PHMSA F7100.3 Incident Report - Liquefied Natural Gas (LNG) Facilities

Incident Reports for Natural Gas Pipeline Operators

LNG Incident Form and Instructions

Incident Reports for Gas Pipeline Operators

OMB: 2137-0635

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2137-0635 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 as provided in
49 USC 60122.

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

OMB NO: ???????
EXPIRATION DATE: ??/??/201?

Report Date

INCIDENT REPORT –
LIQUEFIED NATURAL GAS (LNG) FACILITIES

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-????. Public reporting for this
collection of information is estimated to be approximately 12 hours per response, including the time for reviewing instructions, gathering the
data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:
Information Collection Clearance Officer, PHMSA, Office of Pipeline Safety (PHP-30) 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
INSTRUCTIONS

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

PART A – KEY REPORT INFORMATION
Last Revision Date
A1. Operator’s OPS-issued Operator Identification Number (OPID):

A2. Name of Operator: ______________________________________________________________________________________
A3. Address of Operator:
A3a. _______________________________________________________________________
(Street Address)

A3b. ___________________________________________________
(City)

A3c. State: /

A3d. Zip Code: /

/ - /

A4. Local time (24-hr clock) and date of the Incident:
/

/
Hour

/
Month

/
Day

A5. Initial Operator National Response Center Report Number:
/

Year

A6. Local time (24-hr clock) and date of initial telephonic report to the
National Response Center (if reported):

A4a. Time Zone for local time (select only one)
Alaska Eastern  Central
Hawaii-Aleutian
 Mountain Pacific.

Hour

/
Month

Day

Year

A6a. Additional NRC Report numbers submitted by the operator:
A4b. Daylight Saving in effect?
Yes No
A4c. reserved for local time of confirmed discovery – proposed in
“Pipeline Safety: Operator Qualification, Cost Recovery, Accident
and Incident Notification, and Other Changes” rulemaking.

Form PHMSA F 7100.3 (rev ??-201?)

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A7. Incident resulted from:






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

A8. 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:

A9. Estimated volume of commodity released unintentionally:

/,/

/ Thousand Cubic Feet (MCF)

A10. Estimated volume of intentional and controlled release/blowdown :

/,/

/ Thousand Cubic Feet (MCF)

A11. Estimated volume of liquid spilled to the ground :

/,/

/ Bbls

A12. Were there fatalities?  Yes  No
If Yes, specify the number in each category:

A13. Were there injuries requiring inpatient hospitalization?
If Yes, specify the number in each category:

 Yes  No

A12a. Operator employees

A13a. Operator employees

A12b. Contractor employees
working for the Operator

A13b. Contractor employees
working for the Operator

A12c. Non-Operator
emergency responders

A13c. Non-Operator
emergency responders

A12d. General public

A13d. General public

A12e. Total fatalities (sum of above)

A13e. Total injuries (sum of above)

Form PHMSA F 7100.3 (rev ??-201?)

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A14. Was the LNG Facility shut down due to the incident?
 Yes  No  Explain: ______________________________________________________________________________
If Yes, complete Questions 14a and 14b. (use local time, 24-hr clock)
A14a. Local time and date of shutdown

Hour

A14b. Local time LNG Facility restarted

Hour

A15. Was there an ignition?

 Yes

Month

Day

Month

/
Day

Year

 Still shut down*
(*Supplemental Report required)

 No

If A15. is Yes, answer A15a and A16.
A15a. Estimated volume of gas consumed by fire (MCF):
A16. Was there an explosion?

 Yes

(must be less than or equal to A9.)

 No

A17. Number of general public evacuated:

/,/

A17a. Estimated average length of evacuation (hours):
A18. Number of operator/contractor personnel evacuated:
Injured Persons not included in A13 The number of persons injured, admitted to a hospital, and remaining in the hospital for at least one
overnight are reported in A13. If a person is included in A13, do not include them in A19.
A19. Number of persons with injuries requiring treatment in a medical facility but not requiring overnight in-patient hospitalization:
If a person is included in A19, do not include them in A20.
A20. Number of persons with injuries requiring treatment by EMTs at the site of incident:
Buildings Affected
A21. Number of residential buildings affected (evacuated or required repair or gas service interrupted):
A22. Number of business buildings affected (evacuated or required repair or gas service interrupted):

Form PHMSA F 7100.3 (rev ??-201?)

