PHMSA F 7100.2.2 Incident Report—TYPE R (Reporting-Regulated) Gas Gatheri

Incident Reports for Natural Gas Pipeline Operators

New RR GG Incident Form and Instructions - PHMSA F 7100.2-2 2021-07-29

OMB: 2137-0635

Document [pdf]

Download: pdf | pdf

NOTICE: This report is required by 49 CFR Part 191. Failure to report can result in a civil penalty as provided in 49
USC 60122.

INCIDENT REPORT
TYPE R (Reporting-Regulated) GAS
GATHERING SYSTEMS

U.S. Department of Transportation
Pipeline and Hazardous Materials
Safety Administration

OMB NO: 2137-0635
Expires: TBD

Report Date
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 2137-0635. Public reporting for this collection
of information is estimated to be approximately 12 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

A1. Operator’s OPS-issued Operator Identification Number (OPID):

 Supplemental

 Final

A2. Name of Operator: auto-populated based on OPID
A3. Address of Operator:
A3a. Street Address:
A3b. City:
A3c. State:
A3d. Zip Code:

auto-populated based on OPID
auto-populated based on OPID
auto-populated based on OPID
auto-populated based on OPID

A4. Earliest local time (24-hr clock) and date an incident reporting criteria was met:
/

Hour

Month

Day

Year

A4a. Time Zone for local time (select only one)  Alaska
A4b. Daylight Saving in effect?
A5. Location of Incident:
Latitude:
/ / / . / /
Longitude: - / / / / . /

 Eastern  Central  Hawaii-Aleutian

 Mountain  Pacific.

 Yes  No
/
/

/
/

A6. Gas released: (select only one, based on predominant volume released)

 Natural Gas
 Landfill Gas
 Other Gas  Name:
A7. Estimated volume of gas released unintentionally:

A8. Estimated volume of intentional and controlled release/blowdown :
A9. Estimated volume of accompanying liquid released:

Form PHMSA F 7100.2.2 (11-2021)

/
/

/,/
/,/

/,/

/
/

Reproduction of this form is permitted

/ thousand standard cubic feet (mcf)
/ thousand standard cubic feet (mcf)

/ Barrels

Page 1 of 18

A10. Were there fatalities?  Yes  No
If Yes, specify the number in each category:
A10a. Operator employees

A10b. Contractor employees
working for the Operator

A10c. Non-Operator
emergency responders

A10d. Workers working on the
right-of-way, but NOT
associated with this Operator

A10e. General public

A10f. Total fatalities (sum of above)

calculated

A11. Were there injuries requiring inpatient hospitalization?
No
If Yes, specify the number in each category:

 Yes 

A11a. Operator employees

A11b. Contractor employees
working for the Operator

A11c. Non-Operator
emergency responders

A11d. Workers working on the
right-of-way, but NOT
associated with this Operator

A11e. General public

A11f. Total injuries (sum of above)

calculated

A12. What was the Operator’s initial indication of the Failure? (select only one)

 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 Incident
 Other _________________________________________________
A12a. If “Controller”, “Local Operating Personnel, including contractors”, “Air Patrol”, or “Ground Patrol by Operator or its contractor” is selected in
Question 12, specify the following: (select only one)

 Operator employee

 Contractor working for the Operator

A13. Local time Operator identified failure

Hour

Month

Day

Year

A14. Part of system involved in Incident: (select only one)






Aboveground Storage, Including Associated Equipment and Piping
Onshore Compressor Station Equipment and Piping
Onshore Regulator/Metering Station Equipment and Piping
Onshore Pipeline, Including Valve Sites

A15. Operational Status at time Operator identified failure (select only one)

 Post-Construction Commissioning
 Post-Maintenance/Repair
 Routine Start-Up
 Routine Shutdown
 Normal Operation, includes pauses during maintenance
 Idle
A16. If A15 = Routine Start-Up or Normal Operation, was the pipeline/facility shut down due to the incident?
 Yes  No  Explain: ______________________________________________________________________________
If Yes, complete Questions A16.a and A16.b: (use local time, 24-hr clock)
A16a. Local time and date of shutdown

A16b. Local time pipeline/facility restarted

Hour

Month
Month

Day

Year

 Still shut down*
*Supplemental Report required

If A12. = Notification from Emergency Responder skip A17.
A17a. Did the operator communicate with Local, State, or Federal Emergency Responders about the incident?

 Yes

 No

If No, skip A17b and c.
A17b. Which party initiated communication about the incident?

 Operator

 Local/State/Federal Emergency Responder

A17c. Local time of initial Operator and Local/State/Federal Emergency Responder communication
/ / / / /
/
Hour

A18. Local time operator resources arrived on site

Hour

Month

Day

Year

A19. Reserved

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 2 of 18

A20a. Local time (24-hr clock) and date of initial operator report to the National Response Center:
/

Hour

Month

Day

Year

A20b. Initial Operator National Response Center Report Number _____________________OR
 NRC Notification Required But Not Made
A20c. Additional NRC Report numbers submitted by the operator: _____________________
A21. Did the gas ignite?

 Yes

 No

If A21 = Yes, then answer A21a through d:
A21a.

Local time of ignition

Hour

Month

Day

A21b. How was the fire extinguished?
 Operator/Contractor  Local/State/Federal Emergency Responder
A21c. Estimated volume of gas consumed by fire (mcf):
A21d. Did the gas explode?

 Yes

Year

 Allowed to burn out  Other, specify:_________

(must be less than or equal to A7.)

 No

If A14. is “Onshore Pipeline, Including Valve Sites”, answer A22a through f
A22a. Initial action taken to control flow upstream of failure location
If Valve Closure, answer A22.b and c:

 Valve Closure  Operational Control - mandatory text field

A22b. Local time of final upstream valve closure

Hour

Month

Day

Year

A22c. Type of upstream valve used to complete upstream isolation of release source:
 Manual  Automatic
 Remotely Controlled
A22d. Initial action taken to control flow downstream of failure location
If Valve Closure, answer A22e and f.:

 Valve Closure  Operational Control - mandatory text field

A22e. Local time of final downstream valve closure

Hour

Month

Day

A22f. Type of downstream valve used to complete downstream isolation of release source:
 Manual  Automatic
 Remotely Controlled
A23. Number of general public evacuated: /

Form PHMSA F 7100.2.2 (11-2021)

/,/

Year

 Check Valve

Reproduction of this form is permitted

Page 3 of 18

PART B – ADDITIONAL LOCATION INFORMATION
B1. Type R Gas Gathering is always Onshore. Auto-populated based on A14
 Yes
B1a. Pipeline/Facility name: _______________________________
B1b. Segment name/ID: __________________________________
B2. State: /

B3. Zip Code: /

B4 ______________________
City

/ - /

B5______________________
County or Parish

B6. Operator designated location: (select only one)

B7.

 Milepost (specify in shaded area below)
 Survey Station No. (specify in shaded area below)
 Not Applicable (B7 will not accept data)

/___/___/___/___/___/___/___/___/___/___/___/___/___/

B8. Was Incident on Federal land, other than the Outer Continental Shelf (OCS)?

 Operator-controlled property

B9. Location of Incident: (select only one)

 Yes

 No

 Pipeline right-of-way

B10. Area of Incident (as found): (select only one)

 Underground  Specify:  Under soil  Under a building
 Under pavement  Exposed due to excavation
 Exposed due to loss of cover  In underground enclosed space (e.g., vault)  Other ________________
B10a. Depth-of-Cover (in): /

/,/

B10.b. Were other underground facilities found within 12 inches of the failure location?  Yes

 No

 Aboveground  Specify:  Typical aboveground facility piping or appurtenance
 Overhead crossing
 In or spanning an open ditch  Inside a building O Inside other enclosed space O Other _______________
 Transition Area  Specify:  Soil/air interface  Wall sleeve  Pipe support or other close contact area
 Other ____________________________
B11. Did Incident occur in a crossing?





 Yes

 No

If Yes, specify type:

Bridge crossing Specify:  Cased  Uncased
Railroad crossing (select all that apply)  Cased
Road crossing
(select all that apply)  Cased
Water crossing

Specify:

 Cased

 Uncased
 Uncased

 Bored/drilled
 Bored/drilled

 Uncased

Name of body of water, if commonly known: ______________________
Approx. water depth (ft) at the point of the Incident: / /,/ / / / OR  Unknown
(select only one of the following)
 Shoreline/Bank/Marsh 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
 Yes  No
Is this water crossing 100 feet or more in length from high water mark to high water mark?

