (NH 3 ) and
propane. For a petrochemical feedstock, such as ethane or ethylene,
which is also classified as a highly volatile liquid, report as “Other HVL”
and specify the appropriate name (e.g., “ethane” or “ethylene”) in the
space provided.
CO 2 (Carbon Dioxide)
Biofuel/Alternate Fuel (including ethanol blends)
Fuel Grade Ethanol is denatured ethanol before it has been mixed with a
petroleum product or other hydrocarbon; sometimes also referred to as
neat ethanol.
Ethanol Blend is ethanol plus a petroleum product such as gasoline. Such
mixtures may be referred to as E10 or E85, for example, representing a
10% or 85% blend respectively. In the space provided, specify the
percentage of ethanol in the mixture. Blends greater than 95% ethanol
should be reported as Fuel Grade Ethanol.
Biodiesel is a diesel liquid distilled from biological feedstocks vs. crude
oil. Biodiesel is typically shipped as a blend mixed with a petroleum
product. Report the percentage biodiesel in the blend as shown. For pure
biodiesel, report 100.
General Information for Questions 9, 10, and 11:
Estimate volumes in barrels. Barrel means a unit of measurement equal to 42 U.S.
standard gallons. If less than 1 barrel, report to 1 decimal place using the conversion table
below. De minimus volumes, including but not limited to those which sometimes result in
some form of ignition, are to be reported as 0.1 barrels.
If estimated volume
is
<5 gallons
5-10 gallons
Report
If estimated volume
is
0.1 barrels
0.2 barrels
24-27 gallons
28-31 gallons
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Report
0.6 barrels
0.7 barrels
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11-14 gallons
15-18 gallons
19-23 gallons
0.3 barrels
0.4 barrels
0.5 barrels
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32-35 gallons
36-39 gallons
40-42 gallons
0.8 barrels
0.9 barrels
1.0 barrels
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9. Estimated volume of commodity released unintentionally
Estimate the amount of commodity released at the failure site. Liquid volume intentionally
removed from the pipeline system in a controlled manner at locations remote from the
failure site are excluded from both Volume Spilled (Part A9) and Volume Recovered (Part
A11). Do not include product consumed by fire in the spill volume, but do include the cost
of this commodity in D8. An estimate of the volume released may be based on a variety
and/or combination of inputs, including:
• calculations made by hydraulic engineers
• volume added to the pipeline segment to repack the line when the line is
placed back in service
• measured volume of free phase commodity recovered, with allowances for
commodity that is not recovered.
• volume calculated to be absorbed by soil or water
• volume calculated to have been lost to evaporation (e.g., for gasoline
spills)
10. Estimated volume of intentional and/or controlled release/blowdown
This section is completed only for HVL and CO2 releases. Estimate the amount of
commodity that was released during any intentional release or controlled blowdown
conducted as part of responding to or recovering from the accident. Intentional and
controlled blowdown implies a level of control of the site and situation by the operator such
that the area and the public are protected during the controlled release.
11. Estimated volume of commodity recovered
Recovered means the commodity is no longer in the environment. The commodity could
have been removed by: absorbent pads or similar mechanisms; transferring to temporary
storage such as a vacuum truck, a frac tank, or similar vessel; soil removal; bio-remediation;
or other similar means of removal or recovery. Liquid volume intentionally removed from
the pipeline system in a controlled manner at locations remote from the failure site are
excluded from both Volume Spilled (Part A9) and Volume Recovered (Part A11). The
volume recovered can be estimated based on a variety or combination of the measurement
of free phase commodity recovered, the amount calculated to be absorbed by soil or water
that was removed from the environment, measurement of oil extracted from absorbent pads,
etc.
12. Were there fatalities?
If a person dies at the time of the accident or within 30 days of the initial accident date due
to injuries sustained as a result of the accident, report as a fatality. If a person dies
subsequent to an injury more than 30 days past the accident date, report as an injury. (Note:
This aligns with the Department of Transportation's general guidelines for all jurisdictional
transportation modes for reporting deaths and injuries.)
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Contractor employees working for the operator are individuals hired to work for or on
behalf of the operator of the pipeline. These individuals are not to be reported as “Operator
employees”.
Non-Operator emergency responders are individuals responding to render professional
aid at the accident scene including on-duty and volunteer fire fighters, rescue workers,
EMTs, police officers, etc. “Good Samaritans” that stop to assist should be reported as
“General public.”
Workers Working on the Right of Way, but NOT Associated with this Operator means
people authorized to work in or near the right-of-way, but not hired by or working on
behalf of the operator of the pipeline. This includes all work conducted within the
right-of-way including work associated with other underground facilities sharing the
right-of-way, building/road construction in or across the right-of-way, or farming.
This category most often includes employees of other pipelines or underground
facilities operators, or their contractors, working in or near a shared right-of-way.
Workers performing work near, but not on, the right-of-way and who are affected
should be reported as “General public”.
13. Were there injuries requiring inpatient hospitalization?
Injuries requiring inpatient hospitalization are injuries sustained as a result of the accident
which require both hospital admission and at least one overnight stay.
See Question 12 for additional definitions that apply.
14. Was the pipeline/facility shut down due to the Accident?
Report any shutdowns that occur as a result of the accident, including but not limited to
those required for damage assessment, temporary repair, permanent repair, and clean-up.
If No is selected, explain the reason that no shutdown was needed in the space provided.
If Yes is selected, complete questions 14.a and 14.b.
14.a. Local time (24hr clock) and date of shutdown
14.b. Local time pipeline/facility restarted
The time is to be shown by 24-hour clock notation, and is to reflect the time in the time
zone where the accident was physically located. (See “Special Instructions”, numbers 9 and
10.) Enter the time and date the pipeline was isolated or equipment stopped in 14.a. The
affected facilities may still contain commodity at this time. Enter the time and date of
restart in 14.b. The intent with this data is to capture the total time that the pipeline or
facility is shutdown due to the accident. If the pipeline or facility has not been restarted at
the time of reporting, select “Still shut down” for Question 14.b and then include the restart
time and date in a future Supplemental Report.