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PART B – ADDITIONAL FACILITY INFORMATION

B1. 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

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)
Interstate or Intrastate
LNG Storage
Number of LNG Tanks
Volume of LNG in Storage at the time of
the Incident (Bbls)

Form PHMSA F 7100.3 (rev ??-201?)

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B2.

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






B3.

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 / Facility at 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
B4.



*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 (rev ??-201?)

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PART C – ADDITIONAL CONSEQUENCE INFORMATION
C1. Estimated Property Damage:
C1a. Estimated cost of public and non-Operator private property damage

/,/

C1b. Estimated cost of Operator’s property damage & repairs

/,/

C1c. Estimated cost of emergency response

/,/

C1d. Estimated other costs

/,/

Describe ___________________________________________________
C1e. Total estimated property damage (sum of above)

$ calculated

Cost of Commodity Released
C1f. Estimated cost of commodity released unintentionally

/,/

C1g. Estimated cost of commodity released during
intentional and controlled blowdown

/,/

C1h. Total estimated cost of commodity released (sum of 1f and g above)

$ calculated

C1i. Estimated Total Cost (sum of 1e and h above)

$ calculated

PART D – ADDITIONAL OPERATING INFORMATION
D1.

Was a computerized Control System in place?

 No
 Yes



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

D2.

 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
E1. 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



E1a. Specify how many were tested:

E1b. Specify how many failed:

E2. 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



E2a. Specify how many were tested:

E2b. Specify how many failed:

Form PHMSA F 7100.3 (rev ??-201?)

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*Select only one APPARENT Cause of the Incident, and answer any questions
on the right or below as indicated. Enter secondary, contributing, or root
causes of the Incident in Part I – Contributing Factors.

PART F – APPARENT CAUSE
F1 - Corrosion Failure
 External Corrosion
 Internal Corrosion

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

Includes earthquakes, subsidence, landslide, or other geological events.

Rains/Floods

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.

 Yes
 Hurricane
 Tropical Storm  Tornado
 Other ______________________________

2. Were the natural forces causing the Incident generated in conjunction with an extreme weather event?
2a. If Yes, specify: (select all that apply)

 No

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 (rev ??-201?)

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

 Damage by Car, Truck, or Other
Motorized Vehicle/Equipment NOT
Engaged in Excavation

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

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

 Third Party

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

 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)

Form PHMSA F 7100.3 (rev ??-201?)

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F6 - Equipment Failure
 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 (rev ??-201?)

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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)

PART I – CONTRIBUTING FACTORS
The Apparent Cause of the accident is contained in Part F. Do not report the Apparent Cause again in this Part I. If Contributing Factors were
identified, select all that apply below and explain each in the Narrative:
External Corrosion
 External Corrosion, Galvanic

Pipe/Weld Failure
 Design-related

 External Corrosion, Atmospheric

 Construction-related

 External Corrosion, Stray Current Induced

 Installation-related

 External Corrosion, Microbiologically Induced

 Fabrication-related

 External Corrosion, Selective Seam

 Original Manufacturing-related

Internal Corrosion
 Internal Corrosion, Corrosive Commodity

Equipment Failure
 Malfunction of Control/Relief Equipment

 Internal Corrosion, Water drop-out/Acid

 Threaded Connection/Coupling Failure

 Internal Corrosion, Microbiological

 Non-threaded Connection Failure

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

 Valve Failure
Incorrect Operation
 Damage by Operator or Operator’s Contractor NOT Excavation
and NOT Vehicle/Equipment Damage

 Heavy Rains/Floods
 Lightning
 Temperature

 Valve Left or Placed in Wrong Position, but NOT Resulting in
Overpressure

 High Winds

 Pipeline or Equipment Overpressured

 Snow/Ice

 Equipment Not Installed Properly

 Tree/Vegetation Root

 Wrong Equipment Specified or Installed

Excavation Damage
 Excavation Damage by Operator (First Party)

 Inadequate Procedure

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

 No procedure established
 Failure to follow procedures

 Previous Damage due to Excavation Activity
Other Outside Force
 Nearby Industrial, Man-made, or Other Fire/Explosion
 Damage by Car, Truck, or Other Motorized Vehicle/Equipment
NOT Engaged in Excavation
 Damage by Boats, Barges, Drilling Rigs, or Other Adrift Maritime
Equipment
 Routine or Normal Fishing or Other Maritime Activity NOT
Engaged in Excavation
 Electrical Arcing from Other Equipment or Facility
 Previous Mechanical Damage NOT Related to Excavation
 Intentional Damage
 Other underground facilities buried within 12 inches of the failure
location

Form PHMSA F 7100.3 (rev ??-201?)