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 4 of 18

PART C – ADDITIONAL FACILITY INFORMATION
C1. Is the pipeline or facility: (select only one)
 Interstate
 Intrastate
C2. Material involved in Incident: (select only one)







Carbon Steel
Plastic
Composite Metallic Reinforced
Composite Non-Metallic Reinforced
Other  *Specify: ____________________________________________

C3. Item involved in Incident: (select only one)

 Pipe  Specify:

 Pipe Body

If Pipe Body: Was this a Puddle/Spot Weld?
If C2. is Carbon Steel
C3b. Wall thickness (in):

 Pipe Seam
 Yes  No

/./

C3a. Nominal Pipe Size:

/./

C3c. SMYS (Specified Minimum Yield Strength) of pipe (psi):

C3d. Pipe specification: _____________________________

C3e. Pipe Seam

/,/

 Unknown

 DSAW
 Specify:  Longitudinal ERW - High Frequency  Single SAW  Flash Welded
 Longitudinal ERW - Low Frequency  Continuous Welded  Furnace Butt Welded
 Longitudinal ERW – Unknown Frequency
 Spiral Welded
 Lap Welded
 Seamless  Other ________________
 Unknown

C3f. Pipe manufacturer: _______________________________ OR
C3g. Pipeline coating type at point of Incident
 Epoxy
 Specify:

 Coal Tar
 Asphalt
 Polyolefin
 Extruded Polyethylene  Cold Applied Tape  Paint
 Composite
 None
 Other _______________________________
C3h. Coating field applied?  Yes  No  Unknown

If C2. is Plastic
C3i. If Plastic  Specify type:

 Polyvinyl Chloride (PVC)
 Polyethylene (PE)
 Cross-linked Polyethylene (PEX)
 Polybutylene (PB)
 Polypropylene (PP)
 Acrylonitrile Butadiene Styrene (ABS)
 Polyamide (PA)
 Cellulose Acetate Butyrate (CAB)
 Unknown
 Other: mandatory text field_

C3j. If Plastic  Specify Standard Dimension Ratio (SDR): /

or wall thickness: /

/./

 Unknown

C3k. If Polyethylene (PE) is selected as the type of plastic in C3j, specify PE Pipe Material Designation Code (i.e., 2406, 3408, etc.)
PE / / / / / or  Unknown

 Weld/Fusion, including heat-affected zone 

Specify:  Pipe Girth Weld  Pipe Plastic Fusion  Other Butt Weld  Fillet Weld
If Pipe Girth Weld is selected, complete items C3.a through h above.
Are any of the C3b through h values different on either side of the girth weld?  Yes  No
If Yes, enter the different value(s) below:
C3l. Wall thickness (in):

/./

C3m. SMYS (Specified Minimum Yield Strength) of pipe (psi):

C3n. Pipe specification: _____________________________ OR

/,/

 Unknown

 Specify:  Longitudinal ERW - High Frequency  Single SAW  Flash Welded
 Longitudinal ERW - Low Frequency  DSAW  Continuous Welded  Longitudinal ERW – Unknown Frequency
 Furnace Butt Welded  Spiral Welded  Lap Welded
 Seamless  Other, describe: ________________________

C3o. Pipe Seam

C3p. Pipe manufacturer: _______________________________

 Unknown

C3q. Pipeline coating type at point of Accident
 Specify:  Fusion Bonded Epoxy (FBE)

 Coal Tar  Asphalt  Polyolefin  Extruded Polyethylene
 Epoxy other than FBE  Cold Applied Tape  Paint  Composite  None  Other, describe: _______________

C3r. Coating field applied?

 Yes

 No

 Unknown

If Plastic Pipe Fusion is selected, complete items C3.a and c3.i through k above.

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 5 of 18

 Valve, excluding Regulator/Control Valves
 Mainline  Specify:  Butterfly  Check





















 Relief Valve
 Auxiliary or Other Valve

 Gate

 Plug

C3s. Mainline valve manufacturer:

 Ball  Globe  Other _______________
OR  Unknown

Compressor, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Meter, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Scraper/Pig Trap, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Odorization System, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Filter/Strainer/Separator, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Dehydrator/Drier/Treater/Scrubber, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and
tubing.
Regulator/Control Valve, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Pulsation Bottle or Drip/Drip Collection Device
Cooler or Heater, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Repair Sleeve or Clamp
Hot Tap Equipment
Tap Fitting (stopple, thread-o-ring, weld-o-let, etc.)
Flange Assembly, including Gaskets
ESD System, including auxiliary piping, connections, valves, and equipment, but excluding product drain lines and tubing.
Drain Lines
Tubing, including Fittings
C3t. Tubing material (select only one):
Stainless steel
Carbon steel
Copper
Other
C3u. Type of tubing (select only one):
Rigid
Flexible
Instrumentation, including Programmable Logic Controllers and Controls
Other ___________________________________

C4. Year item involved in Incident was installed:

C5. Year item involved in Incident was manufactured:

/
/

 Unknown

/ OR
/

 Unknown

C6. Type of release involved: (select only one)

 Mechanical Puncture  Approx. size: /__/__/__/__/./__/in. (axial) by /__/__/__/__/./__/in. (circumferential)
 Leak  Select Type:  Pinhole
 Crack
 Connection Failure
 Seal or Packing
 Other
 Rupture  Select Orientation:  Circumferential
 Longitudinal
 Other ________________________________
Approx. size: /__/__/__/__/./__/ in. (widest opening) by /__/__/__/__/__/./__/in. (length circumferentially or axially)

 Other



*Describe: ___________________________________________________________________

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 6 of 18

PART D – ADDITIONAL CONSEQUENCE INFORMATION
D1. Class Location of Incident: (select only one)
 Class 1 Location

 Class 2 Location
D2. Estimated Property Damage:
D2a. Estimated cost of public and non-Operator private property damage

/,/

D2b. Estimated cost of Operator’s property damage & repairs

/,/

D2c. Estimated cost of emergency response

/,/

D2d. Estimated other costs

/,/

Describe: _______________________________
D2e. Total estimated property damage (sum of above)

$ calculated

Cost of Gas Released
Cost of Gas in $ per thousand standard cubic feet (mcf): ______________
D2f. Estimated cost of gas released unintentionally

$ calculated

D2g. Estimated cost of gas released during intentional and controlled blowdown

$ calculated

D2h. Total estimated cost of gas released (sum of 7.f & 7.g above)

$ calculated

D2i. Estimated Total Cost (sum of D7e and D7h)

$ calculated

Injured Persons not included in A11 The number of persons injured, admitted to a hospital, and remaining in the hospital for at least one overnight
are reported in A11. If a person is included in A11, do not include them in D3.
D3. Estimated number of persons with injuries requiring treatment in a medical facility but not requiring overnight in-patient hospitalization:
If a person is included in D3, do not include them in D4.
D4. Estimated number of persons with injuries requiring treatment by EMTs at the site of incident:
Buildings Affected
D5. Number of residential buildings affected (evacuated or required repair or gas service interrupted):
D6. Number of business buildings affected (evacuated or required repair or gas service interrupted):
D7. Wildlife impact:
 Yes  No
D7a. If Yes, specify all that apply:
 Fish/aquatic

 Birds
 Terrestrial

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 7 of 18

PART E – ADDITIONAL OPERATING INFORMATION
E1. Estimated pressure at the point and time of the Incident (psig):

/,/

E1a. Estimated gas flow in pipe segment at the point and time of the incident (MSCF/D):

E2. Maximum Allowable Operating Pressure (MAOP) at the point and time of the Incident (psig) :

/,/

/
/

/ or  Not Determined

E3-E5 Reserved
If A14. is “Onshore Pipeline, Including Valve Sites”, answer E6 through E8.
E6. Length of segment between upstream and downstream shut-off valves closest to failure location (ft):

/,/

E7 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:______________________________
E8 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:_______________________________

E9 Was a Supervisory Control and Data Acquisition (SCADA)-based system in place on the pipeline or facility involved in the Incident?
 No
 Yes  E9.a Was it operating at the time of the Incident?
 Yes
 No

 Yes
 No
E9.b Was it fully functional at the time of the Incident?
E9.c Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume or pack calculations) assist with
the initial indication of the Incident?
 Yes
 No
E9.d Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist with the
confirmed discovery of the Incident?
 Yes
 No
E10 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 Incident?
(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 Incident
 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: ____________________________________

PART F – RESERVED

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 8 of 18

Select only one box from PART G in the shaded column on the
left representing the APPARENT Cause of the Incident, and
answer the questions on the right. Enter secondary, contributing,
or root causes of the Incident in Part K – Contributing Factors.