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15. Did the Commodity Ignite?
Ignite means the released commodity caught fire.
16. Did the Commodity Explode?
Explode means the ignition of the released commodity occurred with a sudden and violent
release of energy.
17. Number of general public evacuated
The number of people evacuated is to be estimated based on operator knowledge, or police,
fire department, or other emergency responder reports. If there was no evacuation
involving the general public, report zero (0). If an estimate is not possible for some reason,
leave the field blank but include an explanation of why it was not possible to provide a
number in PART H – Narrative Description of the Accident.
18. Time sequence (use local time, 24-hour clock)
In 18a, enter the date/time the operator became aware of the failure. The earliest date/time
than an accident reporting criteria was met is reported in item A4. In some cases, the
operator may become aware of a failure before an accident reporting criteria is met. In
other cases, one of more accident reporting criteria may be met before the operator becomes
aware of the failure. In 18b, enter the date/time operator responders, company or contract,
arrived on site. Chronologically, 18b must be concurrent with or later than 18a. These
times are to be shown by 24-hour clock notation and reported in the time zone where the
accident occurred. (See “Special Instructions”, numbers 8 and 9.) PHMSA will use this
data to calculate incident response times.
PART B – ADDITIONAL LOCATION INFORMATION
1. Was the origin of the accident onshore?
Answer Yes or No as appropriate and complete only the designated questions.
If Onshore
2 – 5. Accident Location
Provide the state, zip code, city, and county/parish in which the accident occurred. If the
accident did not occur within a municipality, select Not Within Municipality in the City
field.
6. Operator-designated Location
This is intended to be the designation that the operator would use to identify the location of
the accident on its pipeline system. Enter the appropriate milepost/valve station or survey
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station number. This designator is intended to allow PHMSA personnel to both return to
the physical location of the accident using the operator’s own maps and identification
systems as well as to identify the “paper” location of the accident when reviewing operator
maps and records.
7. Pipeline/Facility Name
Multiple pipeline systems and/or facilities are often operated by a single operator. This
information identifies the particular pipeline system or pipeline facility name commonly
used by the operator on which the accident occurred, for example, the “West Line 24”
Pipeline”, or “Gulf Coast Pipeline”, or “Wooster Terminal”.
8. Segment name/ID
Within a given pipeline system and/or facility, there are typically multiple segment or
station identifiers, names, or ID’s which are commonly used by the operator. The
information reported here helps locate and/or record the more precise accident location, for
example, “Segment 4-32”, or “MP 4.5 to Wayne County Line”, or “Dublin Pump Station”,
or “Witte Meter Station”.
9. Was the Accident on Federal Lands other than Outer Continental Shelf?
Federal Lands other than Outer Continental Shelf means all lands the United States owns,
including military reservations, except lands in National Parks and lands held in trust for
Native Americans. Accidents at Federal buildings, such as Federal Court Houses, Custom
Houses, and other Federal office buildings and warehouses, are NOT to be reported as being
on Federal Lands.
10. Location of Accident
Operator-controlled Property would normally apply to an operator’s facility, which may
or may not have controlled access, but which is often fenced or otherwise marked with
discernible boundaries. This “operator-controlled property” does not refer to the pipeline
right-of-way, which is a separate choice for this question.
11. Area of Accident (as found)
This refers to the location on the pipeline at which commodity was released, resulting in the
accident. It does not refer to adjacent locations in which released commodity may have
accumulated or ignited.
Underground means pipe, components, or other facilities installed below the natural
ground level, road bed, or below the underwater natural bottom.
Under pavement includes under streets, sidewalks, paved roads, driveways, and parking
lots.
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Exposed due to Excavation means that a normally buried pipeline had been exposed by
any party (operator, operator’s contractor, or third party) preparatory to or as a result of
excavation. The cause of the release, however, may or may not necessarily be related to
excavation damage. This category could include a corrosion leak not previously evidenced
by stained vegetation, but found during an ILI dig, or a release caused by a non-excavation
vehicle where contact happened to occur while the pipeline was exposed for a repair or
examination. Natural forces might also damage a pipeline that happened to be temporarily
exposed. In each case, the cause should be appropriately reported in PART G of this form.
Aboveground means pipe, components, or other facilities that are above the natural grade.
Typical aboveground facility piping includes any pipe or components installed
aboveground such as those at pump stations, valve sites, and breakout tank farms.
Transition area means the junction of differing material or media between pipes,
components, or facilities such as those installed at a belowground-aboveground junction
(soil/air interface), another environmental interface, or in close contact to supporting
elements such as those at water crossings, pump stations and break out tank farms.
12. Did Accident occur in a crossing?
Use Bridge Crossing if the pipeline is suspended above a body of water or roadway,
railroad right-of-way, etc., either on a separately designed pipeline bridge or as a part of or
connected to a road, railroad, or passenger bridge.
Use Railroad Crossing or Road Crossing, as appropriate, if the pipeline is buried beneath
rail bed or road bed.
Use Water Crossing if the pipeline is in the water, beneath the water, in contact with the
natural ground of the lake bed, etc., or buried beneath the bed of a lake, reservoir, stream or
creek, whether the crossing happens to be flowing water at the time of the accident or not.
The name of the body of water should be provided if it is commonly known and understood
among the local population. (The purpose of this information is to allow persons familiar
with the area in which the accident occurred to identify the location and understand it in its
local context. Research to identify names that are not commonly used is not necessary since
such names would not fulfill the intended purpose. If a body of water does not have a name
that is commonly used and understood in the local area, this field may be left blank).