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(Attach additional sheets as
necessary)

PART G – NARRATIVE DESCRIPTION OF THE INCIDENT

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

PART H – PREPARER AND AUTHORIZED PERSON

Preparer's Name (type or print)

Preparer’s Telephone Number

Preparer's Title (type or print)

Preparer's E-mail Address

Preparer’s Facsimile Number
________________

Authorized Signer’s Name

Date

Authorized Signer Telephone Number
Authorized Signer’s E-mail Address

Authorized Signer’s Title

Form PHMSA F 7100.3 (rev ??-201?)

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Reproduction of this form is permitted

Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

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 detection of the incident. Requirements for submitting reports are in §191.7 and
§191.15.
Activation of an emergency shutdown system for any reason other than an actual emergency
need not be reported, as described in §191.3 under "Incident". For purposes of this requirement,
an 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
http://phmsa.dot.gov/pipeline/library/forms. The applicable forms are listed in the section titled
Accidents/Incidents/Annual Reporting Forms.

ONLINE REPORTING REQUIREMENTS
Incident Reports must be submitted online through the PHMSA Portal at
https://portal.phmsa.dot.gov/portal, unless an alternate method is approved (see Alternate Reporting
Methods below). You will not be able to submit reports until you have met all of the Portal
registration requirements – see
http://opsweb.phmsa.dot.gov/portal_message/PHMSA_Portal_Registration.pdf
Completing these registration requirements could take several weeks. Plan ahead and register
well in advance of the report due date.

Use the following procedure for online reporting:
1. Go to the PHMSA Portal at https://portal.phmsa.dot.gov/portal
2. Enter PHMSA Portal Username and Password; press enter
3. Select OPID; press “continue” button.
4. On the left side menu under “Incident/Accident (2010 to present)” select “ODES 2.0”
5. Under “Create Reports” on the left side of the screen, select “Liquefied Natural Gas
(LNG)” and proceed with entering your data.
6. Click “Submit” when finished with your data entry to have your report uploaded to
PHMSA’s database as an official submission of an Incident Report; or click “Save”
which doesn’t submit the report to PHMSA but stores it in a draft status to allow you to

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Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

come back to complete your data entry and report submission at a later time. Note: The
“Save” feature will allow you to start a report and save a draft of it which you can print
out and/or save as a PDF to email to colleagues in order to gather additional
information and then come back to accurately complete your data entry before
submitting it to PHMSA.
7. Once you click “Submit”, the system will check if all applicable portions of the report
have been completed. If portions are incomplete, a listing of these portions will appear
above the row of Parts. If all applicable portions have been completed, the system will
show your Saved Incident/Accident Reports in the top portion of the screen and your
Submitted Incident/Accident Reports in the bottom portion of the screen. Note: To
confirm that your report was successfully submitted to PHMSA, look for it in the bottom
portion of the screen where you can also view a PDF of what you submitted.
Supplemental Report Filing – Follow Steps 1 through 4 above, and double-click a submitted
report from the Submitted Incident/Accident Reports list. The report will default to a “Read
Only” mode that is pre-populated with the data you submitted previously. To create a
supplemental report, click on “Create Supplemental” found in the upper right corner of the
screen. At this point, you can amend your data and make an official submission of the report to
PHMSA as either a Supplemental Report or as a Supplemental Report plus Final Report (see
“Specific Instructions, PART A, Report Type”), or you can use the “Save” feature to create a draft of
your Supplemental Report to be submitted at some future date.
Alternate Reporting Methods
Operators for whom electronic reporting imposes an undue burden and hardship may submit a
written request for an alternate reporting method. Operators must follow the requirements in
§191.7(d) to request an alternate reporting method and must comply with any conditions
imposed as part of PHMSA’s approval of an alternate reporting method.

