PHMSA F-7100.3-1 LNG Annual Report

Incident and Annual Reports for Gas Pipeline Operators

LNGAnnualReportwInstructionsJune2011

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⚠️ Notice: This form may be outdated.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:

Document [pdf]

Download: pdf | pdf

Notice: This report is required by 49 CFR Part 191. Failure to report may result in a civil penalty not to exceed $100,000 for each violation
for each day the violation continues up to a maximum of $1,000,000 as provided in 49 USC 60122.

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

ANNUAL REPORT FOR CALENDAR YEAR 20___
LIQUEFIED NATURAL GAS (LNG) FACILITIES

Form Approved
OMB No. 2137-0522
Expires: 01/31/2014
INITIAL REPORT

SUPPLEMENTAL REPORT




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 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.
Important: Please read the separate instructions for completeing 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.
PART A - OPERATOR INFORMATION

DOT USE ONLY

1. OPERATOR’S 5 DIGIT IDENTIFICATION NUMBER (OPID)

2. NAME OF COMPANY OR ESTABLISHMENT:

/
IF SUBSIDIARY, NAME OF PARENT:
__________________________________________________

3. INDIVIDUAL WHERE ADDITIONAL INFORMATION MAY BE
OBTAINED:

4. HEADQUARTERS ADDRESS:

Name

Company Name

Title

Street Address

__________________________________________________
Email Address

State: /

/ Zip Code: /

/__/__/__/-/__/__/__/-/__/__/__/__/

Telephone Number

/ - /

5. DOES THIS REPORT REPRESENT A CHANGE FROM LAST YEAR’S FINAL REPORTED INFORMATION FOR PART B, OR INCLUDE
LEAKS OR REPORTABLE INCIDENTS IN PART C OR SAFETY-RELATED CONDITIONS OR EVENTS IN PART D? (Select all that apply. If
there are changes to PART B, or if there are numbers to report in PARTS C or D, complete those sections. Also, if there are changes to PART B
from the previous year’s report, select the relevant checkbox(es) for the YES questions below.)
 This report is FOR CALENDAR YEAR 2010 reporting or is a FIRST-TIME REPORT and, therefore, the remaining
choices in this Question 5 do not apply. Complete all remaining PARTS of this form as applicable.
 NO, there are NO CHANGES from last year’s final reported information for PART B. Do NOT complete PART B, but
complete PARTS C and/or D when applicable.
 YES, this report represents a CHANGE FROM LAST YEAR’S FINAL REPORTED INFORMATION for PART B due
to corrected information; however, the assets and operations are the same as those which were covered under last year’s
report. Submit a Supplement for last year’s report, and then complete PART B and, when applicable, PARTS C and/or D.
 YES, this report represents a CHANGE FROM LAST YEAR’S FINAL REPORTED INFORMATION for PART B
because of the following change(s) in assets and/or operations from those which were covered under last year’s report.
Complete PART B and, when applicable, PARTS C and/or D. (Select all reasons for these changes from the following list)








Merger of companies and/or operations
Acquisition of LNG facility
Divestiture of LNG facility
New construction or new installation of LNG facilities
Modifications to existing LNG facilities
Change in OPID
Other  Describe: _______________________________________________

 NO, there are NO LEAKS OR REPORTABLE INCIDENTS RESULTING IN A RELEASE to report in PART C.
NOT complete PART C, but complete PARTS B and/or D when applicable.

 NO, there are NO SAFETY-RELATED CONDITIONS OR EVENTS to report in PART D. Do NOT complete PART D,
but complete PARTS B and/or C when applicable.

Form PHMSA F 7100.3-1 (Rev. 06-2011)

Pg. 1 of 4
Reproduction of this form is permitted.