For Approximate Water Depth (ft) of the lake, reservoir, etc., estimate the typical water
depth at the location of the accident, ignoring seasonal, weather-related, and other factors
which may affect the water depth from time to time.
If Offshore
13. Approximate water depth (ft.), at the point of the Accident
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This is be the estimated depth from the surface of the water to the seabed at the point of the
accident regardless of whether the pipeline is below/on the bottom, underwater but
suspended above the bottom, or above the surface (e.g., on a platform).
14. Origin of the Accident
Area and Tract/Block numbers are to be provided for either State or OCS waters, whichever
is applicable.
For Nearest County/Parish, as with the name of an onshore body of water (see Question 12
above), the data collected is intended to allow persons familiar with the area in which the
accident occurred to identify the location and understand it in its local context.
Accordingly, it is not necessary to take measurements to determine which county/parish is
“nearest” in cases where the accident location is approximately equidistant from two (or
more). In such cases, the name of one of the nearby counties/parishes is to be provided.
PART C – ADDITIONAL FACILITY INFORMATION
1. Is the pipeline or facility [Interstate or Intrastate]?
As defined in section 195.2, Interstate pipeline means a pipeline or that part of a pipeline
that is used in transportation of hazardous liquids or carbon dioxide in interstate or foreign
commerce.
As defined in section 195.2, Intrastate pipeline means a pipeline or that part of a pipeline
to which Part 195 applies that is not an interstate pipeline.
Operators may refer to Appendix A of Part 195 for further guidance.
3. Item involved in Accident
Pipe (whether pipe body or pipe seam) means the pipe through which the commodity is
transported, not including auxiliary piping, tubing or instrumentation.
Nominal diameter of pipe is also called Nominal pipe size. It is the diameter in whole
number inches (except for pipe less than 4”) used to describe the pipe size; for example, 85/8 pipe has a nominal pipe size of 8”. Decimals are unnecessary for this measure (except
for pipe less than 4”).
Enter pipe wall thickness in inches. Wall thickness is typically less than an inch, and is
standard among different pipeline types and manufacturers. Accordingly, use three decimal
places to report wall thickness: 0.312, 0.281, etc.
SMYS means specified minimum yield strength and is the yield strength prescribed by the
specification under which the material is purchased from the manufacturer.
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Pipe Specification is the specification to which the pipe was manufactured, such as API 5L
or ASTM A106.
Pipe seam means the longitudinal seam (longitudinal weld) created during manufacture of
the joint of pipe.
Pipe Seam Type Abbreviations
SAW means submerged arc weld
ERW means electric-resistance weld
DSAW means double submerged arc weld
Auxiliary piping means piping, usually small in diameter that supports the operation of the
mainline or facility piping and does not include tubing. Examples of auxiliary piping
include discharge and drain lines, sample lines, etc.
If the accident occurred on an item not provided in this section, select “Other” and
specify the item that failed in the space provided.
6. Type of Accident involved (select only one)
Mechanical puncture means a puncture of the pipeline, typically by a piece of equipment
such as would occur if the pipeline were pierced by directional drilling or a backhoe bucket
tooth. Not all excavation-related damage will be a “mechanical puncture.” (Precise
measurement of size – e.g., micrometer – is not needed. Approximate measurements can be
provided in inches and one decimal.)
Leak means a failure resulting in an unintentional release of the transported commodity
that is often small in size, usually resulting in a low flow release of low volume, although
large volume leaks can and do occur on occasion.
Rupture means the pipeline facility has burst, split, or broken and the operation of the
pipeline facility is immediately impaired. Pipeline ruptures often result in a higher flow
release of larger volume. The terms “circumferential” and “longitudinal” refer to the
general direction or orientation of the rupture relative the pipe’s axis. They do not
exclusively refer to a failure involving a circumferential weld such as a girth weld, or to a
failure involving a longitudinal weld such as a pipe seam. (Precise measurement of size –
e.g., micrometer – is not needed. Approximate measurements can be provided in inches and
one decimal.)
PART D – ADDITIONAL CONSEQUENCE INFORMATION
Per 195.450, High Consequence Area means:
1. A commercially navigable waterway, which means a waterway where a
substantial likelihood of commercial navigation exists;
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2. A high population area, which means an urbanized area as defined and
delineated by the Census Bureau that contains 50,000 or more people and has a
population density of at least 1,000 people per square mile;
3. An other populated area, which means a place as defined and delineated by
the Census Bureau that contains a concentrated population, such as an
incorporated or unincorporated city, town, village, or other designated
residential or commercial area;
4. An unusually sensitive area, as defined in §195.6
*
*
*
*
*
5.b Estimated amount released in or reaching water
An estimate of the volume released in or reaching water may be based on a variety and/or
combination of inputs, including those mentioned above for PART A, Questions 9 and 10.
5.c Name of body of water, if commonly known:
The name of the body of water should be provided if it is commonly known and understood
among the local population. The purpose of this information is to allow persons familiar
with the area in which the accident occurred to identify the location and understand it in its
local context. Research to identify names that are not commonly used is not necessary since
such names would not fulfill the intended purpose. If a body of water does not have a name
that is commonly used and understood in the local area, this field should be left blank.
6. At the location of this Accident, had the pipeline segment or facility been identified
as one that “could affect” a High Consequence Area (HCA) as determined in the
Operator’s Integrity Management Program?
This question should be answered based on the classification of the involved segment in the
operator’s integrity management (IM) program at the time of the accident, whether or not
consequences to an HCA ensued. It is possible that a release on a pipeline segment that
“could affect” an HCA might not actually affect an HCA. It is also possible that releases
from segments thought not able to affect an HCA might have such an affect. This could
indicate a deficiency in the operator’s IM program for identifying segments that can affect
HCAs, and all of this information is useful for PHMSA’s overall evaluations concerning the
efficacy of IM regulation.
