PHMSA F-7100.3 Incident Report - LNG (Liquefied Natural Gas) Facility

Incident and Annual Reports for Gas Pipeline Operators

LNGincidentlReportwInstructions

Incident and Annual Reports for Gas Pipeline Operators

OMB: 2137-0522

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2137-0522 can be found here:

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NOTICE: This report is required by 49 CFR Part 191. Failure to report can result in a civil penalty not to exceed
$100,000 for each violation for each day that such violation persists except that the maximum civil penalty shall not
exceed $1,000,000 as provided in 49 USC 60122.

OMB NO: 2137-0522
EXPIRATION DATE: mm/dd/yyyy

Report Date

INCIDENT REPORT –
LIQUEFIED NATURAL GAS (LNG) FACILITIES

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

No.
(DOT Use Only)

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure
to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information
displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2137-0522. Public reporting for this
collection of information is estimated to be approximately 10 hours per response, including the time for reviewing instructions, gathering the
data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:
Information Collection Clearance Officer, PHMSA, Office of Pipeline Safety (PHP-30) 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
INSTRUCTIONS

Important:
Please read the separate instructions for completing this form before you begin. They clarify the
information requested and provide specific examples. If you do not have a copy of the instructions, you can obtain
one from the PHMSA Pipeline Safety Community Web Page at http://www.phmsa.dot.gov/pipeline.
Report Type: (select all that apply)
 Original  Supplemental  Final

PART A – KEY REPORT INFORMATION
1. Operator’s OPS-issued Operator Identification Number (OPID):

2. Name of Operator: ______________________________________________________________________________________
3. Address of Operator:
3.a _______________________________________________________________________
(Street Address)

3.b ___________________________________________________
(City)

3.c State: /

3.d Zip Code: /

/ - /

4. Local time (24-hr clock) and date of the Incident:
/

Hour

/
Month

5. National Response Center Report Number:

Day

Year

6. Local time (24-hr clock) and date of initial telephonic report to the
National Response Center (if reported):
/

Hour

/
Month

/
Day

Year

7. Incident resulted from:






Unintentional release of commodity
Intentional release of commodity
Emergency shutdown
Reasons other than the above  Describe:

8. Commodity released: (select only one, based on predominant volume released)









No release of commodity involved
Natural Gas while being handled in gaseous phase
LNG (Liquefied Natural Gas) while being handled in liquid phase
LPG (Liquefied Petroleum Gas) while being handled in liquid phase
Petroleum Gas while being handled in gaseous phase
Refrigerant Gas
Other Commodity  Name:

9. Estimated volume of commodity released unintentionally:

/,/

/ Thousand Cubic Feet (MCF)

10. Estimated volume of intentional and controlled release/blowdown :

/,/

/ Thousand Cubic Feet (MCF)

11. Estimated volume of liquid spilled to the ground :

/,/

/ Bbls

Form PHMSA F 7100.3

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Reproduction of this form is permitted

12. Were there fatalities?  Yes  No
If Yes, specify the number in each category:

13. Were there injuries requiring inpatient hospitalization?
If Yes, specify the number in each category:

 Yes  No

12.a Operator employees

13.a Operator employees

12.b Contractor employees
working for the Operator

13.b Contractor employees
working for the Operator

12.c Non-Operator
emergency responders

13.c Non-Operator
emergency responders

12.d General public

13.d General public

12.e Total fatalities (sum of above)

13.e Total injuries (sum of above)

14. Was the LNG Facility shut down due to the incident?
 Yes  No  Explain: ______________________________________________________________________________
If Yes, complete Questions 14.a and 14.b: (use local time, 24-hr clock)
14.a Local time and date of shutdown

Hour

14.b Local time LNG Facility restarted

Hour

 Yes

 No

 Yes

 No

15. Was there an ignition?
16. Was there an explosion?

17. Number of general public evacuated:

Month

Day

Month

Day

/,/

18. Number of operator/contractor personnel evacuated: /

/,/

Year

/
Year

 Still shut down*
(*Supplemental Report required)

PART B – ADDITIONAL FACILITY INFORMATION
1.

Facility Information: (select Facility/Plant from dropdown list)
LNG FACILITY / PLANT

Name of LNG Plant / Facility
NPMS LNG ID
Plant / Facility Status
Plant / Facility Location
State
/

Latitude
-/

Longitude

/
/

/ . /

/
/
/

/
/

Process
Liquefaction/Vaporization Rate
(MMCF/D) at the time of the Incident
Number of Vaporizers in service at the
time of the Incident
Total Capacity (MMCF/D)
LNG Source (list all that apply)
PHMSA- or State-inspected
LNG Storage
Number of LNG Tanks
Volume of LNG in Storage at the time of
the Incident (Bbls)

Form PHMSA F 7100.3

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Reproduction of this form is permitted

Type of LNG Plant / Facility: (select all that apply)






3.

Base Load
Peak Shaving
Satellite
Mobile / Temporary (select the following based on use at time of Incident)
 Intrastate
 Interstate
Other  Describe:

Function of LNG Plant / Facilityat the time and date of the Incident: (select all that apply)

 Marine Terminal (select one or both)
 Import Terminal
 Export Terminal
 Storage (select one or both)
 With Liquefaction
 Without Liquefaction
 Stranded Utility
 Vehicular Fuel
 Nitrogen Rejection Unit or Other Special Use
4.