Form Approved
OMB No. 2137-0522
Expires: 01/31/2014

PART B - FACILITY DESCRIPTION, TYPE, AND FUNCTION

Name, ID, and Status, should be EXACTLY THE SAME as NPMS fields LNG_NM, LNG_ID, and STATUS_CD.
Location must match the location submitted to NPMS. The LNG Facility ID (LNG_ID in NPMS) is a unique ID for a
specific facility and is assigned by the Operator.
Use the following key to complete the Descriptive table(s) below:
Status Codes
I In Service
B Abandoned
R Retired

LNG Source
T Truck
R Railroad
M Ship/Barge
L Liquefaction

Type of LNG Plant / Facility
BL Base Load
PS Peak Shaving
SA Satellite
MT Mobile/Temporary
OT Other  Describe

Function of LNG Plant / Facility
MI Marine Terminal - Import
ME Marine Terminal - Export
MB Marine Terminal – Both
SL Storage w/ Liquefaction
SN Storage w/o Liquefaction
SB Storage w/ Both
SU Stranded Utility
VF Vehicular Fuel
NR Nitrogen Rejection Unit
OT Other  Describe
LNG Plant / Facility
#1

LNG Plant / Facility
#2

Add Plants /
Facilities as needed

Name of LNG Plant / Facility
NPMS LNG ID
Location of Plant / Facility
For a fixed LNG Plant/Facility,
provide the State (e.g., TX); for a
Mobile/Temporary facility, provide
the Zip Code where it is
typically stored.
Plant / Facility Status
Date Put In Service
Process
Liquefaction Rate (MMCF/D)
Number of Vaporizers
Total Capacity (MMCF/D)
LNG Source
Interstate or Intrastate
LNG Storage
Number of LNG Tanks
Total Capacity (Bbls)
Type of LNG Plant / Facility
Function of LNG Plant / Facility
Inspection UNIT ID
(DOT INTERNAL USE ONLY)

Form PHMSA F 7100.3-1 (Rev. 06-2011)

Pg. 2 of 4
Reproduction of this form is permitted.

Form Approved
OMB No. 2137-0522
Expires: 01/31/2014

For each LNG Facility listed above (that is, for each column completed above), complete PARTs C and D.
PARTs C and D
The data reported in these PARTs C and D apply to LNG PLANT / FACILITY NUMBER /__/__/ (from PART B)
PART C – LEAKS AND REPORTABLE
INCIDENTS IN PAST YEAR

Record the number of leaks and reportable incidents resulting in a release detected and repaired,
by location and cause. (NOTE: Careful review of the instructions is required.)
Incidents and Leaks
Leaks

Cause

Incidents

Plant Piping and
Equipment

Storage Tank

Other Location

Totals

External Corrosion

Calc

Internal Corrosion

Calc

Natural Force Damage

Calc

Excavation Damage

Calc

Other Outside Force Damage

Calc

Construction-,
Installation-, or
Fabrication-related

Calc

Original
Manufacturingrelated

Calc

Low Temperature
Embrittlement

Calc

Equipment Failure

Calc

Incorrect Operation

Calc

Other Causes

Calc

In-plant Piping
or Weld ONLY
(For these
types of
failures
involving
Equipment,
see the
Instructions)

Totals

Calc

Form PHMSA F 7100.3-1 (Rev. 06-2011)

Calc

Pg. 3 of 4
Reproduction of this form is permitted.

PART D – OTHER CONDITIONS AND EVENTS

Record the number of Safety-Related Conditions and Events.

Number of
Safety-Related
Conditions Reported

TYPE

Form Approved
OMB No. 2137-0522
Expires: 01/31/2014

Number of Events

Totals

Rollover

Calc

Security Breach

Calc

ESD Actuations not reported as
Incidents
- Activated by false signal
- Activated by maintenance or other
non- emergency event
Insulation Degradation

Calc

Other Types

Calc
Totals

Calc
Calc

Calc

PART E - PREPARER SIGNATURE
/__/__/__/-/__/__/__/-/__/__/__/__/
Telephone Number

Preparer's Name(type or print)

/__/__/__/-/__/__/__/-/__/__/__/__/
Preparer's Title

Facsimile Number

Preparer's E-mail Address

Form PHMSA F 7100.3-1 (Rev. 06-2011)

Pg. 4 of 4
Reproduction of this form is permitted.