7. Did the released commodity reach or occur in one or more High Consequence Area
(HCA)?
Generally, a spilled commodity will have “reached” an HCA if the spill zone intersects the
boundaries of the HCA polygon as mapped by the National Pipeline Mapping System. The
HCA maps should be available as a part of each operator’s Integrity Management Program
as per §195.452.
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Guidance from the Pipeline Performance Tracking System (PPTS) is available
at
http://www.api.org/oil-and-natural-gas-overview/transporting-oil-and-naturalgas/pipeline-performance-ppts/ppts-related-files.aspx, specifically PPTS Advisory 2004-1.
7.a. HCA Type (select all that apply)
Refer to the definitions in §195.450 listed at the start of Part D. Leave this question
blank if the released commodity did not reach or occur in a High Consequence Area.
8. Estimated Property Damage
All relevant costs available at the time of submission must be included on the initial written
Accident Report as well as being updated as needed on Supplemental Reports. This
includes (but is not limited to) costs due to property damage to the operator’s facilities and
to the property of others, commodity lost, facility repair and replacement, and
environmental cleanup and damage. Do NOT include costs incurred for facility repair,
replacement, or change that are NOT related to the accident and which are typically done
solely for convenience. An example of doing work solely for convenience is working on
non-leaking facilities unearthed because of the accident. Litigation and other legal expenses
related to the accident are not reportable.
Operators are to report costs based on the best estimate available at the time a report is
submitted. It is likely that an estimate of final repair costs may not be available when the
initial report must be submitted (30 days, per §195.54). The best available estimate of these
costs should be included in the initial report. For convenience, this estimate can be revised,
if needed, when Supplemental Reports are filed for other reasons, however, when no other
changes are forthcoming, Supplemental Reports are to be filed as new cost information
becomes available. If Supplemental Reports are not submitted for other reasons, a
Supplemental Report is to be filed for the purpose of updating or correcting the estimated
cost if these costs differ from those already reported by 20 percent or $20,000, whichever is
greater.
Public and Non-operator private property damage estimates generally include physical
damage to the property of others, the cost of environmental investigation and remediation of
a site not owned or operated by the operator, laboratory costs, third party expenses such as
engineers or scientists, and other reasonable costs, excluding litigation and other legal
expenses related to the accident.
Cost of commodity lost includes the cost of the commodity not recovered and/or the cost
of recovered commodity downgraded to a lower value or re-processed, and is to be based on
the volume reported in PART A, Questions 9 and 11. The volume of commodity consumed
by fire is not included in A9, but the cost of the commodity should be included in this
section.
Operator’s property damage estimates generally include physical damage to the property
of the operator or owner company such as the estimated installed or replacement value of
the damaged pipe, coating, component, materials, or equipment due to the accident,
excluding litigation and other legal expenses related to the accident.
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When estimating the Cost of repairs to company facilities, the standard shall be the cost
necessary to safely restore pipeline facilities to the pre-accident level of service. Cost of
repairs include the cost to access, excavate, and repair the pipeline using methods,
materials, and labor necessary to re-establish operations. These costs may include the cost
of repair sleeves or clamps, re-routing of piping, or the removal from service of an
appurtenance, tank, or pipeline component. When more comprehensive repairs or
improvements are justified but not required for continued operation, the cost of such repairs
or replacement is not attributable to the accident. Costs associated with improvements to
the pipeline or other facilities to mitigate the risk of future failures are not included.
Estimated costs of Operator’s emergency response include emergency response
operations necessary to return the accident site to a safe state, actions to minimize the
volume of commodity released, conduct reconnaissance, identify the extent of accident
impacts, and contain, control, mitigate, recover, and remove the commodity from the
environment, to the maximum extent practicable. They include materials, supplies, labor,
and benefits. Costs related to stakeholder outreach, media response, etc. are not to be
included. The estimated costs of long-term remediation activities should be included in
Environmental Remediation estimates.
Environmental remediation includes the estimated cost to remediate a site such as those
associated with engineering, scientists, laboratory costs, and the installation, operation, and
maintenance of long-term recovery systems, etc.
Other costs are to include any and all costs which are not included above. Operators are to
NOT use this category to report any costs which belong in cost categories separately listed
above.
Costs are to be reported in only one category and are not to be double-counted. Costs can
be split between two or more categories when they overlap more than one reporting
category.
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PART E – ADDITIONAL OPERATING INFORMATION
1.Estimated Pressure
Enter the operating pressure, in psig, at the location and time of the accident.
2. Maximum Operating Pressure (MOP)
Enter the MAOP, in psig, at the point and time of the accident.
3.Pressure Description
The online reporting software will select the appropriate value.
4. Not including pressure reductions required by PHMSA regulations (such as for
repairs and pipe movement), was the system or facility relating to the Accident
operating under an established pressure restriction with pressure limits below those
normally allowed by the MOP?
Consider both voluntary and mandated pressure restrictions. A pressure restriction is to be
considered mandated by PHMSA or a state regulator if it was directed by an order or other
formal correspondence. Pressure reductions imposed by the operator as a result of
regulatory requirements, e.g., a pressure reduction taken because an anomaly identified
during an IM assessment could not be repaired within the required schedule
(§195.452(h)(3)), is not to be considered mandated by PHMSA.
5.a. Type of upstream valve used to initially isolate release source
Identify the type of valve used to initially isolate the release on the upstream side. In
general, this will be the first upstream valve selected by the operator to minimize the release
volume but may not be the closest to the accident site or the one that was eventually used
for the final isolation of the release site for repair.