RETRACTING A 30-DAY WRITTEN REPORT
An operator who reports an incident in accordance with §191.15 (oftentimes referred to as a 30day written report) and upon subsequent investigation determines that the event did not meet the
criteria in §191.3 may request that the report be retracted. Requests to retract a 30-day written
report are to be emailed to [email protected]. Requests are to include the
following information:
a. The Report ID (the unique 8-digit identifier assigned by PHMSA)
b. Operator name
c. PHMSA-issued OPID number
d. The number assigned by the National Response Center (NRC) when an
immediate notice was made in accordance with §191.5. If Supplemental
Reports were made to the NRC for the event, list all NRC report numbers
associated with the event.
e. Date of the event
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Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

f. Location of the event
g. A brief statement as to why the report should be retracted.
Note: PHMSA no longer requests that operators rescind erroneously reported “Immediate
Notices” filed with the NRC in accordance with §191.5 (oftentimes referred to as “Telephonic
Reports”).

SPECIAL INSTRUCTIONS
Certain data fields must be completed before an Original Report will be accepted. Your Original
Report will not be able to be submitted online until the required information has been provided,
although your partially completed form can be saved online so that you can return at a later time
to provide the missing information.
1. An entry should be made in each applicable space or check box, unless otherwise directed by
the section instructions.
2. If the data is unavailable, enter “Unknown” for text fields and leave numeric fields and fields
using check boxes or “radio” buttons blank.
3. Estimate data only if necessary. Provide an estimate in lieu of answering a question with
“Unknown” or leaving the field blank.
Estimates should be based on best-available
information and reasonable effort.
4. For unknown or estimated data entries, the operator should file a Supplemental Report when
additional or more accurate information becomes available.
5. If the question is not applicable, enter “N/A” for text fields and leave numeric fields and
fields using check boxes or “radio” buttons blank. Do not enter zero unless this is the actual
value being submitted for the data in question.
6. If OTHER is checked for any answer to a question, include an explanation or description on
the line provided, making it clear why “Other” was the necessary selection.
7. Pay close attention to each question for the phrase:
a. (select all that apply)
b. (select only one)
If the phrase is not provided for a given question, then “select only one” should apply.
“Select only one” means that you should select the single, primary, or most applicable
answer. DO NOT SELECT MORE ANSWERS THAN REQUESTED. “Select all that
apply” requires that all applicable answers (one or more than one) be selected.
8. Date format = mm/dd/yy or for year = /yyyy/

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Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

9. 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/

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 gas transmission facility in Denver,
Colorado at 2:00 pm MST, but an individual located in Houston is filing the report after
having been notified at 3:00 pm CST, the time of the incident is to 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)
Select the appropriate report box or boxes to indicate the type of report being filed. Depending
on the descriptions below, the following combinations of boxes – and only one of these
combinations - may be selected:
•
•
•
•

Original Report
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.

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INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

 Original Report

plus

 Final Report

Select both Original Report and Final Report if ALL of the information requested is known and
can be provided at the time the initial report is filed, including final property damage costs and
apparent failure cause information. Selecting both these types of reports will indicate that further
information is not expected to be forthcoming through a Supplemental Report. If, however, for
some reason new, updated, and/or corrected information becomes available unexpectedly, the
operator is to 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 Supplemental Reports are to be
submitted, as necessary, in order to provide new, updated, and/or corrected information when it
becomes available and, per §191.15(c), each Supplemental Report containing new, updated,
and/or corrected information is to be filed as soon as practicable. Submission of new, updated,
and/or corrected information is NOT to be delayed in order to accumulate “enough” to “warrant”
a Supplemental Report, or to complete a Final Report. Supplemental Reports must be filed as
soon as practicable following the Operator’s awareness of new, updated, and/or corrected
information. Failure to comply with these requirements can result in enforcement actions,
including the assessment of civil penalties as provided in 49 USC 60122.
In those cases in which investigations are ongoing, operators should file a Supplemental Report
within one year even in those instances where no new, updated, and/or corrected information has
been obtained, indicating such in PART G – Narrative Description of the Incident.
For Supplemental Reports filed online, all data previously submitted will automatically populate
in the form. Page through the form to make edits and additions where needed.
 Supplemental Report

plus

 Final Report

If an Original Report has already been filed AND new, updated, and/or corrected information is
now being submitted via a Supplemental Report, AND the operator is reasonably certain that no
further information will be forthcoming, then Final Report is to also be selected along with
Supplemental Report. (See also the requirements stated above under “Supplemental Report”.)
Important: If an operator files one of the two types of Final Reports (either Original plus Final or
Supplemental plus Final) and then subsequently finds that new, updated, and/or corrected
information needs to be provided, the operator is to submit another Supplemental Report,
selecting the appropriate report types (Supplemental or Supplemental plus Final) for the newly
submitted report and explaining the circumstances in PART G – Narrative Description of the
Incident.