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
GENERAL INSTRUCTIONS
All section references are to Title 49 of the Code of Federal Regulations (49 CFR). The Liquefied
Natural Gas (LNG) Facilities Annual Report has been revised as of calendar year 2010 affecting
submissions for 2010 and beyond. This Annual Report is required per §191.17 and must be filed per
§191.7. Read through the Annual Report and instructions carefully before beginning to complete the
Report. Where common data elements exist between this Report and an operator’s NPMS submission,
the data submitted by the operator on their Annual Report should be the same as the data submitted
through NPMS when possible. (Additionally, and in order to align an operator’s NPMS submission
with their Annual Report data, PHMSA suggests that operators send their NPMS submission to
PHMSA by March 15, representing LNG Facility assets as of December 31 of the previous year.)
Each operator of a liquefied natural gas facility must submit an Annual Report for that system on DOT
Form PHMSA F 7100.3–1. This report must be submitted each year, not later than March 15, for the
preceding calendar year, except that for the 2010 reporting year the report must be submitted by
August 15, 2011. In order to improve the accuracy of reported data, operators are requested to review
prior years’ Reports in order to validate that their reported numbers are accurate, or to identify and
correct inconsistencies or errors that are either found or that may exist in any previously reported data.
Operators should file Supplemental Reports as necessary, including those supplementing prior years’
Reports.
The terms “component,” “liquefied natural gas or LNG,” “LNG Facility,” “LNG Plant,” and
“operator”, are defined in §193.2007.
If you need copies of the Form PHMSA F 7100.3-1 and/or instructions, they can be found on the
Pipeline Safety Community main page, http://phmsa.dot.gov/pipeline, by clicking Data and Statistics
and then selecting the Forms hyperlink. If you have questions about this Report or these instructions,
call PHMSA’s Information Resources Manager at 202-366-8075.

Rev 06-2011

Page 1 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
ONLINE REPORTING REQUIREMENTS
Annual Reports must be submitted online unless an alternate method is approved (see Alternate
Reporting Methods below).
The following two separate PIN/password requirements must be fulfilled prior to submitting data
online:
1. You must have an Office of Pipeline Safety (OPS) provided Operator Identification
Number (OPID) and Personal Identification Number (PIN). If you do not have one,
complete and submit the form located on the OPS Online Data Entry and Operator
Registration
System
New
Operator
Registration
web
site
at
http://opsweb.phmsa.dot.gov/cfdocs/opsapps/pipes/new_operator.cfm to obtain one.
2. You must ALSO have a Username and Password obtained by registering through the
PHMSA Portal. If you have an OPS OPID and PIN, you may obtain a Username
and Password through the PHMSA Portal. If you do not have a Username and
Password for the PHMSA Portal, go to https://portal.phmsa.dot.gov/pipeline and
click on Create Account and complete the form as required.
Important: Each operator without an OPID is to plan accordingly and allow for several weeks prior to
the due date of the Report to obtain their OPID from PHMSA.

REPORTING METHOD
Use the following procedures to complete an Annual Report:
1. Navigate
to
the
Pipeline
Safety
Community
main
page,
http://www.phmsa.dot.gov/pipeline, click the ONLINE DATA ENTRY link listed.
2. Click on the “Year 2010 and later” hyperlink under the LNG Facilities Report subtitle.
This takes you to the PHMSA Portal login screen.
3. Enter your “Username” and “Password” and click on “Login”.
4. Under “Create Reports” on the left side of the screen, under Annual select “LNG
Facilities” 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 submission. Also, only one Annual Report for an
OPID may be submitted per year.
5. To save intermediate work without formally submitting it to PHMSA, click Save. To
modify a draft of an Annual Report that you saved, go to Saved Reports and click
on LNG Facilities. Locate your saved report by the date or report year. Select the
Rev 06-2011

Page 2 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
record by clicking on it once, and then click Modify below the record.
6. Once all sections of the form have been completed, click on Validate to ensure all
required fields have been completed and data meets all other requirements. A list of
errors will be generated that must be fixed prior to submitting an Annual Report.
7. Click Submit when you have completed the Report (for either an Initial Report or a
Supplemental Report), and are ready to initiate formal submission of your Report to
PHMSA.
8. A confirmation message will appear that confirms a record has been successfully
submitted. To save or print a copy of your submission, go to Submitted Reports on
the left hand side, and click on LNG Facilities. Locate your submitted report by the
date or report year, and then click on the PDF icon to either open the file and print it,
or save an electronic copy.
9. To submit a Supplemental Report, go to Submitted Reports on the left hand side,
and click on LNG Facilities. Locate your submitted report by the date or report year.
Select the record by clicking on it once, and then click “Create Supplemental”.

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.