5.b. Type of downstream valve used to initially isolate release source
Identify the type of valve used to initially isolate the release on the downstream side. In
general, this will be the first downstream valve selected by the operator to minimize the
release volume but may not be the closest to the accident site or the one that was eventually
used for the final isolation of the release site for repair.
5.c. Length of segment isolated between valves (ft)
Identify the length in feet between the valves identified in Questions 5.a and 5.b that were
initially used to isolate the spill area.
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5.f. Function of pipeline system
Gathering means a crude oil pipeline 8-5/8 inches or less nominal outside diameter that
transports petroleum from a production facility.
Trunkline/Transmission means all other pipeline assets not meeting the gathering
definition.
% SMYS means at the maximum operating pressure, the hoop stress created as a
percentage of the specified minimum yield strength (SMYS) of the pipe.
6. Was a Supervisory Control and Data Acquisition (SCADA)-based system in place
on the pipeline or facility involved in the Accident?
This does not mean a system designed or used exclusively for leak detection.
6.a. Was it operating at the time of the Accident?
Was the SCADA system in operation at the time of the accident?
6.b. Was it fully functional at the time of the Accident?
Was the SCADA system capable of performing all of its functions, whether or not it
was actually in operation at the time of the accident? If No, describe functions that
were not operational in PART H – Narrative Description of the Accident.
6.c and d. Did SCADA-based information (such as alarm(s), alert(s), event(s),
and/or volume calculations) assist with the detection (or confirmation) of the
Accident?
Select Yes if SCADA-based information was used to confirm the accident even if
the initial report or identification may have come from other sources. Use of
SCADA data for subsequent estimation of amount of commodity lost, etc. is not
considered use to confirm the accident.
Select No if SCADA-based information was not used to assist with identification of
the accident.
7. Was a CPM leak detection system in place on the pipeline or facility involved in the
Accident?
This means a system designed and used exclusively for leak detection.
Follow instructions for Question 6 above.
8. How was the Accident initially identified for the Operator? (select only one)
Controller per the definition in API RP 1168 means a qualified individual whose function
within a shift is to remotely monitor and/or control the operations of entire or multiple
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sections of pipeline systems via a SCADA system from a pipeline control room, and who
has operational authority and accountability for the daily remote operational functions of
pipeline systems.
Local Operating Personnel including contractors means employees or contractors
working on behalf of the operator outside the control room.
9. Was an investigation initiated into whether or not the controller(s) or control room
issues were the cause of or a contributing factor to the Accident?
Select only one of the choices to indicate whether an investigation was/is being conducted
(Yes) or was not conducted (No). If an investigation has been completed, select all the
factors that apply in describing the results of the investigation.
Cause means an action or lack of action that directly led to or resulted in the pipeline
accident.
Contributing factor means an action or lack of action that when added to the existing
pipeline circumstances heightened the likelihood of the release or added to the impact of the
release.
Controller Error means that the controller failed to identify a circumstance indicative of a
release event, such as an abnormal operating condition, alarm, pressure drop, change in
flow rate, or other similar event.
Incorrect Controller action means that the controller errantly operated the means for
controlling an event. Examples include opening or closing the wrong valve, or hitting the
wrong switch or button.
PART F – DRUG & ALCOHOL TESTING INFORMATION
Requirements for post-accident drug and alcohol tests are in 49 CFR §199.105 and
§199.225 respectively. If the accident circumstances were such that tests were not required
by these regulations, and if no tests were conducted, select No. If tests were administered,
select Yes and report separately the number of operator employees and number of
contractors working for the operator who were tested and the number of each that failed
such tests.
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PART G – APPARENT CAUSE
PART G – Apparent Cause
Select the one, single sub-cause listed under sections G1 thru G8 that best describes
the apparent cause of the Accident. These sub-causes are contained in the shaded
column on the left under each main cause category. Answer the corresponding
questions that accompany your selected sub-cause, and describe any secondary,
contributing, or root causes of the Accident in PART H – Narrative Description of the
Accident.
G1 – Corrosion Failure
Corrosion includes a release or failure caused by galvanic, atmospheric, stray current,
microbiological, or other corrosive action. A corrosion release or failure is not limited to a
hole in the pipe or other piece of equipment. If the bonnet or packing gland on a valve or
flange on piping deteriorates or becomes loose and leaks due to corrosion and failure of
bolts, it is to be classified as Corrosion. (Note: If the bonnet, packing, or other gasket has
deteriorated to failure, whether before or after the end of its expected life, but not due to
corrosive action, it is to be classified under G6 - Equipment Failure.)
External Corrosion
2. Type of corrosion – if Stress Corrosion Cracking, or other environmental cracking, was
the apparent cause, use section G5.
4.a. Under cathodic protection means cathodic protection in accordance with §195.563 or
§195.573(b). Recognizing that older pipelines may have had cathodic protection added
over a number of years, provide an estimate if the exact year cathodic protection started is
unknown.
Internal Corrosion
9. Location of corrosion
A low point in pipe includes portions of the pipe contour in which water might settle out.
This includes, but is not limited to, the low point of vertical bends at a crossing of a foreign
line or road/railroad, etc., an elbow, a drop out or low point drain.
10. Was the commodity treated with corrosion inhibitors or biocides?
Select Yes if corrosion inhibitors or biocides were included in the commodities transported.
12. Were cleaning/dewatering pigs (or other operations) routinely utilized?
13. Were corrosion coupons routinely utilized?
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For purposes of these Questions 12 and 13, “routinely” refers to an action that is performed
on more than a sporadic or one-time basis as part of a regular program with the intent to
ensure that water build-up and/or settling and internal corrosion do not occur.
Either External or Internal Corrosion
14. List the year of the most recent inspections
Complete this question only when any corrosion failure sub-cause is selected AND the item
involved in the accident (as reported in PART C, Question 3) is “Tank/Vessel”. Do not
complete if the item involved is Pipe, Weld, or any other item.