Describe:

Item involved in Incident: (select only one)



















Pump
Compressor
Vaporizer
Cold Box
High Pressure Hose/Line
Break-away Coupling
Emergency Shut-Off Valve (ESV)
In–plant Piping
Storage Tank / Vessel
Meter / Regulator / Control Valve
Relief Valve
Strainer / Filter
Instrumentation / Sensor Line
Flange / Gasket
Weld
Other  Describe:
No item involved

Form PHMSA F 7100.3

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Reproduction of this form is permitted

PART C – ADDITIONAL CONSEQUENCE INFORMATION
1.

Estimated cost to Operator:
1.a Estimated cost of public and non-Operator private property damage
paid/reimbursed by the Operator
$/

/,/

1.b Estimated cost of commodity released unintentionally

/,/

1.c Estimated cost of commodity released during
intentional and controlled blowdown

/,/

1.d Estimated cost of Operator’s property damage & repairs

/,/

1.e Estimated cost of Operator’s emergency response

/,/

1.f Estimated other costs

/,/

Describe ___________________________________________________
1.g Estimated total costs (sum of above)

PART D – ADDITIONAL OPERATING INFORMATION
1.

Was a computerized Control System in place?

 No
 Yes



1.a Was it operating at the time of the Incident?
1.b Was it fully functional at the time of the Incident?

 Yes
 Yes

 No
 No

How was the Incident initially detected: (select only one)











Computerized Control System ((such as alarm(s), alert(s), event(s), leak detection, temperature, pressure, etc.)
Gas Detectors
Low Temperature Sensors
Flame Detectors
Static shut-in test or other pressure or leak test
Local operating personnel, including contractors working for the Operator
Remote operating personnel
Notification from Public
Other  _________________________________________________________ (Explain in PART G Narrative)

PART E – DRUG & ALCOHOL TESTING INFORMATION
1. As a result of this Incident, were any Operator employees tested under the post-accident drug and alcohol testing requirements of DOT’s
Drug & Alcohol Testing regulations?

 No
 Yes



1.a Specify how many were tested:

1.b Specify how many failed:

2. As a result of this Incident, were any Operator contractor employees tested under the post-accident drug and alcohol testing requirements of
DOT’s Drug & Alcohol Testing regulations?

 No
 Yes



2.a Specify how many were tested:

2.b Specify how many failed:

Form PHMSA F 7100.3

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Reproduction of this form is permitted

PART F – APPARENT CAUSE

Select only one APPARENT Cause of the Incident, and answer any questions
on the right or below as indicated. Describe secondary, contributing, or root
causes of the Incident in the narrative (PART G).

F1 - Corrosion Failure
 External Corrosion
 Internal Corrosion

F2 - Natural Force Damage
 Earth Movement, NOT due to Heavy
Rains/Floods

Includes earthquakes, subsidence, landslide, or other geological events.
Includes washouts/scouring, flotation, mudslide, and other rain- or floodwater-caused
events.
Includes a direct lightning strike or secondary impact such as resulting nearby fires or
wildfires.
Includes thermal stress, frost heave, frozen components, and other weather-related
temperature effects.

 Heavy Rains/Floods
 Lightning
 Temperature (Weather-related)
 High Winds
 Other Natural Force Damage

1. Describe: _________________________________________________

Complete the following if any Natural Force Damage sub-cause is selected.
2. Were the natural forces causing the Incident generated in conjunction with an extreme weather event?
2.a If Yes, specify: (select all that apply)

 Yes

 No

 Hurricane
 Tropical Storm  Tornado
 Other ______________________________

F3 – Excavation Damage
 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

Form PHMSA F 7100.3

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Reproduction of this form is permitted

F4 - Other Outside Force Damage
 Nearby Industrial, Man-made, or
Other Fire/Explosion as Primary
Cause of Incident

 Damage by Car, Truck, or Other

1. Vehicle/Equipment operated by: (select only one)
 Operator
 Operator’s Contractor

Motorized Vehicle/Equipment NOT
Engaged in Excavation

 Damage by Boats, Barges, Drilling
Rigs, or Other Maritime Equipment or
Vessels Set Adrift or Which Have
Otherwise Lost Their Mooring

 Third Party

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

 Electrical Arcing from Other
Equipment or Facility

 Previous Mechanical Damage NOT
Related to Excavation

 Intentional Damage

Specify:

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

 Other Outside Force Damage

Did the Intentional Damage involve a breach of security?
 No
 Yes (Explain fully in the PART G Narrative)

Describe: _________________________________________________________

F5 - Material Failure of Pipe or Weld

Use this section to report material failures ONLY IF the “Item Involved
in Incident” (from PART B, Question 4) is “In-plant Piping” 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)
 Construction-, Installation-, or
Fabrication-related

 Original Manufacturing-related
(NOT girth weld or other welds
formed in the field)

 Low Temperature Embrittlement

Was insulation degradation a factor in this failure?

 Yes

 No

(due to a process fluid)

F6 - Equipment Failure

Form PHMSA F 7100.3

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Reproduction of this form is permitted

 Malfunction of Control/Relief
Equipment

 Pump/Compressor or
Pump/Compressor-related
Equipment

 Threaded Connection/Coupling
Failure

 Non-threaded Connection Failure
 Defective or Loose Tubing or Fitting
 Failure of Equipment Body (except
Pump/Compressor), Vessel Plate, or
other Material

 Other Equipment Failure

1. Describe: ____________________________________________________________
_______________________________________________________________________

Complete the following if any Equipment Failure sub-cause is selected.
2.

Did this failure involve Low Temperature Embrittlement due to process fluids?

Was insulation degradation a factor in this failure?