PART G – APPARENT CAUSE
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
 Selective Seam  Other ____________________________________
2a. If 2 is Stray Current, specify  Alternating Current  Direct Current
AND
2b. Describe the stray current source: ___________________________
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 or submerged?
 Yes  4a. Was failed item considered to be under cathodic
protection at the time of the incident?
 Yes  Year protection started: / / / / /

 No

4b. Was shielding, tenting, or disbonding of coating
evident at the point of the incident?
 Yes  No
4c. Has one or more Cathodic Protection Survey been
conducted at the point of the incident? (select all that
apply)
 Yes, CP Annual Survey Most recent year conducted / / / /

 Yes, Close Interval SurveyMost recent year conducted/ / / / /
 Yes, Other CP Survey  Most recent year conducted: / / / / /
Describe other CP survey ___________________________________

 No

 No  4d. Was the failed item externally coated or painted?
 Yes  No
5. Was there observable damage to the coating or paint in the vicinity of
the corrosion?
 Yes  No  N/A Bare/Ineffectively Coated Pipe

 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  Erosion
 Other ______________________________________________
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  Drop-out  Dead-Leg
 Other ______________________________________________
10. Was the gas/fluid treated with corrosion inhibitors or biocides?
 Yes  No
11. Was the interior coated or lined with protective coating?
 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

Form PHMSA F 7100.2.2 (11-2021)

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Page 9 of 18

 No

G2 - Natural Force Damage - only one sub-cause can be picked from shaded left-hand column

 Earth Movement, NOT due to Heavy Rains/Floods

1. Specify:  Earthquake  Subsidence
 Other __________________

 Landslide

 Heavy Rains/Floods

2. Specify:  Washout/Scouring
 Other _______________

 Flotation  Mudslide

 Lightning

3. Specify:
nearby fires

 Direct hit  Secondary impact such as resulting

 Temperature

4. Specify:

 Thermal Stress
 Frozen Components

 Frost Heave
 Other

________________________________

 High Winds
 Trees/Vegetation Roots
 Snow/Ice impact or Accumulation
5. Describe: __________________________

 Other Natural Force Damage
Complete the following if any Natural Force Damage sub-cause is selected.

6. Were the natural forces causing the Incident generated in conjunction with an extreme weather event?
6a. If Yes, specify: (select all that apply)

Form PHMSA F 7100.2.2 (11-2021)

 Yes

 No

 Hurricane  Tropical Storm
 Tornado
 Other ______________________________

Reproduction of this form is permitted

Page 10 of 18

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 the following if any Excavation Damage sub-cause is selected.
1. Did the operator get prior notification of the excavation activity?

 Yes  No
 One-Call System

1a. If Yes, Notification received from: (select all that apply)
 Excavator  Contractor
1b. Per the primary Incident Investigator results, did State law exempt the excavator from notifying the one-call center?
 Yes  No  Unknown
If yes, answer 1c. through 1e.
1c. select one of the following:
 Excavator is exempt
 Activity is exempt and did not exceed the limits of the exemption
 Activity is exempt and exceeded the limits of the exemption
 Other mandatory text field: _______________________________________
1d. Exempting authority
_
1e. Exempting criteria
___
2. Do you want PHMSA to upload the following information to CGA-DIRT (www.cga-dirt.com)?

Yes

 Landowner

 No

3. Right-of-Way where event occurred: (select all that apply)

 Public  Specify:  City Street  State Highway  County Road  Interstate Highway  Other
 Private  Specify:  Private Landowner  Private Business  Private Easement
 Pipeline Property/Easement
 Power/Transmission Line
 Railroad
 Dedicated Public Utility Easement
 Federal Land
 Unknown/Other
4 Was the facility part of a Joint Trench?
5. Did this event involve a Cross Bore?

 No

Yes

 No

Yes

6. Measured Depth from Grade (select only one)
 Embedded in Concrete/Asphalt Pavement  <18 inches
 Measured depth from grade __________ inches

 18 – 36 inches

 > 36 inches

7. Type of excavator: (select only one)

 Contractor
 Railroad

 County
 State

 Developer
 Utility

 Farmer
 Municipality
 Unknown/Other

 Occupant

8. Type of excavation equipment: (select only one)

 Auger
 Explosives
 Probing Device

 Backhoe/Trackhoe
 Farm Equipment
 Trencher

 Boring
 Grader/Scraper
 Vacuum Equipment

 Drilling
 Hand Tools
 Bulldozer

 Directional Drilling
 Milling Equipment
 Unknown/Other

9. 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

10. Was the One-Call Center notified?

 Yes

10a. 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 If No, skip to question 11
/

10b. If this is a State where more than a single One-Call Center exists, list the name of the One-Call Center notified:
10c. Was work area white lined?
11. Type of Locator:

 No

 Yes

 Facility Owner

 Unknown

 Contract Locator

12. Were facility locate marks visible in the area of excavation?

 No

 Yes

13. Did the damage cause an interruption in service?

 No

 Yes

13a. If Yes, specify duration of the interruption:

Form PHMSA F 7100.2.2 (11-2021)

 Unknown/Other
 Unknown
 Unknown/Other

/___/___/___/___/ hours

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Page 11 of 18

14. Description of the CGA-DIRT Root Cause (select the predominant CGA-DIRT Root Cause from the list below):
Notification Issue
 No notification made to the One-Call Center/811
☐ Excavator dug outside area described on ticket
☐ Excavator dug prior to valid start date/time
☐ Excavator dug after valid ticket expired
☐ Excavator provided incorrect notification information
Excavation Issue
☐ Excavator dug prior to verifying marks by test-hole (pothole)
☐ Excavator failed to maintain clearance after verifying marks
☐ Excavator failed to protect/shore/support facilities
☐ Improper backfilling practices
☐ Marks faded or not maintained
☐ Improper excavation practice not listed above
Locating Issue
☐ Facility not marked due to Abandoned facility
☐ Facility not marked due to Incorrect facility records/maps
☐ Facility not marked due to Locator error
☐ Facility not marked due to No response from operator/contract locator
☐ Facility not marked due to Tracer wire issue
☐ Facility not marked due to Unlocatable Facility
☐ Facility marked inaccurately due to Abandoned facility
☐ Facility marked inaccurately due to Incorrect facility records/maps
☐ Facility marked inaccurately due to Locator error
☐ Facility marked inaccurately due to Tracer wire issue
Miscellaneous Root Causes
☐ Deteriorated facility
☐ One Call Center Error
☐ Previous damage
☐ Root Cause not listed (comment required):

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 12 of 18

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 Incident

 Damage by Car, Truck, or Other Motorized

1. Vehicle/Equipment operated by: (select only one)
 Operator  Operator’s Contractor  Third Party
If this sub-section is picked, please complete questions 5-11 below

 Damage by Boats, Barges, Drilling Rigs, or Other Maritime

2. Select one or more of the following IF an extreme weather event
was a factor:
 Hurricane
 Tropical Storm
 Tornado
 Heavy Rains/Flood
 Other
______________________________

Vehicle/Equipment NOT Engaged in Excavation

Equipment or Vessels Set Adrift or Which Have Otherwise
Lost Their Mooring

 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
 Intentional Damage

3. Specify:

 Other Outside Force Damage

4. Describe: _____________________________________________

 Vandalism
 Terrorism
 Theft of transported commodity  Theft of equipment
 Other ________________________________________

Complete the following if Damage by Car, Truck, or Other Motorized Vehicle/Equipment NOT Engaged in Excavation sub-cause is selected.
5. Was the driver of the vehicle or equipment issued one or more citations related to the incident?
If 5 is Yes, what was the nature of the citations (select all that apply)
5a. Excessive Speed
5b. Reckless Driving
5c. Driving Under the Influence
5e. Other, describe: _______________________
6. Was the driver under control of the vehicle at the time of the collision?