15.a. If Yes, for each tool used, select type of internal inspection tool and indicate most
recent year run
Magnetic Flux Leakage Tool is an in-line inspection tool using an imposed magnetic flux
to detect instances of pipe wall loss from corrosion. Includes low- and high-resolution MFL
tools. Does not include transverse flux MFL tools, which are a separate choice in this
question.
Ultrasonic refers to an in-line inspection tool that uses ultrasonic technology to measure
wall thickness and detect instances of wall loss.
Transverse Field/Triaxial tools are specialized magnetic flux leakage tools that use a flux
oriented to improve ability to detect crack anomalies.
Combination Tool refers to any in-line inspection tool that uses a combination of these
inspection technologies in a single tool.
16. Has one or more hydrotest or other pressure test been conducted since original
construction at the point of the Accident?
Information from the initial post-construction hydrostatic test is not to be reported.
17. Has one or more Direct Assessment been conducted on this segment?
This refers to direct assessment as defined in §195.553. Instances in which one or more
indirect monitoring tools (e.g., close interval survey, DCVG) have been used that might be
used as part of direct assessment but which were not used as part of the direct assessment
process defined in §195.553 do NOT constitute a Direct Assessment for purposes of this
question.
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G2 – Natural Force Damage
Natural Force Damage includes a release or failure resulting from earth movement,
earthquakes, landslides, subsidence, lightning, heavy rains/floods, washouts, flotation,
mudslide, scouring, temperature, frost heave, frozen components, high winds, or similar
natural causes.
Earth Movement, NOT due to Heavy Rains/Floods refers to accidents caused by land
shifts such as earthquakes, subsidence, or landslides, but not mudslides which are presumed
to be initiated by heavy rains or floods.
Heavy Rains/Floods refer to all water-related natural force causes. While mudslides
involve earth movement, report them here since typically they are an effect of heavy rains
or floods.
Lightning includes both damage and/or fire caused by a direct lighting strike and damage
and/or fire as a secondary effect from a lightning strike in the area. An example of such a
secondary effect would be a forest fire started by lightning that results in damage to a
pipeline system asset which results in an accident.
Temperature includes weather-related temperature and thermal stress effects, either heat or
cold, where temperature was the initiating cause.
Thermal stress refers to mechanical stress induced in a pipe or
component when some or all of its parts are not free to expand or contract
in response to changes in temperature.
Frozen components would include accidents where components are
inoperable because of freezing and those due to cracking of a piece of
equipment due to expansion of water during a freeze cycle.
High Winds includes damage caused by wind-induced forces. Select this category if the
damage is due to the force of the wind itself. Damage caused by impact from objects blown
by wind would be reported under G4 - Other Outside Force Damage.
Other Natural Force Damage. Select this sub-cause for types of Natural Force Damage
not included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
Answer Questions 6 and 6.a if the accident occurred in conjunction with an extreme
weather event such as a hurricane, tropical storm, or tornado. If an extreme weather event
related to something other than a hurricane, tropical storm, or tornado was involved,
indicate Other and describe the event in the space provided.
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G3 – Excavation Damage
Excavation Damage includes a release or failure resulting directly from excavation damage
by operator's personnel (oftentimes referred to as “first party” excavation damage) or by the
operator’s contractor (oftentimes referred to as “second party” excavation damage) or by
people or contractors not associated with the operator (oftentimes referred to as “third
party” excavation damage). Also, this section includes a release or failure determined to
have resulted from previous damage due to excavation activity. For damage from outside
forces OTHER than excavation which results in a release, use G2 - Natural Force Damage
or G4 - Other Outside Force, as appropriate. Also, for a strike, physical contact, or other
damage to a pipeline or facility that apparently was NOT related to excavation and that
results in a delayed or eventual release, report the accident under G4 as “Previous
Mechanical Damage NOT related to Excavation.”
Excavation Damage by Operator (First Party) refers to accidents caused as a result of
excavation by a direct employee of the operator.
Excavation Damage by Operator’s Contractor (Second Party) refers to accidents caused
as a result of excavation by the operator’s contractor or agent or other party working for the
operator.
Excavation Damage by Third Party refers to accidents caused by excavation damage
resulting from actions by personnel or other third parties not working for or acting on behalf
of the operator or its agent.
Previous Damage due to Excavation Activity refers to accidents that were apparently
caused by prior excavation activity and that then resulted in a delayed or eventual
release. Indications of prior excavation activity might come from the condition of the pipe
when it is examined, or from records of excavation at the site, or through metallurgical
analysis or other inspection and/or testing methods. Dents and gouges in the 10:00-to-2:00
o’clock positions on the pipe, for instance, may indicate an earlier strike, as might marks
from the bucket or tracks of an earth moving machine or similar pieces of equipment.
1.a. If Yes, for each tool used, select type of internal inspection tool and indicate most
recent year run
Magnetic Flux Leakage Tool is an in-line inspection tool using an imposed magnetic flux
to detect instances of pipe wall loss from corrosion. Includes low- and high-resolution MFL
tools. Does not include transverse flux MFL tools, which are a separate choice in this
question.
Ultrasonic refers to an in-line inspection tool that uses ultrasonic technology to measure
wall thickness and detect instances of wall loss.
Transverse Field/Triaxial tools are specialized magnetic flux leakage tools that use a flux
oriented to improve ability to detect crack anomalies.
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Combination Tool refers to any in-line inspection tool that uses a combination of these
inspection technologies in a single tool.
3. Has one or more hydrotest or other pressure test been conducted since original
construction at the point of the Accident?
Information from the initial post-construction hydrostatic test is not to be reported.
4. Has one or more Direct Assessment been conducted on this segment?
This refers to direct assessment as defined in §195.553. Instances in which one or more
indirect monitoring tools (e.g., close interval survey, DCVG) have been used that might be
used as part of direct assessment but which were not used as part of the direct assessment
process defined in §195.553 do not constitute a Direct Assessment for purposes of this
question.