 Yes

 No

F7 - Incorrect Operation
 Damage by Operator or Operator’s
Contractor NOT Related to
Excavation and NOT due to
Motorized Vehicle/Equipment
Damage

 Storage Tank or Pressure Vessel
Allowed or Caused to Overfill or
Overpressure

 Valve Left or Placed in Wrong
Position, but NOT Resulting in an
Overfill or Overpressure
 Pipe 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: ______________________________________________________

Form PHMSA F 7100.3

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Reproduction of this form is permitted

F8 – Other Incident Cause
 Miscellaneous

1. Describe:
___________________________________________________________________________
___________________________________________________________________________
2. Specify:

 Unknown

 Investigation complete, cause of Incident unknown
 Still under investigation, cause of Incident to be determined*
(*Supplemental Report required)
(Attach additional sheets as
necessary)

PART G – NARRATIVE DESCRIPTION OF THE INCIDENT

__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

PART H – PREPARER AND AUTHORIZED SIGNATURE

Preparer's Name (type or print)

Preparer’s Telephone Number

Preparer's Title (type or print)

Preparer's E-mail Address
Authorized Signature

Preparer’s Facsimile Number
Date

Authorized Signature Telephone Number

Authorized Signature’s Name (type or print)

Authorized Signature’s E-mail Address

Authorized Signature’s Title (type or print)

Form PHMSA F 7100.3

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Reproduction of this form is permitted

INSTRUCTIONS FOR FORM PHMSA F-7100.3
INCIDENT REPORT –
LNG (LIQUEFIED NATURAL GAS) FACILITY
GENERAL INSTRUCTIONS
Each operator of a liquefied natural gas (LNG) facility shall file Form PHMSA F-7100.3
for an incident that meets the criteria in 49 CFR §191.3 as soon as practicable but not more
than 30 days after the incident. Requirements for submitting reports are in §191.7.
Activation of an emergency shutdown system for any reason other than an actual
emergency need not be reported, as described in 49 CFR §191.3 under "Incident". For
purposes of this requirement, an actual emergency is defined in §193.2007.
PHMSA requires electronic reporting. Follow these instructions for electronic filing or to
request an alternative reporting method. If you have questions about this report or these
instructions, contact PHMSA’s Information Resources Manager at (202) 366-8075. If you
need copies of Form PHMSA F-7100.3 and/or instructions they can be found on the
Pipeline Safety Community main page, http://phmsa.dot.gov/pipeline, by clicking the
Forms hyperlink and scrolling down to the section entitled PHMSA/OPS Forms
(accidents/incidents/annuals).
§191.3 Definitions.
*

Incident means any of the following events:
(1) An event that involves a release of gas from a pipeline, or of liquefied natural gas,
liquefied petroleum gas, refrigerant gas, or gas from an LNG facility, and that results
in one or more of the following consequences:
(i) A death,
hospitalization;

personal

injury

necessitating

in-patient

(ii) Estimated property damage of $50,000 or more, including loss to
the operator and others, or both, but excluding cost of gas lost;
(iii) Unintentional estimated gas loss of 3 million cubic feet or more;
(2) An event that results in an emergency shutdown of an LNG facility. Activation of
an emergency shutdown system for reasons other than an actual emergency does not
constitute an incident.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 1 of 21

(3) An event that is significant in the judgment of the operator, even though it did not
meet the criteria of paragraphs (1) or (2) of this definition.
§191.5 Telephonic notice of certain incidents.
(a) At the earliest practicable moment following discovery, each operator shall give
notice in accordance with paragraph (b) of this section of each incident as defined in
§191.3.
(b) Each notice required by paragraph (a) of this section shall be made by telephone
to 800-424-8802 (in Washington, DC, 267-2675) and shall include the following
information:
(1) Names of operator and person making report and their telephone
numbers.
(2) The location of the incident.
(3) The time of the incident.
(4) The number of fatalities and personal injuries, if any.
(5) All other significant facts that are known by the operator that are
relevant to the cause of the incident or extent of the damages.
§ 191.15 Transmission systems; gathering systems; and liquefied natural gas facilities:
Incident report.
(a) General. Each operator of a transmission or a gathering pipeline system must
submit DOT Form PHMSA F 7100.2 as soon as practicable but not more than 30 days
after detection of an incident required to be reported under § 191.5 of this part.
(b) LNG. Each operator of a liquefied natural gas plant or facility must submit DOT
Form PHMSA F-7100.3 as soon as practicable but not more than 30 days after
detection of an incident required to be reported under § 191.5 of this part.
(c) Supplemental report. Where additional related information is obtained after a
report is submitted under paragraph (a) or (b) of this section, the operator must make
a supplemental report as soon as practicable with a clear reference by date to the
original report.
Further information regarding when reports are identified as “Final” will be covered below
under Part A – Key Report Information.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 2 of 21

REPORTING METHODS
Incident Reports must be submitted online unless an alternate method is approved (see
Alternate Reporting Methods below). Use the following procedure for online reporting:
1. Navigate to the new Electronic Incident Accident (EIA) System at the following
URL http://pipelineonlinereporting.phmsa.dot.gov/.
2. Enter Operator ID and PIN (the name that appears is the operator name assigned to the
operator ID and PIN and is automatically populated by our database and cannot be
changed by the operator at the time of filing).
3. Under “Create Reports” on the left side of the screen, select the type of report you would
like to create (i.e., gas transmission or gas distribution incident, or hazardous liquid
accident) and proceed with entering your data. Note: Data fields marked with a single
asterisk are considered required fields that must be completed before the system will accept
your initial filing.
4. Click “Submit” when finished with your filing to have your report uploaded to our
database; 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 filing 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 to
gather additional information and then come back to accurately complete your data entry
before submitting it to PHMSA.
5. Once you hit [Submit], the system will return you to the initial view of the screen that lists
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.
Note: Supplemental Report Filing – Follow Steps 1 and 2 above, and then select a report
from the [Submitted Incident/Accident Reports] lists as described in Step 5. The report will
default to Supplemental and pre-populate data fields with data you previously submitted. At
this point, you can amend your data and re-submit the report to PHMSA as a Supplemental
Report.
If you submit your report online, DO NOT
DOT as this may result in duplicate entries.