 Yes

 No  Unknown

7. Estimated speed of the vehicle at the time of impact (miles per hour)?_______________or  Unknown
8. Type of vehicle? (select only one)

 Motorcycle/ATV

 Passenger Car  Small Truck  Bus  Large Truck

9. Where did the vehicle travel from to hit the pipeline facility? (select only one)
 Roadway
 Driveway
 Parking Lot

 Loading Dock

 Off-Road

10. Shortest distance from answer in 9. to the damaged pipeline facility (in feet): .________________________
11. At the time of the Incident, were protections installed to protect the damaged pipeline facility from vehicular damage?

 Yes

 No

If 11. is Yes, specify type of protection (select all that apply):
11a. Bollards/Guard Posts
11b. Barricades – include Jersey barriers and fences in instructions
11c. Guard Rails
11d. Other, describe: _________________________________

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 13 of 18

G5 - Material Failure of Pipe or Weld, Only one sub-cause can be
picked from shaded left-hand column

Use this section to report material failures ONLY IF the “Item
Involved in Incident” (from PART C, Question 3) is “Pipe” or
“Weld.”

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)
 Design-, Construction-, Installation-, or Fabrication-related
 Original Manufacturing-related

(NOT girth weld or other welds formed in the field)

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:
Cracking

 Environmental Cracking-related

 Stress Corrosion Cracking

 Sulfide Stress

 Hydrogen Stress Cracking  Hard Spot
 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 __________________________________
5. Post-construction pressure test value (psig) /

Form PHMSA F 7100.2.2 (11-2021)

 Arc Burn  Crack
 Burnt Steel

 Lack of Fusion

 Unknown

Reproduction of this form is permitted

Page 14 of 18

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
 Pressure Regulator
 ESD System Failure
 Other _____________________________________________

 Compressor or Compressor-related Equipment

2. Specify:  Seal/Packing Failure
 Crack in Body
 Pressure Vessel Failure

 Body Failure
 Appurtenance Failure

 Other _______________________________________
 Threaded Connection/Coupling Failure

3. Specify:

 Pipe Nipple  Valve Threads  Mechanical Coupling
 Threaded Pipe Collar
 Threaded Fitting
 Other _______________________________________

 Non-threaded Connection Failure

4. Specify:

 O-Ring
 Gasket
 Seal (NOT compressor seal) or Packing
 Other___________________________________

 Defective or Loose Tubing or Fitting
 Failure of Equipment Body (except Compressor), Vessel
Plate, or other Material

5. Describe: ______________________________________________

 Other Equipment Failure
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
 Improper maintenance
 Mismatched items (different manufacturer for tubing and tubing fittings)
 Dissimilar metals
 Breakdown of soft goods due to compatibility issues with transported gas/fluid
 Valve vault or valve contributed to the release
 Alarm/status failure
 Misalignment
 Thermal stress
 Erosion/abnormal wear
 Other _______________________________________________________

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 15 of 18

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

 Valve Left or Placed in Wrong Position, but NOT
Resulting in an Overpressure
 Pipeline or Equipment Overpressured

 Equipment Not Installed Properly
 Wrong Equipment Specified or Installed
 Other Incorrect Operation

1. Describe:
__________________________________________________

Complete the following if any Incorrect Operation sub-cause is selected.
2. Was this Incident related to: (select all that apply)
 Inadequate procedure
 No procedure established
 Failure to follow procedure
 Other: ______________________________________________________
3. What category type was the activity that caused the Incident:
 Construction
 Commissioning
 Decommissioning
 Right-of-Way activities
 Routine maintenance
 Other maintenance
 Normal operating conditions
 Non-routine operating conditions (abnormal operations or emergencies)
G8 – Other Incident Cause - only one sub-cause can be picked from shaded left-hand column

 Miscellaneous

1. Describe:
______________________________________________

 Unknown

2. Specify

 Investigation complete, cause of Incident unknown

Mandatory comment field: ______________________

 Still under investigation, cause of Incident to be

determined*
(*Supplemental Report required)

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 16 of 18

PART J – RESERVED
PART K – CONTRIBUTING FACTORS
The Apparent Cause of the accident is contained in Part G. Do not report the Apparent Cause again in this Part K. If Contributing Factors were
identified, select all that apply below and explain each in the Narrative:
External Corrosion
Pipe/Weld Failure
 External Corrosion, Galvanic
 Design-related
 External Corrosion, Atmospheric

 Construction-related

 External Corrosion, Stray Current Induced

 Installation-related

 External Corrosion, Microbiologically Induced

 Fabrication-related

 External Corrosion, Selective Seam

 Original Manufacturing-related

Internal Corrosion
 Internal Corrosion, Corrosive Commodity

 Environmental Cracking-related, Stress Corrosion Cracking
 Environmental Cracking-related, Sulfide Stress Cracking

 Internal Corrosion, Water drop-out/Acid

 Environmental Cracking-related, Hydrogen Stress Cracking

 Internal Corrosion, Microbiological

 Environmental Cracking-related, Hard Spot

 Internal Corrosion, Erosion

Equipment Failure

Natural Forces
 Earth Movement, NOT due to Heavy Rains/Floods

 Malfunction of Control/Relief Equipment
 Compressor or Compressor-related Equipment

 Heavy Rains/Floods

 Threaded Connection/Coupling Failure

 Lightning

 Non-threaded Connection Failure

 Temperature

 Defective or Loose Tubing or Fitting

 High Winds

 Failure of Equipment Body (except Compressor), Vessel Plate,
or other Material

 Tree/Vegetation Root
Excavation Damage
 Excavation Damage by Operator (First Party)

Incorrect Operation

 Excavation Damage by Operator’s Contractor (Second Party)
 Excavation Damage by Third Party

 Damage by Operator or Operator’s Contractor NOT Excavation
and NOT Vehicle/Equipment Damage
 Valve Left or Placed in Wrong Position, but NOT Resulting in
Overpressure

 Previous Damage due to Excavation Activity
Other Outside Force
 Nearby Industrial, Man-made, or Other Fire/Explosion
 Damage by Car, Truck, or Other Motorized Vehicle/Equipment
NOT Engaged in Excavation
 Damage by Boats, Barges, Drilling Rigs, or Other Adrift
Maritime Equipment
 Routine or Normal Fishing or Other Maritime Activity NOT
Engaged in Excavation

 Pipeline or Equipment Overpressured
 Equipment Not Installed Properly
 Wrong Equipment Specified or Installed
 Inadequate Procedure
 No procedure established
 Failure to follow procedures

 Electrical Arcing from Other Equipment or Facility
 Previous Mechanical Damage NOT Related to Excavation
 Intentional Damage
 Other underground facilities buried within 12 inches of the
failure location

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 17 of 18

PART H – NARRATIVE DESCRIPTION OF THE INCIDENT

(Attach additional sheets as necessary)

__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
PART I – PREPARER AND AUTHORIZED PERSON

Preparer's Name (type or print)
Preparer's Title (type or print)

Preparer’s Telephone Number

Preparer's E-mail Address
Local Contact Name: optional
Local Contact Email: optional

Preparer’s Facsimile Number

Local Contact Phone: optional

Authorized Signer Telephone Number
Authorized Signer-Name

Authorized Signer’s Title
Authorized Signer’s E-mail Address

Form PHMSA F 7100.2.2 (11-2021)

Reproduction of this form is permitted

Page 18 of 18

Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

GENERAL INSTRUCTIONS
Each operator of a Type R reporting regulated gas gathering pipeline system shall file Form
PHMSA F 7100.2.2 for an incident that meets the criteria in 49 CFR §191.3 as soon as practicable
but not more than 30 days after detection of the incident. Requirements for submitting reports are
in §191.7 and §191.15.
The intentional and controlled release of gas for the purpose of maintenance or other routine
operating activities is not to be reported. For the volume reporting threshold, reports are required
if the volume of gas unintentionally released is 3 million cubic feet or more.
Form PHMSA F 7100.2.2 and these instructions can be found on
http://phmsa.dot.gov/pipeline/library/forms. The applicable documents are listed in the section
titled Accident/Incident/Annual Reporting Forms.

ONLINE REPORTING REQUIREMENTS
Incident 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 (2010 to present)” select “ODES 2.0”
5. Under “Create Reports” on the left side of the screen, select “Type R Reporting-Regulated
Gas Gathering” 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 Incident 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 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.

Page 1 of 29

Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

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 then 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
§191.7(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 incident in accordance with §191.15 (oftentimes referred to as a 30-day
written report) and upon subsequent investigation determines that the event did not meet the criteria
in §191.3 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 §191.5. 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.
Note: PHMSA no longer requests that operators rescind erroneously reported “Immediate Notices”
filed with the NRC in accordance with §191.5 (oftentimes referred to as “Telephonic Reports”).