7. – 17. Complete these questions for any excavation damage sub-cause. Instructions for
answering
these
questions
can
be
found
at
CGA’s
web
site, https://www.damagereporting.org/dr/control/userGuide.do.
G4 – Other Outside Force Damage
Other Outside Force Damage includes, but is not limited to, a release or failure resulting
from non-excavation-related outside forces, such as nearby industrial, man-made, or other
fire or explosion; damage by vehicles or other equipment; failures due to mechanical
damage; and, intentional damage including vandalism and terrorism.
Nearby Industrial, Man-made or other Fire/Explosion as Primary Cause of Accident
applies to situations where the fire occurred before - and caused - the release. Examples of
such an accident would be an explosion or fire at a neighboring facility or installation
(chemical plant, tank farm, other industrial facility) or structure, debris, or brush/trees that
results in a release at the operator’s pipeline or facility. This includes forest, brush, or
ground fires that are caused by human activity. If the fire, however, is known to have been
started as a result of a lightning strike, the accident’s cause is to be classified under G2 Natural Force Damage. Arson events directed at harming the pipeline or the operator
should be reported as G4 - Intentional Damage (see below).
Damage by Car, Truck, or Other Motorized Vehicle/Equipment NOT Engaged in
Excavation. An example of this sub-cause would be a stopple tee that releases commodity
when damaged by a pickup truck maneuvering near the pipeline. Other motorized vehicles
or equipment include tractors, backhoes, bulldozers and other tracked vehicles, and heavy
equipment that can move. Include under this sub-cause accidents caused by vehicles
operated by the pipeline operator, the pipeline operator’s contractor, or a third party, and
specify the vehicle/equipment operator’s affiliation from one of these three groups.
Pipeline accidents resulting from vehicular traffic loading or other contact should also be
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reported in this category. If the activity that caused the release involved digging, drilling,
boring, grading, cultivation or similar activities, report under G3 - Excavation Damage.
Damage by Boats, Barges, Drilling Rigs, or Other Maritime Equipment or Vessels Set
Adrift or Which Have Otherwise Lost Their Mooring. This sub-cause includes impacts
by maritime equipment or vessels (including their anchors or anchor chains or other
attached equipment) that have lost their moorings and are carried into the pipeline facility
by the current. This sub-cause also includes maritime equipment or vessels set adrift as a
result of severe weather events and carried into the pipeline facility by waves, currents, or
high winds. In such cases, also indicate the type of severe weather event. Do NOT report
in this sub-cause accidents which are caused by the impact of maritime equipment or
vessels while they are engaged in their normal or routine activities; such accidents are to be
reported as “Routine or Normal Fishing or Other Maritime Activity NOT Engaged in
Excavation” under this section G4 (see below) so long as those activities are not excavation
activities. If those activities are excavation activities such as dredging or bank stabilization
or renewal, the accident is to be reported under G3 - Excavation Damage.
Routine or Normal Fishing or Other Maritime Activity NOT Engaged in Excavation.
This sub-cause includes accidents due to shrimping, purse seining, oil drilling, or oilfield
workover rigs, including anchor strikes, and other routine or normal maritime-related
activities UNLESS the movement of the maritime asset was due to a severe weather event
(this type of accident should be reported under “Damage by Boats, Barges, Drilling Rigs, or
Other Maritime Equipment or Vessels Set Adrift or Which Have Otherwise Lost Their
Mooring” in this section G4); or the accident was caused by excavation activity such as
dredging of waterways or bodies of water (this type of accident is to be reported under G3 Excavation Damage).
Electrical Arcing from Other Equipment or Facility such as a pole transformer or
adjacent facility’s electrical equipment.
Previous Mechanical Damage NOT Related to Excavation. This sub-cause covers
accidents where damage occurred at some time prior to the release that was apparently NOT
related to excavation activities, and would include prior outside force damage of an
unknown nature, prior natural force damage, prior damage from other outside forces, and
any other previous mechanical damage other than that which was apparently related to prior
excavation. Accidents resulting from previous damage sustained during construction,
installation, or fabrication of the pipe or weld from which the release eventually occurred
are to be reported under G5 - Material Failure of Pipe or Weld. (See this sub-cause for
typical indications of previous construction, installation, or fabrication damage.) Accidents
resulting from previous damage sustained as a result of excavation activities should be
reported under G3 – Previous Damage due to Excavation Activity. (See this sub-cause for
typical indications of prior excavation activity.)
Intentional Damage
Vandalism means willful or malicious destruction of the operator’s pipeline
facility or equipment. This category would include arson, pranks, systematic
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damage inflicted to harass the operator, motor vehicle damage that was inflicted
intentionally, and a variety of other intentional acts.
Terrorism, per 28 CFR §0.85 General Functions, includes the unlawful use of force
and violence against persons or property to intimidate or coerce a government, the
civilian population, or any segment thereof, in furtherance of political or social
objectives. Operators selecting this item are encouraged to also notify the FBI.
Theft of commodity or Theft of equipment means damage by any individual or
entity, by any mechanism, specifically to steal, or attempt to steal, the transported
commodity or pipeline equipment.
Other Describe in the space provided and, if necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
Other Outside Force Damage. Select this sub-cause for types of Other Outside Force
Damage not included otherwise, and describe in the space provided. If necessary, provide
additional explanation in PART H – Narrative Description of the Accident.
G5 – Material Failure of Pipe or Weld
Use this section to report material failures only if “Item Involved in accident” (PART C,
Question 3) is “Pipe” (whether “Pipe Body” or “Pipe Seam”) or “Weld.” Indicate how the
sub-cause was determined or if the sub-cause is still being investigated.
