OQ Program Review (PHMSA Form 14) Date: GAS SYSTEM OPERATIONS Gas Supplier Services: Residential Commercial Industrial Other Number of reportable safety related conditions last year Number of deferred leaks in system Number of non-reportable safety related conditions last year Number of third party hits last year Miles of main within inspection unit(total miles and miles in class 3 & 4 Miles of transmission pipeline within unit (total miles and miles in areas) class 3 & 4 areas) Actual Operating Pressure Operating Pressure(s): MAOP (Within last year) (At time of Inspection) Feeder: Town: Other: Does the operator have any transmission pipelines? Compressor stations? Use Attachment 1. Yes No Have incident reports and the annual report been reviewed for accuracy and analyzed for trends and operator issues? Comments: Pipe Specifications: Year Installed (Range) Pipe Diameters (Range) Material Type Line Pipe Specification Used Mileage SMYS % Operator Qualification Field Validation Important: Per OPS, the OQ Field Inspection Protocol Form (Rev 4, May 2007) shall be used by the inspector as part of this standard inspection. When completed, the inspector will upload this information into the PHMSA OQ Database (OQDB) located at Date Completed/Uploaded Integrity Management Field Validation Per PHMSA, IMP Field Verification Form shall be used by the inspector as part of this Important: (Rev 6/18/2012) standard inspection. When completed, the inspector will upload this information into the PHMSA IM Database (IMDB) located at http://primis.phmsa.dot.gov/gasimp/home.gim Date Completed/Uploaded: PART 199 Drug and Alcohol Testing Regulations and Procedures S U NA NC Drug & Alcohol Testing & Misuse Prevention Program Use PHMSA Form #13, Rev – 3/19/2010. Do not ask the company to have a drug and alcohol expert available for Subparts A - C this portion of your inspection. REPORTING RECORDS S U N/A N/C
OQ Program Review (PHMSA Form 14) Date: GAS SYSTEM OPERATIONS Gas Supplier Services: Residential Commercial Industrial Other Number of reportable safety related conditions last year Number of deferred leaks in system Number of non-reportable safety related conditions last year Number of third party hits last year Miles of transmission pipeline within unit (total miles and miles in class 3 & 4 areas) Miles of main within inspection unit(total miles and miles in class 3 & 4 areas) Operating Pressure(s): MAOP (Within last year) Actual Operating Pressure (At time of Inspection) Feeder: Town: Other: Does the operator have any transmission pipelines? Compressor stations? Use Attachment 1. Have incident reports and the annual report been reviewed for accuracy and analyzed for trends and operator issues? Yes No Comments: Pipe Specifications: Year Installed (Range) Pipe Diameters (Range) Material Type Line Pipe Specification Used Mileage SMYS % Operator Qualification Field Validation Important: Per OPS, the OQ Field Inspection Protocol Form (Rev 4, May 2007) shall be used by the inspector as part of this standard inspection. When completed, the inspector will upload this information into the PHMSA OQ Database (OQDB) located at Date Completed/Uploaded Integrity Management Field Validation Important: Per PHMSA, IMP Field Verification Form (Rev 6/18/2012) shall be used by the inspector as part of this standard inspection. When completed, the inspector will upload this information into the PHMSA IM Database (IMDB) located at http://primis.phmsa.dot.gov/gasimp/home.gim Date Completed/Uploaded: PART 199 Drug and Alcohol Testing Regulations and Procedures S U NA NC Subparts A - C Drug & Alcohol Testing & Misuse Prevention Program – Use PHMSA Form #13, Rev 3/19/2010. Do not ask the company to have a drug and alcohol expert available for this portion of your inspection. REPORTING RECORDS S U N/A N/C