SPECIFIC INSTRUCTIONS
Make an entry in each block for which data is available. Estimate data only if necessary. Avoid
entering any data as UNKNOWN or 0 (zero) except where zero is appropriate to indicate that there
were no instances or amounts of the attribute being reported.
Enter the Calendar Year for which the Report is being filed, bearing in mind that reporting
requirements are for the preceding calendar year (i.e., for the March 15, 2011 deadline, the Report
should provide information for assets as they existed at the end of the 2010 calendar year).
Select Initial Report if this is the original filing for the calendar year. Select Supplemental Report
if this is a follow-up to a previously filed Report to amend or correct information for that calendar
year.

Rev 06-2011

Page 3 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
PART A – OPERATOR INFORMATION
Complete all 5 sections of Part A before continuing to Part B.
1. Operator’s 5-digit Identification Number (OPID)
All operators that meet the definition of an “operator” under §193.2007 must have a PHMSAassigned Operator Identification Number (also known as an OPID). If the person completing the
Report does not know the OPID for the facility(ies) being reported, this information may be
requested from PHMSA’s Information Resources Manager at 202-366-8075. (See instructions on
the ONLINE DATA ENTRY page as described above.)
2. Name of Company or Establishment
This is the company name used when registering for an OPID and PIN in the Online Data Entry
System. When completing the Report online, the Name of Operator is automatically filled in based
on the OPID entered in Part A, Question 1. If the name that appears does not coincide with the
OPID, contact PHMSA’s Information Resources Manager.
If the company corresponding to the OPID is a subsidiary, enter the name of the parent company.
3. Individual where additional information may be obtained
Enter the name, title, email address, and telephone number of the individual who should be
contacted if additional information regarding this Report submission is needed.
4. Headquarters address
Enter the address and phone number of the operator’s corporate headquarters.
5. Does this Report represent a change from last year’s final reported information for Part B,
or include leaks or reportable incidents in Part C, or Safety-Related Conditions or Events in
Part D?
Select “This Report is for calendar year 2010 reporting or is a first-time Report…” only for the
reporting of calendar year 2010 data, including any supplements to that information, or if this is a
first-time filing of an Annual Report for these facilities. Because this revision of the Annual
Report will be used for the first time to report data for calendar year 2010, some of the “Parts” of
this Report referred to in this question are new and, therefore, no comparable data will have been
reported for the prior year. For calendar year 2010 only, all operators should respond to this
question by selecting the box “This Report is for calendar year 2010 reporting or is a first-time
Report…”, and then complete all remaining Parts of the Report as applicable. Similarly, if no
Annual Report has been previously filed for this operator, OPID, or facility(ies), or for other
reasons, select the box “This Report is for calendar year 2010 reporting or is a first-time Report…”,
and then complete all remaining Parts of the Report as applicable.
Rev 06-2011

Page 4 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
For calendar year submissions beyond 2010, an option has been created to allow the operator to
provide information for relevant Parts when certain portions of the information have not changed.
Select “No” related to Part B if there are no changes in the information reported in Part B of this
form from the information reported for the prior year in Part B for the LNG Facility(ies) that is(are)
the subject of this Report. If this box is selected, Part B need not be completed.
When there are changes in the information reported for the current reporting year compared against
the prior calendar year, these changes can occur for one of the two following reasons:
1) New information or new calculations may have changed the understanding of
facility data, leading to differences in some data elements reported on the Annual
Report in the previous year’s Report, even though the physical assets themselves
have not changed, or
2) The facility(ies) may have changed – either physically or operationally.
Select one or both of the two “Yes” boxes if reported facility information has
changed. If the change is due to a change in the facility(ies) and/or operations
(number 2 above), select the appropriate box or boxes to indicate the nature of the
change(s). If “Other” is selected, provide a brief description of the change. If
either one of or both “Yes” boxes are selected, complete Part B.
•

Merger, Acquisition, or Divestiture involves a change in ownership or
operating responsibility that would likely result in changes in the reported
information.

•

New construction or new installation that would likely result in changes in
reported information.

•

Modifications that would likely result in changes in reported information.

•

Change in an operator’s OPID number – or changes in the facilities covered
by a particular OPID number - may result in changes throughout the Annual
Report.

Select “No” related to Part C if there have been no leaks or reportable incidents from the facility
during the reporting year that would be reported in Part C. Do not complete Part C.
Select “No” related to Part D if there have been no Safety-Related Conditions or other Events
during the reporting year that would be reported in Part D. Do not complete Part D.