This section includes releases in or failures from defects or anomalies within the material of
the pipe body or within the pipe seam or other weld due to faulty manufacturing procedures,
defects resulting from poor construction, installation, or fabrication practices, and in-service
stresses such as vibration, fatigue, and environmental cracking.
Construction-, Installation-, or Fabrication-related includes a release or failure caused
by a dent, gouge, excessive stress, or some other defect or anomaly introduced during the
process of constructing, installing, or fabricating pipe and pipe welds, including welding or
other activities performed at the facility. Included are releases from or failures of wrinkle
bends, field welds, and damage sustained in transportation to the construction or fabrication
site. Not included are failures due to seam defects, which are to be reported as Original
Manufacturing-related (see below).
Original Manufacturing-related (NOT girth weld or other welds formed in the field)
includes a release or failure caused by a defect or anomaly introduced during the process of
manufacturing pipe, including seam defects and defects in the pipe body. This option is not
appropriate for wrinkle bends, field welds, girth welds, or other joints fabricated in the field.
Use this option for failures such as those due to defects of the longitudinal weld or
inclusions in the pipe body.
Environmental Cracking-related includes failures by Stress Corrosion Cracking, Sulfide
Stress Cracking, Hydrogen Stress Cracking or other environmental cracking mechanism.
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If Construction, Installation, Fabrication-related or Original Manufacturing-related is
selected, then select any contributing factors. Examples of Mechanical Stress include
failures related to overburden or loss of support.
G6 – Equipment Failure
This section applies to failures of items other than “Pipe” (“Pipe Body” or “Pipe Seam”)
or “Weld”.
Equipment Failure includes a release or failure resulting from: malfunction of
control/relief equipment including valves, regulators, or other instrumentation; failures of
compressors, or compressor-related equipment; failures of various types of connectors,
connections, and appurtenances; failures of the body of equipment, vessel plate, or other
material (including those caused by construction-, installation-, or fabrication-related and
original manufacturing-related defects or anomalies); and, all other equipment-related
failures.
Malfunction of Control/Relief Equipment. Examples of this type of accident cause
include: overpressurization resulting from malfunction of a control or alarm device; relief
valve malfunction; valves failing to open or close on command; or valves which opened or
closed when not commanded to do so. If overpressurization or some other aspect of this
accident was caused by incorrect operation, the accident should be reported under G7 Incorrect Operation.
ESD System Failure means failure of an emergency shutdown system.
Other Equipment Failure. Select this sub-cause for types of Equipment Failure not
included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
G7 – Incorrect Operation
Incorrect Operation includes a release or failure resulting from operating, maintenance,
repair, or other errors by facility personnel, including, but not limited to improper valve
selection or operation, inadvertent overpressurization, or improper selection or installation
of equipment.
Other Incorrect Operation. Select this sub-cause for types of Incorrect Operation not
included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
G8 – Other Accident Cause
This section is provided for accidents whose cause is currently unknown, or where
investigation into the cause has been exhausted and the final judgment as to the cause
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remains unknown, or where a cause has been determined which does not fit into any of the
main cause categories listed in sections G1 thru G7.
If the accident cause is known but doesn’t fit into any category in sections G1 thru G7,
select Miscellaneous and enter a description of the accident cause, continuing with a more
thorough explanation in PART H - Narrative Description of the Accident.
If the accident cause is unknown at the time of filing this report, select Unknown in this
section and specify one reason from the accompanying two choices. Once the operator’s
investigation into the accident cause is completed, the operator is to file a Supplemental
Report as soon as practicable either reporting the apparent cause or stating definitively that
the cause remains Unknown, along with any other new, updated, and/or corrected
information pertaining to the accident. This Supplemental Report is to include all new,
updated, and/or corrected information pertaining to all portions of the report form known at
this time, and not only that information related to the apparent cause.
Important Note: Whether the investigation is completed or not, or if the cause continues
to be unknown, Supplemental Reports are to be filed reflecting new, updated, and/or
corrected information as and when this information becomes available. In those cases in
which investigations are ongoing for an extended period of time, operators are to file a
Supplemental Report within one year of their last report for the accident even in those
instances where no new, updated, and/or corrected information has been obtained, with an
explanation that the cause remains under investigation in PART H – Narrative Description
of Accident. Additionally, final determination of the apparent cause and/or closure of the
investigation does NOT preclude the need for the operator’s filing of additional
Supplemental Reports as and when new, updated, and/or corrected information becomes
available.
PART H – NARRATIVE DESCRIPTION OF THE ACCIDENT
Concisely describe the accident, including the facts, circumstances, and conditions that may
have contributed directly or indirectly to causing the accident. Include secondary,
contributing, or root causes when possible, or any other factors associated with the cause
that are deemed pertinent. Use this section to clarify or explain unusual conditions, to
provide sketches or drawings, and to explain any estimated data. Operators submitting
reports on-line will be afforded the opportunity to attach/upload files (in PDF or JPG format
only) containing sketches, drawings, or additional data.
If you selected Miscellaneous in section G8, the narrative is to describe the accident in
detail, including all known or suspected causes and possible contributing factors.
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PART I – PREPARER AND AUTHORIZED SIGNATURE
The Preparer is the person who compiled the data and prepared the responses to the report
and who is to be contacted for more information (preferably the person most knowledgeable
about the information in the report or who knows how to contact the person most
knowledgeable). Enter the Preparer’s e-mail address if the Preparer has one, and the phone
and fax numbers used by the Preparer.
The Authorized Signer is responsible for assuring the accuracy and completeness of the
reported data. In addition to their title, a phone number and email address are to be
provided for the Authorized Signer.
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| File Type | application/pdf |
| Author | PHMSA |
| File Modified | 2015-06-04 |
| File Created | 2015-06-04 |