Page 2 of 29

Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

SPECIAL INSTRUCTIONS
Certain data fields must be completed before an Original Report will be accepted. Your 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 best-available information
and reasonable effort.
4. For unknown or estimated data entries, the operator should file a Supplemental Report when
additional or more accurate information becomes available.
5. If the question is not applicable, 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 is not provided 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:
Time format Examples:
a. (0000) = midnight = /0/0/0/0/
b. (0800) = 8:00 a.m. = /0/8/0/0/
c. (1200) = Noon
= /1/2/0/0/
d. (1715) = 5:15 p.m. = /1/7/1/5/
e. (2200) = 10:00 p.m. = /2/2/0/0/

Page 3 of 29

Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Local time always refers to time at the site of the incident. Note that time zones at the
incident site may be different than the time zone for the person discovering or reporting the
event. For example, if a release occurs at a gas gathering 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 incident is to be reported as 1400 hours based on
the time in Denver, which is the physical site of the incident.

PART A – KEY 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 incident 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 becomes available and, per
§191.15(c), each Supplemental Report containing new, updated, and/or corrected information is to
be filed as soon as practicable. 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 as soon as practicable 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 as
provided in 49 USC 60122.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

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.
A1. 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 202-3668075 if you need assistance with an OPID. Business hours are 8:30 AM to 5:00 PM Eastern Time.
A2. 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.
A3. Address of Operator
For online entries, the headquarters 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.
A4. Earliest local time (24-hour clock) and date an incident reporting criteria was met
Enter the earliest local date/time an incident reporting criteria was met. Consequences occur
when the pipeline system fails, but the extent of the consequences are often not fully known until
hours, days, weeks, or months later.
For the fatality, injury, and property damage reporting criteria, enter the date/time that the
consequences first occurred rather than the date/time the consequences are fully quantified.
For the release volume reporting criteria, estimate the date/time when the amount of commodity
released reached the volume reporting criteria.
See “Special Instructions”, numbers 8 and 9 for examples of Date format and Time format
expressed as a 24-hour clock.
A4a. Select the local time zone where the Incident occurred (select only one).
A4b. Select “Yes” if Daylight Saving was in effect at the time of the Incident, or “No” if
it was not.
A5. Location of Incident

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

The latitude and longitude of the incident 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.
If you cannot locate the incident 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).
A6. Gas released
Select the type of gas released. Landfill Gas includes biogas.
Important Note for Questions 7, 8, and 9: Volumes consumed by fire and/or explosion are to be
included in the estimated volumes reported.
A7. Estimated volume of gas released unintentionally
Estimate the amount of gas that was released (in thousands of standard cubic feet, mcf) from the
beginning of the incident until such time as gas is no longer being released from the pipeline system
or until intentional and controlled blowdown has commenced. Estimates are to be based on bestavailable information. Important Note: Volumes consumed by fire and/or explosion are to be
included in the estimated volume reported.
The volumes released during an Emergency Shutdown (ESDs) or relief valve activation should be
reported. When ESDs or relief valves are activated as the result of a safety condition that has
occurred, the volume released should be included in the “unintentional” category, even if safety
equipment performed as designed (such as a power loss or upon a PLC command). This would
include when an employee intentionally activates the ESD in response to an unintentional safety
condition, such as a grass fire in the station yard.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

A8. Estimated volume of intentional and controlled release/blowdown
Estimate the amount of gas that was released (in thousands of standard cubic feet, mcf) during any
intentional release or controlled blowdown conducted as part of responding to or recovering from
the incident. 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.
Occasionally actions associated with response to an incident can involve activation of the
Emergency Shutdown (ESD) and associated relief equipment that occurs on a planned maintenance
basis after the incident initial safety response and the area has been evaluated for damage. For
example, an engine crankcase explosion has occurred and only one compressor in the area is
damaged. The immediate unintentional release was to activate the blowdown equipment associated
with this engine only. However, upon reviewing the damage, it was determined that the ESD
system should be activated for an entire station as more than one engine’s systems were affected
by the incident. The volume of intentional ESD release or associated relief devices that has
occurred after the evaluation in anticipation for the repairs should be included in the “intentional”
volume released.
A9. Estimated volume of accompanying liquid released
Estimate the amount of accompanying liquid that was spilled to the ground (or other containment)
as a liquid (in barrels) from the beginning of the incident until such time as the liquid is no longer
being released from the system. 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. Small
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
5-10
11-14
15-18
19-23

gallons
gallons
gallons
gallons
gallons

Report
0.1
0.2
0.3
0.4
0.5

barrels
barrels
barrels
barrels
barrels

If estimated volume
is
24-27
28-31
32-35
36-39
40-42

gallons
gallons
gallons
gallons
gallons

Report
0.6
0.7
0.8
0.9
1.0

barrels
barrels
barrels
barrels
barrels

A10. Were there fatalities?
If a person dies at the time of the incident or within 30 days of the initial incident date due to injuries
sustained as a result of the incident, report as a fatality. If a person dies subsequent to an injury
more than 30 days past the incident 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.)
Select “Yes” or “No” and if “Yes” is selected, enter the category of person(s) and number of
fatalities resulting from the Incident.
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”.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Non-Operator emergency responders are individuals responding to render professional aid at the
incident scene, including on-duty and volunteer fire fighters, rescue workers, EMTs, police officers,
etc. “Good Samaritans” that stop to assist are to 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 are to be reported as “General public”.
A11. Were there injuries requiring inpatient hospitalization?
Injuries requiring inpatient hospitalization are injuries sustained as a result of the incident and that
require both hospital admission and at least one overnight stay.
Select “Yes” or “No” and if “Yes” is selected, enter the category of person(s) and number of
fatalities resulting from the Incident.
See Question A10 for additional definitions that apply.
A12. What was the Operator’s initial indication of the Failure? (select only one)
Select the best option to describe the manner in which the operator initially identified the failure
resulting in this reported Incident.
Controller means a qualified individual whose function within a shift is to remotely monitor and/or
control the operations of entire or multiple 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.
A12a. If the Incident was identified by Operator’s personnel or a contractor working for the
Operator (including controller, air and ground patrols) in A12, identify if it was by an Operator
employee, or a contractor working for the Operator.
A13. When did the operator identify the failure?
Enter the date/time of the operator’s initial indication of the failure. The earliest date/time that an
incident reporting criteria was met is reported in item A4. In some cases, the operator may become
aware of a failure before an incident reporting criteria is met. In other cases, one or more incident
reporting criteria may be met before the operator becomes aware of the failure.
A14. What part of the system was involved in the Incident?

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Select the best description of the part of the system that was involved in the Incident. Only one
selection may be made.
A15. What was the operational status of the pipeline at the time the failure was identified?
Select the best description of the operating status of the pipeline system at the date/time reported
in A4.
Post-Construction Commissioning means the introduction of product, testing and
commissioning of the pipeline prior to the start of commercial operations.
Post-Maintenance/Repair means purging and packing of the pipeline when returning it to
service from maintenance or repairs.
Routine Start-Up means the start-up of the pipeline, facility or system in normal operations, or
returning from maintenance or other idle status following a time of no flow, but the where the
pipeline remained liquid full, and the start-up was being conducted under normal start-up
procedures.
Routine Shutdown means the stoppage of equipment or the system from a normal operation
status.
Normal Operation, include pauses during maintenance means the pipeline is operating
normally, and any of the maintenance that is occurring does not require product to be removed
from the pipeline or system. Product sampling, inhibitor injection, in-line inspection, installation
of repairs, and other activities covered by the operator’s Operation and Maintenance Procedures
are examples of the maintenance included in this category.
Idle means that the pipeline has been removed from service for commercial reasons or to make
repairs. The pipeline may contain product, an inert gas, or be empty. When residual product
accumulates in an excavation and ignites, Idle is the proper status.
A16. Was the pipeline/facility shut down due to the Incident?
If A15. is Routine Start-Up or Normal Operations, indicate if shutdown occurred as a result of the
incident, including but not limited to those required for damage assessment, temporary repair,
permanent repair, and clean-up. Do not include equipment shutdowns that do not affect the pipeline
or system operation. For example, if a compressor shutdown occurred as part of the incident, but
the pipeline was able to continue operating, select No. If No is selected, explain the reason that no
shutdown was needed in the space provided. A possible explanation for the example above would
be “The pipeline continued to operate through the station bypass piping and did not require a
pipeline shutdown.”
If Yes is selected, complete Questions 16a and 16b.
16a. Local time (24hr clock) and date of shutdown
16b. Local time pipeline/facility restarted