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A1. Operator’s OPS-Issued Operator Identification Number (OPID)
For online entries, the OPID will automatically populate based on the selection you made when
entering the Portal. If you have log-in credentials for multiple OPID, be sure the report is being
created for the appropriate OPID. Contact PHMSA’s Information Resources Manager at 202-3668075 if you need assistance with an OPID. Business hours are 8:30 AM to 5:00 PM Eastern Time.

A2. Name of Operator
This is the company name associated with the OPID. For online entries, the name will automatically
populate based on the OPID entered in A1. If the name that appears is not correct, you need to submit
an Operator Name Change (Type A) Notification.

A3. Address of Operator
For online entries, the headquarters address will automatically populate based on the OPID entered in
A1. If the address that appears is not correct, you need to change it in the online Contacts module.

A4. 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”, numbers 8 and 9 for examples of Date format and Time format
expressed as a 24-hour clock.
A4a. Select the local time zone where the Incident occurred (select only one).
A4b. Select “Yes” if Daylight Saving was in effect at the time of the Incident, or “No” if
it was not.
A4c. reserved for local time of confirmed discovery – proposed in “Pipeline Safety: Operator
Qualification, Cost Recovery, Accident and Incident Notification, and Other Changes”
rulemaking.
A5. Initial Operator National Response Center (NRC) Report Number
§191.5 requires that incidents meeting the criteria outlined in §191.3 be reported directly to the
24-hour National Response Center (NRC) at 1-800-424-8802 at the earliest practicable
moment. The NRC assigns numbers to each call. The number assigned to that Immediate
Notice (sometimes referred to as the “Telephonic Report”) is to be entered in Question 5.
A6. Local time (24-hr clock) and date of initial operator report to the National Response
Center
Enter the time and date of the initial operator Immediate Notice/telephonic report of the incident
to the NRC. The time is to be shown by 24-hour clock notation, and is to reflect the time in the

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INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

time zone where the incident was physically located. (See “Special Instructions”, numbers 8 and
9.)
A6a. Additional NRC Report Numbers
If the operator made more than one call to the NRC, enter each additional NRC report number.
A7. Incident resulted from
Indicate whether the incident resulted from the intentional or unintentional release of
commodity, an emergency shutdown, or as the result of other reasons. If “Reasons other than the
above” is selected, describe the circumstances.
A8. Commodity released
Select 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.
General Information for Questions 9, 10, and 11:
Important Note: Volumes consumed by fire and/or explosion are to be included in the estimated
volumes reported in 9 and 10.
A9. 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 are to
be based on the best-available information.
A10. 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.
A11. 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). Small
volumes, including but not limited to those which sometimes result in some form of ignition, are
to be reported as 0.1 barrels.

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If estimated volume is
<5 gallons
5-10 gallons
11-14 gallons
15-18 gallons
19-23 gallons

0.1
0.2
0.3
0.4
0.5

Report
barrels
barrels
barrels
barrels
barrels

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

Report
0.6 barrels
0.7 barrels
0.8 barrels
0.9 barrels
1.0 barrels

A12. Were there fatalities?
If a person dies at the time of the incident or within 30 days of the initial incident date due to
injuries sustained as a result of the incident, report as a fatality. If a person dies subsequent to an
injury more than 30 days past the incident date, report as an injury. (Note: This aligns with the
Department of Transportation's general guidelines for all jurisdictional transportation modes for
reporting deaths and injuries.)
Contractor employees working for the operator are individuals hired to work for or on behalf
of the operator of the facility. These individuals are not to 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 are to be reported as “General public.”
A13. Were there injuries requiring inpatient hospitalization?
Injuries requiring inpatient hospitalization are injuries sustained as a result of the incident and
that require hospital admission and at least one overnight stay.
See Question 12 for additional definitions.
A14. Was the LNG Facility shut down due to the incident?
Report any shutdowns that occur as a result of the incident, including but not limited to those
required for damage assessment, temporary repair, permanent repair, and clean-up. 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 are not to 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 14a and 14b.