MAIL OR FAX the completed report to

Alternate Reporting Methods
Operators for whom electronic reporting imposes an undue burden and hardship may
submit a written request for an alternative reporting method. Operators must follow the
requirements in §191.7(c) to request an alternative reporting method and must comply with
any conditions imposed as part of PHMSA’s approval of an alternate reporting method.
Type or print all entries when submitting hardcopy forms.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 3 of 21

RESCINDING A REPORT
An operator who reports an incident and upon subsequent investigation determines that the
event did not meet the criteria in 49 CFR 191.3 may request that the report be rescinded.
Requests for rescission should be submitted on operator letterhead and mailed or faxed to
the Information Resources Manager at the address/fax number below. Requests may also
be submitted by email to [email protected]. Requests should
include the following information:
a. The Report ID, the unique 8-digit identifier assigned by PHMSA,
b. Operator name,
c. PHMSA-issued operator ID number,
d. The number assigned by the National Response Center (NRC) when a
telephonic report was made in accordance with 49 CFR 191.5, If
supplemental reports were made to the NRC for the incident, list all NRC
report numbers associated with the event.
e. Date of the incident,
f. Location of the incident, and
g. A brief statement as to why the report should be rescinded.
Mail rescissions to:
DOT/PHMSA Office of Pipeline Safety
Information Resources Manager,
1200 New Jersey Ave., SE
nd

East Building, 2 Floor, (PHP-20)
Room Number E22-321
Washington, DC 20590
Fax rescissions to: Information Resources Manager at (202) 366-4566.

SPECIAL INSTRUCTIONS
1. Certain data fields must be completed before an Original Report will be accepted. The data
fields that must be completed for an Original Report to be accepted are indicated on the
online form . 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. If filing a hardcopy
of this report, the report will not be accepted by PHMSA unless all of these fields have been
completed.
2. An entry should be made in each applicable space or check box, unless otherwise directed by
the section instructions.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 4 of 21

3. If the data is unavailable, enter “unknown” for text fields and leave numeric fields and fields
using check boxes or “radio” buttons blank.
4. 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.
5. For unknown or estimated data entries, the operator should file a Supplemental Report when
additional or more accurate information becomes available.
6. 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.
7. For questions requiring non-zero numeric answers, all data fields should be filled in using
zeroes when appropriate.
Example:
(Part A, Question 13.a) Operator employees injured:

/0/0/0/4/

(4 people)

8. 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.
9. Pay close attention to each question for the phrase:
a. (select all that apply)
b. (select only one)
If a 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.
10. Date format = mm/dd/yy or for year = /yyyy/
11. Time format: All times are reported as a 24-hour clock:
Time format examples:
a. (0000) = midnight =
b. (0800) = 8:00 a.m. =
c. (1200) = Noon
=
d. (1715) = 5:15 p.m. =
e. (2200) = 10:00 p.m. =

/0/0/0/0/
/0/8/0/0/
/1/2/0/0/
/1/7/1/5/
/2/2/0/0/

12. 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 an LNG facility in Denver, Colorado at 2:00 pm
MST, but a supervisor located in Houston is filing the report after having been notified at
Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 5 of 21

3:00 pm CST, the time of the incident should be reported as 1400 hours based on the time in
Denver, which is the physical site of the incident.

SPECIFIC INSTRUCTIONS

PART A – KEY REPORT INFORMATION
Report Type: (select all that apply)
Check the appropriate report box or boxes to indicate the type of report being filed.
Depending on the descriptions below, the following combinations of boxes may be
selected:
• Original Report
• Original Report plus Final Report
• Supplemental Report
• Supplemental Report plus Final Report


Original Report

Select this type of report if this is the FIRST report filed for this incident, and not enough
information is available at this time to conclude that this is also a Final Report where no
further information will be forthcoming. Select Original Report in cases where further
information may be forthcoming, such as when final property damage numbers or apparent
failure cause is not immediately available).


Original Report

plus



Final Report

Select both the Original Report and Final Report boxes 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. Selecting both these boxes will
indicate that further information is not expected to be forthcoming through a Supplemental
Report. If, however, for some reason new information or corrected information becomes
available unexpectedly, the operator should still file a Supplemental Report indicating such
and explaining the circumstances in Part G – Narrative Description of the Incident.


Supplemental Report

Select this type of report only if you have already filed an Original Report AND you are
now providing new, updated, and/or corrected information. Multiple supplements are to be
submitted, as necessary, in order to provide new, updated, and/or corrected information
when it becomes available.
Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 6 of 21

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.
For Supplemental Reports filed by fax or mail, check the Supplemental Report box,
complete Part A, Questions 1 through 8 and then enter ONLY information that has changed
or is being added for the remainder of the report. Do NOT enter previously submitted
information that has not changed other than Part A, Questions 1-8 before completing Part H
– Preparer and Authorized Signature. Part A, Questions 1-8 and Part H need to be repeated
with each filing in order to properly associate the Supplemental Report with previously
filed reports.
Operators are encouraged to file Supplemental Reports within one year in those instances
where the Supplemental Report is used to update information from investigations that were
still ongoing when the prior report was filed.