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

The time is to be shown by 24-hour clock notation, and is to reflect the time in the time zone where
the incident was physically located. (See “Special Instructions”, numbers 9 and 10.) Enter the time
and date the pipeline was isolated or equipment stopped in 16a. The affected facilities may still
contain gas at this time. Enter the time and date of restart in 16b. The intent with this data is to
capture the total time that the pipeline or facility is shutdown due to the incident. If the pipeline or
facility has not been restarted, select “Still shut down” for Question 15b and then include the restart
time and date in a future Supplemental Report.
A17. Operator Communication with Local, State, or Federal Emergency Responders
In an Advisory Bulletin dated October 11, 2012, PHMSA reminded Operators of the need to
communicate with Emergency Responders in the early stages of a potential Incident. This is
typically accomplished by contacting Public Safety Access Points (PSAPs) along the pipeline route.
The purpose of the communication is to assist in the identification, location, and planning for
response to pipeline Incidents through coordination and information sharing.
A17a. Select Yes if there was communication about the incident. If A12. is “Notification from
Emergency Responder”, A17a. will automatically populate with Yes.
If 17a. is no, skip 17b. and 17c.
A17b. Select the party initiating the communication. If A12. is “Notification from Emergency
Responder”, A17b. will automatically populate with “Local/State/Federal Emergency
Responder”.
A17c. Enter the local date and time of the initial communication. If A12. is “Notification from
Emergency Responder”, A17c. will automatically populate with the value in A13.
A18. What time did Operator resources arrive on site?
Enter the date/time operator responders, company or contract, arrived on site. The time is to be
shown by 24-hour clock notation and reported in the time zone where the incident occurred. (See
“Special Instructions”, numbers 8 and 9.) PHMSA will use this data to calculate incident response
times.
A19. reserved
A20a. Local time (24-hr clock) and date of initial operator report to the National Response
Center
Enter the time and date of the initial Immediate Notice of the incident 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 incident did not
occur in the eastern time zone. (See “Special Instructions”, numbers 9 and 10.)
A20b. Initial Operator National Response Center (NRC) Report Number
§191.5 requires that incidents meeting the criteria outlined in §191.3 be reported directly to the 24hour National Response Center (NRC) at 1-800-424-8802 at the earliest practicable moment .
The NRC assigns numbers to each call. Enter the number assigned to the operator’s initial

Page 10 of 29

Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Immediate Notice (sometimes referred to as the “Telephonic Report”). 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.
A20c. Additional NRC Report Numbers
If the operator made more than one call to the NRC, enter each additional NRC report number.
A21. Did the gas ignite?
Ignite means the released gas caught fire, or a conflagration, detonation or explosion occurred,
even if there was no residual fire after the initial ignition event. If the answer is “Yes,” enter the
time and date of the ignition in 21a. The time is to be shown by 24-hour clock notation in the time
zone where the Incident occurred. If the fire was extinguished, select “Operator/Contractor” or
“Local/State/Federal Emergency Responder,” to indicate who extinguished the fire, or select
“Allowed to Burn Out,” if it was not extinguished, in 21b. Enter the estimated volume of gas
consumed by fire in thousands of standard cubic feet, MCF in 21c.
A21d. Did the gas explode?
Explode means the ignition of the released gas occurred with a sudden and violent release of
energy.
A22. Flow Control
If A14. is “Onshore Pipeline, Including Valve Sites” OR “Offshore Pipeline, Including Riser and
Riser Bend”, answer A22.
The initial response to gas pipeline emergencies is typically understood to be isolation of the
incident location from the source of gas. However, sometimes there are operational means other
than valve closures to achieve this goal. These questions are intended to understand the response
actions and the time of valve closures intended to isolate the incident location. Valve data is for
the first upstream or downstream valve selected by the operator to minimize the release volume but
may not be the closest to the incident site or the one that was eventually used for the final isolation
of the release site for repair.
Upstream of Failure - If an action other than valve closure was taken to isolate the incident site
from the upstream pipeline, select “Operational Control” for 22a and provide a description of the
operation control employed.
If 22a. is “Valve Closure”, complete 22b. and 22c.
A22b. Enter the time of the valve closure that achieved isolation of the incident location from
upstream piping.
A22c. Identify the type of valve used to initially isolate the release on the upstream side.
Downstream of Failure - If an action other than valve closure was taken to isolate the incident site
from the downstream pipeline, select “Operational Control” for 22d. and provide a description of
the operation control employed.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

If 22d. is “Valve Closure”, complete 22e. and 22f.
A22e. Enter the time of the valve closure that achieved isolation of the incident location from
downstream piping.
A22f. Identify the type of valve used to initially isolate the release on the downstream side.
A23. 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).

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

PART B – ADDITIONAL LOCATION INFORMATION
B1. Type R gas gathering is always Onshore
Populated automatically based on response to A14.
B1a. 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 incident occurred, for example, the “West Line 24” Pipeline”, or “Gulf Coast
Pipeline”, or “Wooster Storage Facility”.
B1b. 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 to be
reported here helps locate and/or record the more precise incident location, for example, “Segment
4-32”, or “MP 4.5 to Wayne County Line”, or “Dublin Compressor Station”, or “Witte Reducing
Station”. Consideration should be given to using the same pipeline segment name that was
submitted to NPMS, where appropriate.
B2. – B5. Incident Location
Provide the state, zip code, city, and county/parish in which the incident occurred. If the incident
did not occur within a municipality, select Not Within Municipality in the City field. If the incident
did not occur within county/parish, select Not Within County/Parish.
B6. and B7. Operator-designated location
This is intended to be the designation that the operator would use to identify the location of the
incident on its pipeline system. Enter the appropriate milepost or survey station number. This
designator is intended to allow PHMSA personnel to refer to the physical location of the incident
using the operator’s maps and records.
B8. Was the Incident on Federal Lands other than the 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.
Incidents 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.
B9. Location of Incident
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.
B10. Area of Incident (as found)
This refers to the location on the pipeline system at which gas was released, resulting in the incident.
It does not refer to adjacent locations in which released gas may have accumulated or ignited.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

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.
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 dead 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 is to be appropriately
reported in PART G of this form.
Exposed due to loss of cover means that erosion, flooding, or some other non-excavation action
has removed the cover that was previously over the pipeline. This loss of cover may be previously
known or unknown by the pipeline operator, but to be reported in this category, the pipeline was
believed to have been exposed prior to the Incident. Loss of cover as a result of the Incident
should not be reported under this category. For example – if a pipeline was buried below
ground immediately prior to a failure, and the force of the failure unearthed the pipeline – it should
still be reported as “Under soil,” for the purposes of this report.
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 compressor stations, valve sites, launcher and receiver and reducing stations.
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,
compressor stations, and gas storage facilities.
If B10. is Underground, answer 10a. and 10b:
B10a. Depth of Cover
Report the depth of cover in inches immediately before the incident. In cases where the incident
changed the depth of cover, the depth prior to the incident will be an estimate.
B10b. Indicate if other underground facilities were found within 12 inches of the failure location.
B11. Did Incident occur in a crossing?
Use Bridge Crossing if the pipeline is suspended above a body of water or roadway, railroad rightof-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.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

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 incident or not. The name of the body
of water is to 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 incident
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 and time of the incident, ignoring seasonal, weather-related, and other factors which
may affect the water depth from time to time.
If B11 is yes, indicate whether the pipe is cased.
If a water crossing, specify the pipe installation method and answer the question about the
length of the crossing.