Rev 06-2011

Page 5 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
PART B – FACILITY DESCRIPTION, TYPE, AND FUNCTION
Report in Part B the elements identified related to the description, type, and function of the
Plants/Facilities covered by this Annual Report, and as they existed at the end of the reporting year.
The Name, ID, and Status of the Plant/Facility, should be EXACTLY THE SAME as NPMS fields
LNG_NM, LNG_ID, and STATUS_CD, and the State where the fixed Plant/Facility is located must
match the location submitted to NPMS. It should be noted that the LNG Facility ID (LNG_ID in
NPMS) is a unique ID for a specific facility and is assigned by the Operator. The following
descriptions apply to the Type of LNG Facility entries:
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:
Mobile LNG facilities are those not characterized as permanent infrastructure that are designed to be
easily moved, e.g. skid-mounted or trailer-mounted, or otherwise portable (see 59A).
Temporary LNG facilities are those used for short term applications to provide supply during planned
construction and maintenance activities or in cases of unplanned events such as peakshaving to meet
unanticipated demand.
Also, see §193.2019:
Mobile/Temporary LNG facilities.
(a) Mobile and temporary LNG facilities for peak shaving application, for service maintenance
during gas pipeline systems repair/alteration, or for other short term applications need not
meet the requirements of this part if the facilities are in compliance with applicable
sections of NFPA 59A (incorporated by reference, see § 193.2013).
Note: When reporting the Zip Code where these Mobile/Temporary facilities are located, indicate the
location where they are typically stored.
Other: Describe the Plant/Facility type in the space provided.

Rev 06-2011

Page 6 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
PART C – LEAKS AND REPORTABLE INCIDENTS IN PAST YEAR
Report separately in Part C leaks as well as Incidents reportable under §191.3 which resulted in a
release of LNG, liquefied petroleum gas, refrigerant gas, or other gas. Leaks are unintentional escapes
of LNG, liquefied petroleum gas, refrigerant gas, or other gas from the facility that are not reportable
as Incidents under §191.3. A non-hazardous release that can be eliminated by lubrication, adjustment,
or tightening is not a leak. Include all leaks repaired or eliminated including by replaced pipe or other
component during the calendar year. Report separately in Part C the total numbers of leaks and
reportable Incidents involving a release of LNG, liquefied petroleum gas, refrigerant gas, or other gas
that were repaired during the reporting year, by location and cause. Report leaks originating in plant
piping and equipment, storage tanks, or other locations separately as indicated on the form. Include all
leaks repaired or eliminated, including by replaced pipe or other component during the calendar year.
Do not include test failures. Incidents reportable under §191.3 should be reported using the same
cause for which the Incident Report was submitted. Enter zero (0) in any cell for which no releases
occurred. Do not leave any cells blank.
For the purposes of this Part C, Leaks and Incidents are to be classified as either:
EXTERNAL CORROSION: includes releases or failures in the pipe or other component due to
galvanic, bacterial, chemical, stray current, or other corrosive action initiating on the outside surface of
the pipe. For PHMSA’s LNG Incident Reporting form, this includes the “External Corrosion” subcause under F1 – Corrosion Failure.
INTERNAL CORROSION: includes releases or failures in the pipe or other component due to
galvanic, bacterial, chemical, stray current, or other corrosive action initiating on the inside surface of
the pipe. From PHMSA’s LNG Incident Reporting form, this includes the “Internal Corrosion” subcause under F1 – Corrosion Failure.
NATURAL FORCE DAMAGE: includes releases or failures 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. For
PHMSA’s LNG Incident Reporting form, this includes main cause F2.
EXCAVATION DAMAGE: includes releases or failures 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 releases or failures determined to have resulted from previous damage due to excavation
activity. This category would include damage to aboveground facilities or piping when incurred
during the conduct of excavation activity. For damage from outside forces OTHER than those
associated with excavation activity, Natural Force Damage or Other Outside Force will most likely
apply. For PHMSA’s LNG Incident Reporting form, this includes main cause F3.
OTHER OUTSIDE FORCE DAMAGE: includes, but are not limited to, releases or failures
resulting from non-excavation-related outside forces, such as nearby industrial, man-made, or other
Rev 06-2011