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 submitter is
reasonably certain that no further information will be forthcoming, then the Final Report
box should also be selected along with the Supplemental Report box.

Supplemental Reports must be filed as soon as practicable following the Operator’s
awareness of new, additional, or updated information. Failure to comply with these
requirements can result in enforcement actions, including the assessment of civil penalties
not to exceed $100,000 for each violation for each day that such violation persists up to a
maximum of $1,000,000.
Important: If an Operator files one of the two types of Final Reports (either Original +
Final or Supplemental + Final) and then subsequently finds that new or corrected
information needs to be provided, the operator is to submit another Supplemental Report,
selecting the appropriate box or boxes (Supplemental or Supplemental + Final) for the
newly submitted report and including an explanation in PART G – Narrative Description of
the Incident.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 7 of 21

In Part A, answer Questions 1 thru 18 by providing the requested
information or by checking the appropriate box.
1. Operator’s OPS-Issued Operator Identification Number (OPID)
The Office of Pipeline Safety (OPS) in the Pipeline and Hazardous Materials Safety
Administration (PHMSA) assigns the operator identification number (OPID). Most OPIDs
are 5 digits. Older OPIDs may contain fewer digits. If your OPID contains fewer than 5
digits, insert leading zeros to fill all blanks. (For example, enter 00395 instead of 395.)
Contact the Information Resources Manager at (202) 366-8075 if you need assistance with
an OPID. Business hours are 8:30 AM to 5:00 PM Eastern Time.
2. Name of Operator
This is the company name used when registering for an OPID and PIN in the Online Data
Entry System. For online entries, the Name of Operator will be automatically filled in
based on the OPID number entered in Question 1. If the name that appears automatically
after entering the OPID is not correct or does not coincide with the OPID entered, contact
the Information Resources Manager at (202)366-8075.
3. Address of Operator
Enter the address of the operator’s business office to which any correspondence related to
the Incident Report should be sent.
4. Local time (24-hour clock) and date of the Incident
Enter the date of the incident and the local time the incident occurred.
See “Special Instructions”, Items 10 and 11 for examples of Date format and Time format
expressed as a 24-hour clock.
5. National Response Center (NRC) Report Number
§191.5 requires that incidents meeting the criteria outlined in §191.3 be reported directly to
the 24-hour National Response Center (NRC) at 1-800-424-8802 at the earliest
practicable moment (generally within 2 hours). The NRC assigns numbers to each call.
The number of that telephonic report is to be entered in Question 5.
6. Local time (24-hr clock) and date of initial telephonic report to the National
Response Center
Enter the time and date of the telephonic report of the incident to the NRC. The time
should be shown by 24-hour clock notation, and should reflect the time in the time zone
where the incident was physically located. (See “Special Instructions”, Items 10 and 11.)

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 8 of 21

7. Incident resulted from
Indicate whether the incident resulted from an unintentional or an intentional release of
commodity, an emergency shutdown, or as the result of other reasons. If “Reasons other
than the above” is selected, describe the circumstances.
8. Commodity released
Report the type of commodity released. Select “No release of commodity involved” if the
incident is from an emergency shutdown or other cause that did not involve a release. If
Other Commodity is selected, enter the specific name of the commodity released.
9. Estimated volume of commodity released unintentionally
Estimate the amount of commodity that was released (in thousands of standard cubic feet,
MCF) from the beginning of the incident until such time as the commodity is no longer
being released from the facility or until intentional and controlled blowdown has
commenced. Estimates should be based on the best available information.
10. Estimated volume of intentional and controlled release/blowdown
Estimate the amount of commodity 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 facility and situation by the Operator such that the area and
the public are protected during the controlled release.
11. Estimated volume of liquid spilled to the ground
Estimate the amount of commodity 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 commodity is
no longer being released from the facility. Barrel means a unit of measurement equal to 42
U.S. standard gallons. If less than 1 barrel, report to 1 decimal place (see table below).
If
estimated
volume is
<6
7-10
11-14
15-18
19-22

Instructions:

Report
gallons
gallons
gallons
gallons
gallons

0.1
0.2
0.3
0.4
0.5

barrels
barrels
barrels
barrels
barrels

If
estimated
volume is
23-27
28-31
32-35
36-39
40-42

Report
gallons
gallons
gallons
gallons
gallons

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

0.6
0.7
0.8
0.9
1.0

barrels
barrels
barrels
barrels
barrels

Page 9 of 21

12. 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. This
aligns with the Department of Transportation's general guidelines for all modes for
reporting deaths and injuries.
Contractor employees working for the operator are individuals hired to work for or on
behalf of the operator of the pipeline. These individuals should not be reported as
“Operator employees”.
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 should be reported as
“General public.”
13. Were there injuries requiring inpatient hospitalization?
Injuries requiring inpatient hospitalization are injuries sustained as a result of the incident
that require hospital admission and at least one overnight stay.
Contractor employees working for the operator (see Item 12).
Non-operator emergency responders (see Item 12).
14. Was the LNG Facility shut down due to the incident?
Report any shutdowns that occur because of damage incurred during the incident or to
make repairs necessitated by the incident. Instances in which an incident was caused by a
situation that did not involve damage to the facility (e.g., emergency shutdown) and in
which no need for repairs resulted should not be reported as being shutdown, even though
the facility may have been shutdown as a precautionary measure to inspect for damages.
If No is selected, explain the reason that no shutdown was needed in the space provided.
If Yes is selected, complete Questions 14.a and 14.b. If the facility has not been restarted
at the time of reporting, check “Still shut down” for Question 14.b and then include the
restart time in a future Supplemental Report.
15. Was there an ignition?
Ignite means the released commodity caught fire.
16. Was there an explosion?
Explode means the ignition of the released commodity with a sudden and violent release of
energy.
Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 10 of 21

17. Number of General Public Evacuated
The number of people evacuated should be estimated based on operator knowledge, or
police, fire or other emergency responder reports. If there was no evacuation involving the
general public, report zero (0). If an estimate is not possible for some reason, leave the
field blank but include an explanation of why it was not possible to provide a number in
Part G – Narrative Description of the Incident.
18. Number of Operator/Contractor Personnel Evacuated
Report here the number of operator employees or contracted personnel evacuated from the
facility. If there was no evacuation from the facility, report zero (0).