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A14a. Local time (24hr clock) and date of shutdown
A14b. Local time facility restarted
The time is to be shown by 24-hour clock notation, and is to reflect the time in the
time zone where the incident was physically located. (See “Special Instructions”,
numbers 8 and 9.) Enter the time and date of the shutdown that is associated with
the onset or occurrence of the incident in 14a and the time and date of restart in 14b.
The intent with this data is to capture the total time that the facility is shutdown due
to the incident. If the facility has not been restarted at the time of reporting, select
“Still shut down” for Question 14b and then include the restart time and date in a
future Supplemental Report.
A15. Was there an ignition?
Ignite means the released commodity caught fire.
A15a. Estimate volume of gas consumed by fire in thousands of standard cubic feet, MCF
A16. Was there an explosion?
Explode means the ignition of the released commodity occurred with a sudden and violent
release of energy.
A17. Number of general public evacuated
The number of people evacuated is to be estimated based on operator knowledge, or police, fire
department, or other emergency responder reports. If there was no evacuation involving the
general public, report zero (0). If an estimate is not possible for some reason, leave the field
blank but include an explanation of why it was not possible to provide a number in PART G –
Narrative Description of the Incident.
A17a. Estimate the average length of evacuation (in hours) for the people in A17.
A18. 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).
Injured persons not included in A13. The number of persons injured, admitted to a hospital,
and remaining in the hospital for at least one overnight are reported in A13. If a person is
included in A13, do not include them in A19.
A19. Number of persons with injuries requiring treatment in a medical facility but not requiring
overnight in-patient hospitalization.
If a person is included in A19, do not include them in A20.

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A20. Number of persons with injuries requiring treatment by EMTs at the site of incident.
Buildings Affected The term ‘affected’ means the building was damaged and required repair,
or evacuated, or had gas service interrupted.
A21. Enter the number of residential buildings affected.
A22. Enter the number of commercial and industrial buildings affected.

PART B – ADDITIONAL FACILITY INFORMATION
B1. 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 is
to be the same as the LNG_NM field reported to the National Pipeline Mapping System (NPMS)
NPMS ID is to be the same as the NPMS field LNG_ID.
Plant / Facility Status is to be the same as NPMS field STATUS_CD. Select one of the
following Status Code descriptions to indicate Plant / Facility Status:
Status Codes
I In Service
B Abandoned
R Retired
Plant / Facility Location is the two-digit abbreviation for the State in which the plant/facility is
located
Process is to 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 the LNG for the Plant / Facility such as Truck,
Railroad, Marine (ship/barge), or Liquefaction. All LNG sources that apply are to be selected.
Select one or more of the following LNG Sources:
LNG Source
T Truck
R Railroad
M Ship/Barge
L Liquefaction

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Interstate or Intrastate
Select Interstate if the LNG Plant/Facility operates under a certificate from the Federal Energy
Regulatory Commission (FERC). Select Intrastate if the LNG Plant/Facility does not operate
under a FERC certificate.
LNG Storage. Report both the number of LNG Tanks and the total volume of LNG in storage
at the time of the incident.
B2. Type of LNG Plant / Facility
Select the type of LNG Plant / Facility involved in the incident:
Base Load: A facility that operates throughout the year to provide gas supply.
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 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.
B3. Function of LNG Plant / Facility at the time and date of the Incident
Identify the function or functions of the plant or facility at the time and date of the Incident.
Indicate all of the functions which were capable of being operational at the Plant / Facility, and
not just those which were involved in the Incident or which were actually operating at the time
and date of the Incident.
B4. 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.

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PART C – ADDITIONAL CONSEQUENCE INFORMATION
C1. Estimated Property Damage
All relevant costs available at the time of submission must be included on the initial written
Incident Report as well as being updated as needed on Supplemental Reports. This includes (but
is not limited to) costs due to property damage to the operator’s facilities and to the property of
others, facility repair and replacement, and environmental cleanup and damage. Do NOT
include cost of commodity lost. Additionally, do NOT include costs incurred for facility repair,
replacement, or changes that are NOT related to the incident and which are typically done solely
for convenience. An example of doing work solely for convenience is working on 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 are to report costs based on the best estimate available at the time a report is
submitted. It is likely that an estimate of final repair costs may not be available when the initial
report must be submitted (within 30 days, per §191.15). The best available estimate of these
costs is to be included in the initial report. For convenience, this estimate can be revised, if
needed, when Supplemental Reports are filed for other reasons, however, when no other changes
are forthcoming, Supplemental Reports are to be filed as new cost information becomes
available. If Supplemental Reports are not submitted for other reasons, a Supplemental Report is
to be filed for the purpose of updating or correcting the estimated cost if these costs differ from
those already reported by 20 percent or $20,000, whichever is greater.
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.
Operator’s property damage estimates generally include physical damage to the property of
the operator or owner company such as the estimated installed or replacement value of the
equipment damaged due to the incident, excluding the cost of any commodity lost. Also to be
excluded are 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. Property damage estimates
include the cost to access, secure, excavate, and repair the pipeline using methods, materials, and
labor necessary to re-establish operations at a predetermined level. 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 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,