Page 7 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
fire or explosion; damage by vehicles or other equipment; releases or failures due to mechanical
damage; and, intentional damage including vandalism and terrorism. For PHMSA’s LNG Incident
Reporting form, this includes main cause F4.
IN-PLANT PIPING OR WELD: Use one of these next three categories to report material failures
only if the item involved in the Incident or leak is in-plant piping or welds. These include 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 low
temperature embrittlement. For PHMSA’s LNG Incident Reporting form, this includes main cause F5.
CONSTRUCTION-, INSTALLATION-, OR FABRICATION-RELATED: includes
releases or failures 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. For PHMSA’s LNG Incident Reporting form, this
includes the sub-cause of the same name under F5.
ORIGINAL MANUFACTURING-RELATED: includes releases or failures caused by
a defect or anomaly introduced during the process of manufacturing the pipe used in inplant piping, including seam defects and defects in the pipe body. For PHMSA’s LNG
Incident Reporting form, this includes the sub-cause of the same name under F5.
LOW TEMPERATURE EMBRITTLEMENT: includes releases in or failures of inplant piping or welds 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 Equipment Failure. For PHMSA’s
LNG Incident Reporting form, this includes the sub-cause of the same name under F5.
EQUIPMENT FAILURE: includes releases from or failures of items other than in-plant piping or
welds, and includes releases or failures 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 releases or failures.
For PHMSA’s LNG Incident Reporting form, this includes main cause F6.
INCORRECT OPERATION: includes releases or failures 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. For
PHMSA’s LNG Incident Reporting form, this includes main cause F7.
OTHER CAUSES: includes releases or failures resulting from any other cause not listed above,
including those of a miscellaneous or unknown or unknowable nature. For PHMSA’s LNG Incident
Reporting form, this includes main cause F8.
Rev 06-2011

Page 8 of 9

INSTRUCTIONS FOR FORM PHMSA F 7100.3-1 (Rev. 06-2011)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
PART D – OTHER CONDITIONS AND EVENTS
Report the number of events that were determined to be significant to safety that occurred at the
facility(ies) during the reporting year, such as movement of tanks and/or tank foundations and
impairment of the structural integrity or safety of tanks, piping, or other LNG facility equipment or
components. Report separately the number of events that were reported as Safety-Related Conditions
(§191.23) and events not reported as Safety-Related Conditions. §191.23(b)(4) specifies that a SafetyRelated Condition Report need not be filed if corrective action is completed before the deadline for
filing a Report. Such events should be included in the “Number of Events” column in Part D.
Conditions or events that resulted in a release of LNG, liquefied petroleum gas, refrigerant gas, or
other gas from the facility should be reported in Part C. Enter zero (0) in any cell for which no events
occurred. Do not leave any cells blank.
Rollover refers to an event in which significant stratification has occurred within a tank and, as a
result, significant quantities of liquefied gas suddenly relocate due to differences in density. Rollovers
have resulted in damage to storage facilities and are safety significant events for LNG carriers and their
unloading operations at import terminals.
Security Breach refers to an actual breach of security. Actuation of security alarms due to
circumstances other than an actual breach need not be reported.
ESD (Emergency Shutdown Device) Actuations that result from actual emergencies must be
reported as Incidents (§§ 191.3 and 191.15). These events need not be reported again here. Report in
this Part ESD Actuations that resulted from causes other than an actual emergency. Report ESD
Actuations that resulted from a false signal separately from those resulting from maintenance or other
non-emergency event at the facility. Do not report intentional, non-emergency ESD’s.
Insulation Degradation refers to reduced effectiveness of insulation (e.g., loss of vacuum) requiring
corrective action. Do not include instances of insulation degradation that contributed to or resulted in a
leak or reportable incident. These should be reported in Part C.
Other Types should include major meteorological or geophysical disturbances or other events that the
operator considers to have been significant to safety including, but not necessarily limited to, SafetyRelated Conditions and safety significant events not otherwise included in other rows of Part D and
that were reported during the reporting year or that would have been reported had corrective action not
been completed before the reporting deadline. Do not report again any events that have been included
in other rows of Part D.

PART E – PREPARER SIGNATURE
The Preparer is the person who compiled the information and prepared the responses to the Report.
Enter the Preparer’s name and title, and e-mail address if the Preparer has one, and the phone and fax
numbers used by the Preparer.
Rev 06-2011

Page 9 of 9

File Type	application/pdf
File Title	ANNUAL REPORT
Subject	GAS TRANSMISSION/GATHERING SYS
Author	Mark Lepofsky
File Modified	2011-06-30
File Created	2011-06-30