PART B – ADDITIONAL FACILITY INFORMATION
1.

Facility Information

Complete the table, providing or editing information for the facility involved in the
incident.
Name of LNG Plant / Facility is the name used by the operator to identify the facility.
This should be the same as the LNG_NM field reported to the National Pipeline Mapping
System (NPMS)
NPMS ID should be the same as the NPMS field LNG_ID.
Plant / Facility Status should be the same as NPMS field STATUS_CD.
following abbreviations to indicate Plant / Facility Status:

Use the

Status Codes
I In Service
B Abandoned
R Retired
Plant / Facility Location should match the location submitted to NPMS. Latitude and
longitude information is particularly important for mobile facilities.
The latitude and longitude of the LNG Facility/Plant 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°

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 11 of 21

All locations in the United States will have a negative longitude coordinate, which has
already been included on the form so that operators do not have to enter the negative
sign.
If you cannot locate the LNG Plant / Facility with a GPS or some other means, the U.S.
Census Bureau provides a tool for determining latitude and longitude,
(http://tiger.census.gov/cgi-bin/mapbrowse-tbl). You can use the online tool to identify the
geographic location of the LNG Plant / Facility. The tool displays the latitude and longitude
in decimal degrees below the map. Any questions regarding the required format,
conversion or how to use the tool noted above can be directed to Amy Nelson
(202.493.0591 or [email protected]).
Process should report the listed process information for the facility at the time of the
incident. Total capacity refers to the entire facility, not any specific piece of equipment.
LNG Source. Identify the source or sources of LNG such as Truck, Railroad, Marine
(ship/barge), or Liquefaction. All LNG sources that apply should be selected. Use the
following abbreviations to indicate the LNG Source(s):
LNG Source
T Truck
R Railroad
M Ship/Barge
L Liquefaction
PHMSA- or State-inspected correlates to the agency that inspects the facility for
compliance with 49 CFR Part 193. (This will either be the federal or PHMSA state agent
for interstate facilities or the state for intrastate facilities.)
LNG Storage. Volume of LNG in Storage at the time of the incident should be the total
volume stored on site at the time of the incident.
2.

Type of LNG Plant / Facility

Check the type of LNG plant or facility involved in the incident:
Base Load: A facility that operates continuously at a constant rate to provide gas supply
throughout the year.
Peak Shaving: LNG peak shaving facilities are used for storing surplus natural gas for use
during peak demand periods such as winter and summer.
Satellite: Satellite peak shaving plants do not include process equipment to convert natural
gas to LNG. Instead, trucks deliver LNG for storage on site. Satellite peak shaving plants
typically inject natural gas into distribution pipeline systems.
Mobile/Temporary: These facilities are used to provide a temporary supply during
scheduled activities such as maintenance or construction or supply emergencies that may
Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 12 of 21

arise. For these facilities, identify whether the facility is associated with or providing
commodity for an interstate or intrastate pipeline.
Other: Describe the plant or facility type in the space provided.
3.

Function of LNG Plant / Facility at the time and date of the Incident

Identify the function or functions of the plant or facility.
4.

Item involved in Incident

Identify the primary item involved in the incident. If the incident occurred on an item
not listed in this section, select Other and specify in the space provided the item that
failed or was otherwise involved in the Incident.

PART C – ADDITIONAL CONSEQUENCE INFORMATION
1.

Estimated cost to Operator

All relevant costs to the operator must be included on the initial written Incident Report as
well as 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, lost commodity, facility
repair and replacement, and environmental cleanup and damage. Do not report costs
incurred for facility repair, replacement, or change that are not related to the incident done
solely for convenience. An example of doing work solely for convenience is working on
other portions of the facility that were shut down because of the incident. Litigation and
other legal expenses related to the Incident are not reportable.
Operators should report costs based on the best estimate available at the time a report is
submitted. It is likely that an estimate of final repair costs may not be available when the
initial report must be submitted (30 days, per § 191.15). The best available estimate of
these costs should be included in the initial report. For convenience, this estimate can be
revised, if needed, when Supplemental Reports are filed for other reasons, however, when
no other changes are forthcoming, Supplemental Reports should be filed as new cost
information becomes available. If Supplemental Reports are not submitted for other
reasons, a Supplemental Report should be filed for the purpose of correcting the estimated
cost if these costs differ from those already reported by 20 percent or $20,000, whichever is
greater.
Public and Non-operator private property damage estimates generally include physical
damage to the property of others, the cost of 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.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 13 of 21