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supplies, labor, and benefits. Costs related to stakeholder outreach, media response, etc. are not
to be included.
Other costs are to include any and all costs which are not included above. Cost of any
commodity lost is NOT to be reported here, but is to be reported under Cost of Commodity
Released. Operators are to NOT use this category to report any costs which belong in cost
categories separately listed above.
Costs are to be reported in only one category and are not to be double-counted. Costs can be
split between two or more categories when they overlap more than one reporting category.
Cost of Commodity Released
use your gas cost, excluding taxes, in dollars per thousand
standard cubic feet (mcf) and the volumes shown below to calculate the commodity cost.
Cost of commodity released unintentionally is to be based on the volume reported
in PART A, Question 9.
Cost of commodity released during intentional and controlled blowdown is to be
based on the volume reported in PART A, Question 10.

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PART D – ADDITIONAL OPERATING INFORMATION
D1. 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.
Select 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.
D2. 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 controllers or other individuals monitoring or
operating a facility from a control room, whether located at the facility or remotely.
Notification from Public includes 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 (such as 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 §199.105 and §199.225
respectively. If the incident circumstances were such that tests were not required per these
regulations, and if no tests were conducted, select No. If tests were administered, select Yes and
report separately the number of operator employees and the number of contractors working for
the operator that were tested and the number of each that failed such tests.

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PART F – APPARENT CAUSE
Select the one, single sub-cause listed under sections F1 thru F8 that best describes the
apparent cause of the Incident. These sub-causes are contained in the shaded column on
the left under each main cause category. Answer the corresponding questions that
accompany your selected sub-cause, and describe any secondary, contributing, 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 or failure is not limited to a hole
in the pipe or other piece of equipment. If the bonnet or packing gland on a valve or flange on
piping deteriorates or becomes loose and leaks due to corrosion and failure of bolts, it is to be
classified as Corrosion. (Note: If the bonnet, packing, or other gasket has deteriorated before
the end of its expected life but not due to corrosive action, the failure is to 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 natural force causes. While mudslides involve
earth movement, report them here since typically they are an effect of heavy rains or floods.
Lightning includes both damage and/or fire caused by a direct lighting strike and damage and/or
fire as a secondary effect from a lightning strike in the area. An example of such a secondary
effect would be a forest fire started by lightning that results in damage to an LNG facility which
results in an incident. (See also the discussion of “secondary ignition” under the General
Instructions.)
Temperature (Weather-related) includes weather-related temperature and thermal stress
effects, either heat or cold, where temperature was the initiating cause. Thermal stress refers to
mechanical stress induced in a pipe or component when some or all of its parts are not free to
expand or contract in response to changes in the ambient temperature. Do NOT report here
incidents caused by embrittlement due to handling of cryogenic/process fluids which are to be
reported 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.