PART C – ADDITIONAL FACILITY INFORMATION
C1. Is the pipeline or facility [Interstate or Intrastate]?
Interstate gas pipeline facility means a gas pipeline facility or that part of a gas pipeline facility
that is used to transport gas and is subject to the jurisdiction of the Federal Energy Regulatory
Commission (FERC) under the Natural Gas Act (15 U.S.C. 717 et seq.).
Intrastate gas pipeline facility means a gas pipeline facility or that part of a gas pipeline facility
that is used to transport gas within a state and is not subject to the jurisdiction of FERC under the
Natural Gas Act (15 U.S.C. 717 et seq.).
The reported jurisdiction should match Annual Report submittals for the pipeline.
C2. Material involved in Incident
Enter the material involved in the Incident. If the material is Other, specify the type of material in
the space provided.
C3. Item involved in Incident
Pipe (whether pipe body or pipe seam) means the pipe through which product is transported, not
including auxiliary piping, tubing, or instrumentation.
Nominal Pipe Size. It is the diameter in whole number inches (except for pipe less than 5”) used
to describe the pipe size; for example, 8-5/8” pipe has a nominal pipe size of 8. Decimals are
unnecessary for this measure (except for pipe less than 5”). For more details, see
http://en.wikipedia.org/wiki/Nominal_Pipe_Size

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Enter pipe wall thickness in inches. Wall thickness is typically less than an inch. 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. If the SMYS is
unknown, and the Operator has designated it as 24,000 for the purposes of MAOP calculations,
enter 24,000.
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
If the frequency of the ERW pipe seam is unknown, and the pipe was manufactured after 1980,
select Longitudinal ERW – High Frequency. Almost all ERW pipe manufactured prior to 1960 is
Low Frequency, and both High and Low Frequency ERW pipe was manufactured between 1960
and 1980.
If differences exist between pipe on either side of a Girth Weld Failure, Populate C3l. through C3r.
as needed.
If the incident occurred on an item not provided in this section, select “Other” and specify the
item that failed in the space provided. Make every effort to find an item category and avoid
the use of “Other” when reporting the Type of Item involved in the Incident.
C4. Year Installed
Enter the year the item that failed was installed.
C5. Year Manufactured
If you know the year the item that failed was manufactured, enter it. Otherwise, select Unknown.
C6. Type of release 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.,
using a micrometer – is not needed. Approximate measurements can be provided in inches and one
decimal.)
Leak means a failure resulting in an unintentional release of gas 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. A leak may be a hole or a crack, and includes separation of materials, pullout and loose

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

connections. Typically, a Leak can be repaired, whereas a Rupture results in the complete failure
of the pipeline.
Rupture means the pipeline facility has burst, split, or broken and the operation of the pipeline
facility is immediately impaired and no longer serviceable. The terms “circumferential” and
“longitudinal” refer to the general direction or orientation of the rupture relative to the pipe’s axis.
For example; a rupture of a girth weld would be circumferential, whereas a split that followed the
length of the pipe (whether in the seam, or not) would be longitudinal. (Precise measurement of
size – e.g., micrometer – is not needed. Approximate measurements can be provided in inches and
decimals.)

PART D – ADDITIONAL CONSEQUENCE INFORMATION
D1. Select the Class Location at the point of the failure
D2. Estimated Property Damage
All relevant costs available at the time of submission must be included on the initial written Incident
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,
facility repair and replacement, and environmental cleanup and damage. Do NOT include cost of
gas lost. Additionally, do NOT include costs incurred for facility repair, replacement, or changes
that are NOT related to the incident 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 incident. Litigation and other legal expenses related to the incident 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 (within 30 days, per §191.15). The best available estimate of these costs is to 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.
D3a. Public and Non-operator private property damage estimates generally include physical
damage to the property of others, the cost of 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 incident.
D3b. Operator’s property damage & repairs 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 incident, excluding the
cost of any gas lost. Also to be excluded are litigation and other legal expenses related to the
incident.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

When estimating the Cost of repairs to company facilities, the standard shall be the cost necessary
to safely restore property to its predefined level of service. Property damage estimates include the
cost to access, secure, excavate, and repair the pipeline using methods, materials, and labor
necessary to re-establish operations at a predetermined level. These costs may include the cost of
repair sleeves or clamps, re-routing of piping, or the removal from service of an appurtenance 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
incident. Costs associated with improvements to the pipeline or other facilities to mitigate the risk
of future failures are not included.
D3c. Emergency response includes emergency response operations necessary to return the
incident site to a safe state, actions to minimize the volume of gas released, conduct reconnaissance,
and to identify the extent of incident impacts. They include materials, supplies, labor, and benefits.
If you reimbursed local, state, or federal emergency responders, include these amounts. Costs
related to stakeholder outreach, media response, etc. are not to be included.
D3d. Other costs are to include any and all costs which are not included above. Cost of any gas
lost is NOT to be reported here, but is to be reported under Cost of Gas Released. 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.
Cost of Gas Released – enter your gas cost, excluding taxes, in dollars per thousand standard cubic
feet (mcf). The cost of gas released will be calculated based on the volumes reported in A7 and
A8.
Injured persons not included in A11. The number of persons injured, admitted to a hospital,
and remaining in the hospital for at least one overnight are reported in A11. If a person is
included in A11, do not include them in D3.
D3. Estimated number of persons with injuries requiring treatment in a medical facility but not
requiring overnight in-patient hospitalization.
If a person is included in D3, do not include them in D4.
D4. Estimated number of persons with injuries requiring treatment by EMTs at the site of incident.
Buildings Affected The term ‘affected’ means the building was either damaged, or evacuated,
or had gas service interrupted.
D5. Enter the number of residential buildings affected.
D6. Enter the number of commercial and industrial buildings affected.
D7. If wildlife was impacted, select Yes and indicate the type in D7a. Otherwise, select No.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

PART E – ADDITIONAL OPERATING INFORMATION
E1. Estimated Pressure and Flow Rate
Enter the estimated operating pressure, in psig, at the location and time of the incident.
Enter the estimated flow rate in the pipeline segment at the location and time of the Incident.
E2. Maximum Allowable Operating Pressure (MAOP)
Enter the MAOP, in psig, at the point and time of the Incident or select Not Determined.
E3-E5 Reserved
If A14. is “Onshore Pipeline, Including Valve Sites”, answer E6 through E8.
E6. Length of segment isolated between valves (ft)
Identify the length in feet between the upstream and downstream shut-off valves closest to the
failure location.
E7 and E8. Answer the questions about internal inspection tools.
E9. Was a Supervisory Control and Data Acquisition (SCADA)-based system in place on the
pipeline or facility involved in the Incident?
This does not mean a system designed or used exclusively for leak detection.
E9a. Was it operating at the time of the Incident?
Was the SCADA system in operation at the time of the incident?
E9b. Was it fully functional at the time of the Incident?
Was the SCADA system capable of performing all of its functions, whether or not it
was actually in operation at the time of the incident? If No, describe functions that
were not operational in PART H – Narrative Description of the Incident.
E9c and d. Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or
volume or pack calculations) assist with the initial indication or confirmed discovery
of the Incident?
Select Yes if SCADA-based information was used to confirm the incident even if the
initial report or identification may have come from other sources. Use of SCADA data
for subsequent estimation of amount of gas lost, etc. is not considered use to confirm
the incident.
Select No if SCADA-based information was not used to assist with identification of the
incident.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

E10. 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 Incident?
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 incident.
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 Reserved
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 Incident. 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 subcause, and enter any secondary, contributing, or root causes of the Incident in PART K –
Contributing Factors. Make every effort to find a category that fits the Incident’s Apparent
Cause and avoid the use of Other and Unknown when possible. Use of Unknown as an
Apparent Cause will require the submittal of a Supplemental Report to revise the Apparent
Cause when it becomes known.
G1 – Corrosion Failure
Corrosion includes a release or failure caused by galvanic, atmospheric, stray current,
microbiological, selective seam, 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.)