Paid/reimbursed means that the entity experiencing the property damage was
compensated by the operator or operator’s representative for the damage or the cost to
repair the damage. Estimate costs, if necessary, for the initial filing, and then file a
Supplemental Report when actual costs become known or as estimated costs change.
Cost of commodity released unintentionally should be based on the volume reported in
Part A, Question 9.
Cost of commodity released during intentional and controlled blowdown should be
based on the volume reported in Part A, Question 10.
Operator’s property damage estimates generally include physical damage to the property
of Operator or Owner Company such as the estimated installed value of the equipment
damaged due to the Incident, excluding litigation and other legal expenses related to the
incident.
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. 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 facility to mitigate the risk of future failures are not
included.
Estimated cost of Operator’s emergency response includes emergency response
operations necessary to return the incident site to a safe state, actions to minimize the
volume of commodity released, conduct reconnaissance, and to identify the extent of
incident impacts. They include materials, supplies, labor, and benefits. Costs related to
stakeholder outreach, media response, etc. should not be included.
Other costs should include any and all costs which are not included above. Operators
should NOT use this category to report any costs which belong in cost categories separately
listed above.
Costs should be reported in only one category and should not be double-counted. Costs
can be split between two or more categories when they overlap more than one reporting
category.

PART D – ADDITIONAL OPERATING INFORMATION
1. Was a computerized Control System in place?
Computerized control systems include distributed control systems (DCS), supervisory
control and data acquisition systems (SCADA), and other types of computer-based systems
used for control of all or a portion of the facility. Computer-based control of an individual
piece of equipment is not considered a computerized control system.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 14 of 21

Answer Yes or No to indicate whether a computerized control system was installed in the
facility. If Yes, then indicate whether the system was operating at the time of the incident,
indicating separately whether the computerized control system was capable of performing
all of its functions, and whether or not it was actually in operation at the time of the
incident. If No, describe why the system was not operating or describe the functions that
were not operational at the time of the incident in Part G – Narrative Description of the
Incident.
2. How was the Incident initially detected? (select only one)
Local operating personnel including contractors means employees or contractors
working on behalf of the operator outside the control room.
Remote operating personnel would include pipeline controllers or other individuals
monitoring or operating a facility from a control room, whether located at the facility or
remotely.
Notification from Public should include notification to the operator directly by a member
of the public including emergency responders, or notification from public safety personnel
when a member of the public reports an incident by dialing 911, or when public safety
personnel, themselves, identify the incident.

PART E – DRUG & ALCOHOL TESTING INFORMATION
Requirements for post-incident drug and alcohol tests are in 49 CFR 199. If the incident
circumstances were such that tests were not required per these regulation, and if no tests
were conducted, check No. If tests were administered, select Yes and report separately the
number of operator employees and contractors working for the operator that were tested
and the number that failed such tests.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 15 of 21

PART F – APPARENT CAUSE
In PART F – Apparent Cause, complete only one of the eight Sections listed as F1
thru F8.
After identifying the main cause category as designated by F1 thru F8, select the one,
single sub-cause that best describes the apparent cause of the incident in the shaded
column on the left. Answer the corresponding questions that accompany your selected
sub-cause, and describe any secondary, contributory, or root causes of the Incident in
Part G – Narrative Description of the Incident.

F1 – Corrosion Failure
Corrosion includes a release or failure caused by galvanic, atmospheric, stray current,
microbiological, or other corrosive action. A corrosion release is not limited to a hole in
the pipe. 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 should be classified as
Corrosion. (Note: If the bonnet, packing, or other gasket has deteriorated before the end of
its expected life but not due to corrosive action, the failure should be classified under F6 Equipment Failure.)
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 incident 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 an
LNG facility which results in an incident.
Temperature (Weather-related) refers to failures due to weather-related temperature
effects, either heat or cold, where temperature was the initial cause. Do NOT report here
incidents caused by embrittlement due to handling of cryogenic/process fluids which

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 16 of 21

should be reported under either F5 – Material Failure of Pipe or Weld if occurring on inplant piping or welds, or under F6 – Equipment if occurring on other equipment.
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. Do
NOT report here Incidents resulting from thermal stresses associated with handling of
cryogenic liquids within the facility. Report these events under either F5 – Material Failure
of Pipe or Weld if occurring on in-plant piping or welds, or under F6 – Equipment if
occurring on other equipment.
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 as section F4 - Other Outside Force Damage.
Answer Questions 2 and 2.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 were involved,
indicate Other and describe in the space provided.
F3 – 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, 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 F2 - Natural Force Damage or F4 Other Outside Force as appropriate.
Excavation Damage by Operator (First Party) refers to incidents caused as a result of
excavation by a direct employee of the operator.
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.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 17 of 21

F4 – Other Outside Force Damage
Other Outside Force Damage includes a release or failure resulting from non-excavationrelated 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. An example of
such a failure would be an explosion/fire at a neighboring facility or installation (chemical
plant, tank farm, other industrial facility) that results in an incident at the operator’s facility.
(Note that an incident report is required only if damage to facilities subject to Part 192
exceeded $50,000, or if one of the other incident criteria in § 191.3 is triggered). This
section should not be used if a release occurred first and then the gas ignited. If the fire is
known to have been started as a result of a lightning strike, the incident’s cause should be
classified under F2 - Natural Force Damage. Arson events directed at harming the pipeline
or the operator should be reported as “Intentional Damage” in this section. Forest fires that
are caused by human activity and result in a release should be reported in this section.
Damage by Car, Truck, or Other Motorized Vehicle/Equipment NOT Engaged in
Excavation. Other motorized vehicles or equipment include tractors, backhoes, bulldozers
and other tracked vehicles, and heavy equipment that can move. Include under this subcause, 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. If the activity involved digging, drilling, boring, grading, cultivation or similar
activities, report under F3 - 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 that have lost their moorings and are carried into the
LNG 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 LNG facility by waves,
currents, or high winds. In such cases, also indicate the type of severe weather event.
Electrical Arcing from Other Equipment or Facility such as a pole transformer or
adjacent facility electrical equipment.
Previous Mechanical Damage NOT Related to Excavation. This sub-cause covers
incidents where damage occurred at some time prior to the release, and would include prior
outside force damage of an unknown nature, 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 damage sustained during construction,
installation, or fabrication of the pipe or a weld should be reported under F5 - Material
Failure of Pipe or Weld.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 18 of 21

Intentional Damage
Vandalism means willful or malicious destruction of the operator’s facility or
equipment. This category would include pranks, systematic damage inflicted
to harass the operator, motor vehicle damage that was inflicted intentionally,
and a variety of other intentional acts.
Terrorism, per 28 C.F.R. §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.
Indicate if a breach of security occurred in conjunction with the incident.
Other Outside Force Damage. Describe in the space provided and, if necessary, provide
additional explanation in Part G.
F5 – Material Failure of Pipe or Weld
Use this section to report material failures only if “Item involved in Incident” (Part B,
Question 5) is “In-plant Piping” or “Weld.” Indicate how the sub-cause was determined
or if the sub-cause is still being investigated.
This section includes releases in or failures from defects or anomalies within the material
of the pipe body or within the pipe seam or other weld due to faulty manufacturing
procedures, defects resulting from poor construction/installation practices, and in-service
stresses such as vibration, fatigue and environmental cracking.
Construction-, Installation-, or Fabrication-related includes a release or failure caused
by a dent, gouge, excessive stress, or some other defect or anomaly introduced during the
process of constructing, installing, or fabricating in-plant piping (or welds which are an
integral part of in-plant piping), including welding or other activities performed at the
facility.
Original Manufacturing-related includes a release or failure caused by a defect or
anomaly introduced during the process of manufacturing the pipe used in in-plant piping,
including seam defects and defects in the pipe body.
Low Temperature Embrittlement (due to a process fluid) means a release in or failure
of in-plant piping or weld due to the effect of handling cryogenic fluids. Embrittlement
failure of equipment other than in-plant piping or weld, including due to effects of spilled
or leaking cryogenic fluids, should be reported under F6 - Equipment Failure.
Was insulation degradation a factor in this failure?
Indicate here whether the reduced effectiveness of insulation was a factor.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 19 of 21

F6 – Equipment Failure
This section applies to failures of items other than “In-plant Piping” or “Weld”.
Equipment Failure includes a release or failure resulting from: malfunction of
control/relief equipment including valves, regulators, or other instrumentation; failures of
pumps or compressors, or pump- 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 low
temperature embrittlement); and, all other equipment-related failures.
Malfunction of Control/Relief Equipment. Examples of this type of incident cause
include: overpressurization resulting from malfunction of control or alarm device; relief
valve malfunction; valves failing to open or close on command; or valves which opened or
closed when not commanded to do so. If overpressurization or some other aspect of this
incident was caused by incorrect operation, the incident should be reported under F7 Incorrect Operation.
Other Equipment Failure. If this is selected, describe the circumstances and provide
information regarding this failure element that make it clear why none of the other possible
choices were appropriate selections.
Did this failure involve Low Temperature Embrittlement due to process fluids?
Indicate here whether the equipment failure identified above involved or was caused by
embrittlement due to handling cryogenic fluids, including impacts from spills.
Was insulation degradation a factor in this failure?
Indicate here whether the reduced effectiveness of insulation was a factor.
F7 – Incorrect Operation
Incorrect Operation includes a release or failure resulting from operating, maintenance,
repair, or other errors by facility personnel, including, but not limited to improper valve
selection or operation, inadvertent overpressurization, or improper selection or installation
of equipment.
Other Incorrect Operation. If this is selected, describe the circumstances.
F8 – Other Incident Cause
This section is provided for incident causes that do not fit in any of the main cause
categories listed in Sections F1 through F7.
If the incident cause is known but doesn’t fit in any category in Sections F1 through F7,
check the Miscellaneous box and enter a description of the incident and continue in Part G,
Narrative Description of the Incident, if more space is needed.
Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 20 of 21

If the incident cause is unknown at time of filing this report, check the Unknown box in
this section and select one reason from the accompanying two choices. If the investigation
is not completed and the cause of the incident is thus still to be determined, file a
supplemental report once the investigation is completed to report the apparent cause.

PART G – 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, to
provide sketches or drawings, and to explain any estimated data. Operators submitting
reports on-line will be afforded the opportunity to attach/upload files containing sketches,
drawings, or additional data.
If you checked the Miscellaneous block in Section F8, the narrative should describe the
incident in detail, including all known or suspected causes and possible contributing
factors.
Operators should use the narrative to describe any secondary, contributing, or root causes
that they consider important but which could not be reported in Part F since only the
apparent cause is reported there.

PART H – PREPARER AND AUTHORIZED SIGNATURE
The Preparer is the person who compiled the data and prepared the responses to the report
and who is to be contacted for more information (preferably the person most
knowledgeable about the information in the report or who knows how to contact the person
most knowledgeable). Enter the Preparer’s e-mail address if the Preparer has one, and the
phone and fax numbers used by the Preparer.
An Authorized Signature must be obtained from an officer, manager, or other person whom
the operator has designated to review and approve (and date) the report. This individual 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 individual signing
as the Authorized Signature.

Instructions:

Incident Report – LNG (Liquefied Natural Gas) Facility

Form PHMSA F-7100.3 (Rev. 10-2010)

Page 21 of 21

File Type	application/pdf
Subject	LNG Incident Report
File Modified	2010-10-06
File Created	2010-10-06