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

External Corrosion
2. Type of corrosion – NOTE: Stress Corrosion Cracking (SCC) failures are to be reported under
cause G5, with a sub-cause of Environmental Cracking-related.
If Stray Current corrosion is selected, specify whether alternating or direct current was involved
and describe the source of the stray current.
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 gas/fluid treated with corrosion inhibitors or biocides?
Select Yes if corrosion inhibitors or biocides were included in the gas/fluid transported.
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.
12. Were cleaning/dewatering pigs (or other operations) routinely utilized?
13. Were corrosion coupons routinely utilized?
F2 – 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 incidents caused by land shifts such
as earthquakes, landslides, or subsidence, 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 incident.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

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 incidents 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.
Tree/Vegetation Root includes damages caused by tree and vegetation roots.
Snow/Ice impact or Accumulation should be indicated when snow and/or ice caused damage to
the gas gathering system asset which results in an incident.
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 Incident.
Answer Questions 6 and 6.a if the incident 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.
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 incident under G4 as
“Previous Mechanical Damage NOT related to Excavation.”
Excavation Damage by Operator (First Party) refers to incidents caused as a result of excavation
by a direct employee of the operator.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Excavation Damage by Operator’s Contractor (Second Party) refers to incidents 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 incidents 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 incidents 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.
Complete the following if any Excavation Damage sub-cause is selected.
1. and 1a. Prior Notification Indicate whether you received prior notification of the excavation
activity. If yes, indicate all of the notification sources.
1b. through 1d. One-Call State Law Exemptions Per the primary Incident Investigator results,
indicate whether State law exempted the excavator from notifying a one-call center. If yes, select
the type of exemption from the list. If “Other” is selected, enter text describing the exemption.
Describe the exempting authority and exempting criteria.
2. – 14. Instructions for answering these questions can be found at
https://www.phmsa.dot.gov/operator-resources/damage-information-reporting-tool-dirt-usersguide.
NOTE: If you have or will be reporting the information in questions 2 thru 14 to CGA-DIRT,
select “No” in question 2 to avoid duplication of data submitted to CGA.
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 Incident applies
to situations where the fire occurred before - and caused - the release. (See also the discussion of
“secondary ignition” under the General Instructions.) Examples of such an incident would be an
explosion or fire that originated at a neighboring facility or installation (chemical plant, tank farm,
or 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

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

incident’s cause is to be classified under G2 - Natural Force Damage. Arson events directed at
harming the pipeline or the operator are to 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 gas 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 incidents 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 incidents resulting from vehicular traffic loading or other
contact are to also be reported in this category. If the activity that caused the incident involved
digging, drilling, boring, blasting, grading, cultivation or similar excavation 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 incidents which are caused by the
impact of maritime equipment or vessels while they are engaged in their normal or routine activities;
such incidents 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 incident is to be reported under G3 - Excavation Damage.
Routine or Normal Fishing or Other Maritime Activity NOT Engaged in Excavation. This
sub-cause includes incidents due to shrimping, purse seining, dredging, 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 inadvertent and due to a severe weather event
(this type of incident is to 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 incident was caused by excavation activity such as dredging of waterways or
bodies of water (this type of incident 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 incidents
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. Incidents 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

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Weld. (See this sub-cause for typical indications of previous construction, installation, or
fabrication damage.) Incidents 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 damage inflicted to
harass the operator, motor vehicle damage that was inflicted intentionally, and a variety
of other intentional acts. (See also the discussion of “secondary ignition” under the
General Instructions.)
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 gas or
pipeline equipment.
Other Describe in the space provided and, if necessary, provide additional explanation
in PART H – Narrative Description of the Incident.
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 Incident.
5 – 11 Additional Data for Damage by Car, Truck, or Other Motorized Vehicle/Equipment
NOT Engaged in Excavation
When answering the questions, include information that can be substantiated from police reports or
other investigative reports.
The following definitions apply for reporting the type of motorized vehicle in Question 10:
Motorcycle/All-Terrain Vehicle (ATV) - All two or three-wheeled motorized vehicles, and some
four-wheeled vehicles are to be reported in this category. Typical vehicles in this category have
saddle type seats and are steered by handlebars rather than steering wheels. This category includes
motorcycles, motor scooters, mopeds, motor-powered bicycles, and three-wheel motorcycles.
Additionally, four-wheeled off-road and all-terrain vehicles (sometimes referred to as “fourwheelers”) are to be reported under this category.
Passenger Car -- All sedans, coupes, and station wagons manufactured primarily for the purpose
of carrying passengers and including those passenger cars pulling recreational or other light
trailers.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Small Truck - All two-axle, four-tire, vehicles, other than passenger cars. Included in this
classification are pickups, panels, vans, and other vehicles such as campers, motor homes,
ambulances, hearses, carryalls, and minibuses.
Bus - All vehicles manufactured as traditional passenger-carrying buses with two axles and six
tires or three or more axles. This category includes only traditional buses (including school buses)
functioning as passenger-carrying vehicles. Modified buses should be considered to be a truck
and should be appropriately classified.
Large Truck - All vehicles on a single frame including trucks, camping and recreational vehicles,
motor homes, etc., with two or more axles and at least two rear wheels on each side
When specifying the type of protection in Question 13; select the category “Barricades” for Jersey
barriers, fencing, and other structures that are other than Guard Rails or Bollards/Guard Posts. If
“Other” is selected, enter text describing the protection.
G5 – Material Failure of Pipe or Weld
Use this section to report material failures only if “Item Involved in Incident” (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 manufacturing processes, material
imperfections, defects resulting from poor construction, installation, or fabrication practices, and
in-service stresses such as vibration, fatigue, and environmental cracking.
Design-, Construction-, Installation-, or Fabrication-related includes a release or failure caused
by improper design practices, a dent, gouge, excessive stress, or some other defect or anomaly
introduced during the process of constructing, installing, or fabricating pipe and pipe welds in the
field, including welding or other activities performed at the construction job site. 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). If a river crossing were directionally
drilled and tied into a buried pipeline without adequate accommodation for expansion and
contraction of the pipe in the drill hole and the pipeline facility fails at the tie-in, this represents an
improper design practice. Select “Design-, Construction-, Installation-, or Fabrication-related” as
the sub-cause.
Original Manufacturing-related (NOT girth welds 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 manufacturing and handling of the plate materials, 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. If the girth welds were completed at the pipe mill (such as in
the case of double joints welded prior to delivery to the jobsite) report those failures in this category.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

Environmental Cracking-related includes failures by Stress Corrosion Cracking, Sulfide Stress
Cracking, Hydrogen Stress Cracking, Hard Spots or other environmental cracking mechanisms.
If Design-, Construction-, Installation-, or Fabrication-related, or Original Manufacturingrelated is selected, then select any contributing factors. Examples of Mechanical Stress include
failures related to overburden or loss of support.
5. Post-construction Pressure Test
If you know the post-construction pressure test value, enter it in psig.
“Unknown.”

Otherwise, select

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 incident cause include:
overpressurization resulting from malfunction of a control or alarm device; malfunction of a relief
valve; 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 incident was caused by
incorrect operation involving human error, the incident is to 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 Incident.
G7 – Incorrect Operation
Incorrect Operation includes a release or failure resulting from operating, maintenance, repair, or
other errors by facility personnel or pipeline controllers, including, but not limited to improper valve
selection or operation, inadvertent overpressurization, or improper selection or installation of
equipment in the field. If the failure occurs in the pipe body or weld, and is a result of inadequate
design or a design error, the Incident is to be reported under G5 – Material Failure of Pipe or Weld,
Design-, Construction-, Installation-, or Fabrication-related.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

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 Incident.
G8 – Other Incident Cause
This section is provided for incidents whose cause is currently unknown, or where investigation
into the cause has been exhausted and the final judgment as to the cause 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. PHMSA will review all G-8 cause selections and determine if it meets the
definition of any category listed in G1 thru G7 before a Final Report is accepted for closure. All
sub cause categories of “Unknown” require a Supplemental Report to be filed before being
accepted as Final.
If the incident cause is known but doesn’t fit into any category in sections G1 thru G7, select
Miscellaneous and enter a description of the incident cause, continuing with a more thorough
explanation in PART H - Narrative Description of the Incident.
If the incident 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 incident 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 incident. 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 incident 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 Incident. 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.

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Instructions for Form PHMSA F 7100.2.2

INCIDENT REPORT –TYPE R (Reporting Regulated) GAS GATHERING SYSTEMS

PART K – CONTRIBUTING FACTORS
Contributing factor means an action or lack of action that when added to the existing
circumstances heightened the likelihood of the release or added to the impact of the release. The
Apparent Cause of the accident is contained in Part G. Do not report the Apparent Cause again in
this Part K. If Contributing Factors were identified, select all that apply and explain each in the
Narrative.

PART H – NARRATIVE DESCRIPTION OF THE INCIDENT
Concisely describe the incident, including the facts, circumstances, and conditions that may have
contributed directly or indirectly to causing the incident. 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, and to explain any estimated data.
If you selected Miscellaneous in section G8, the narrative is to describe the incident in detail,
including all known or suspected causes and possible contributing factors.

PART I – PREPARER AND AUTHORIZED PERSON
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 or persons 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 Person 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 Person.

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File Type	application/pdf
Author	PHMSA
File Modified	2021-11-02
File Created	2021-11-02