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High Winds includes damage caused by wind-induced forces. Select this category if the
damage is due to the force of the wind itself. Damage caused by impact from objects blown by
wind would be reported under F4 - Other Outside Force Damage.
Other Natural Force Damage. Select this sub-cause for types of Natural Force Damage not
included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART G – Narrative Description of the Incident.
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 was involved, indicate Other and
describe the event 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, this section includes a release or failure determined to have resulted from
previous damage due to excavation activity. For damage from outside forces OTHER than
excavation which results in a release, use F2 - Natural Force Damage or F4 - Other Outside
Force, as appropriate. Also, for a strike, physical contact, or other damage to equipment or a
facility that apparently was NOT related to excavation and that results in a delayed or eventual
release, report the incident under F4 as “Previous Mechanical Damage NOT related to
Excavation.”
Excavation Damage by Operator (First Party) refers to incidents caused as a result of
excavation by a direct employee of the operator.
Excavation Damage by Operator’s Contractor (Second Party) refers to incidents caused as a
result of excavation by the operator’s contractor or agent or other party working for the operator.
Excavation Damage by Third Party refers to incidents caused by excavation damage resulting
from actions by personnel or other third parties not working for or acting on behalf of the
operator or its agent.
Previous Damage due to Excavation Activity refers to incidents that were apparently caused
by prior excavation activity and that then resulted in a delayed or eventual release. Indications of
prior excavation activity might come from the condition of the pipe when it is examined, or from
records of excavation at the site, or through metallurgical analysis or other inspection and/or
testing methods. Dents and gouges in the 10:00-to-2:00 o’clock positions on the pipe, for
instance, may indicate an earlier strike, as might marks from the bucket or tracks of an earth
moving machine or similar pieces of equipment.

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F4 – Other Outside Force Damage
Other Outside Force Damage includes, but are not limited to, a release or failure resulting from
non-excavation-related outside forces, such as nearby industrial, man-made, or other fire or
explosion; damage by vehicles or other equipment; failures due to mechanical damage; and,
intentional damage including vandalism and terrorism.
Nearby Industrial, Man-made or other Fire/Explosion as Primary Cause of Incident applies
to situations where the fire occurred before - and caused - the release. (See also the discussion of
“secondary ignition” under the General Instructions.) Examples of such a failure would be an
explosion or fire at a neighboring facility or installation (chemical plant, tank farm, or other
industrial facility) or structure, debris, or brush/trees that results in an incident at the operator’s
facility. This includes forest, brush, or ground fires that are caused by human activity. If the
fire, however, is known to have been started as a result of a lightning strike, the incident’s cause
is to be classified under F2 - Natural Force Damage. Arson events directed at harming the
facility or the operator are to be reported as F4 - Intentional Damage (see below). This sub-cause
is NOT to be used if the release occurred first and then the gas released from the LNG Facility
ignited.
Damage by Car, Truck, or Other Motorized Vehicle/Equipment NOT Engaged in
Excavation. An example of this sub-cause would be a stopple tee that releases LNG when
damaged by a pickup truck maneuvering at the facility. Other motorized vehicles or equipment
include tractors, backhoes, bulldozers and other tracked vehicles, and heavy equipment that can
move. Include under this sub-cause, incidents caused by vehicles operated by the operator, the
operator’s contractor, or a third party and specify the vehicle/equipment operator’s affiliation
from one of these three groups. If the activity that caused the incident involved digging, drilling,
boring, grading, cultivation or similar excavation 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 (including their anchors or anchor chains or other attached
equipment) 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. Do NOT report in this sub-cause incidents
which are caused by the impact of maritime equipment or vessels while they are engaged in their
normal or routine activities; such incidents are to be reported as “Other Outside Force Damage”
in this section F4 (see below) so long as those activities are not excavation activities. If those
activities are excavation activities such as dredging or bank stabilization or renewal, the incident
is to be reported under F3 - Excavation Damage.
Electrical Arcing from Other Equipment or Facility such as a pole transformer or adjacent
facility’s electrical equipment.

Page 17 of 21

Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

Previous Mechanical Damage NOT Related to Excavation. This sub-cause covers incidents
where damage occurred at some time prior to the release that was apparently NOT related to
excavation activities, and would include prior outside force damage of an unknown nature, prior
natural force damage, prior damage from other outside forces, and any other previous
mechanical damage other than that which was apparently related to prior excavation. Incidents
resulting from previous damage sustained during construction, installation, or fabrication of the
pipe or weld from which the release eventually occurred are to be reported under F5 - Material
Failure of Pipe or Weld. (See this sub-cause for typical indications of previous construction,
installation, or fabrication damage.) Incidents resulting from previous damage sustained as a
result of excavation activities should be reported under F3 – Previous Damage due to Excavation
Activity. (See this sub-cause for typical indications of prior excavation activity.)
Intentional Damage
Vandalism means willful or malicious destruction of the operator’s facility or
equipment. This category would include arson, pranks, systematic damage inflicted
to harass the operator, motor vehicle damage that was inflicted intentionally, and a
variety of other intentional acts. (See also the discussion of “secondary ignition”
under the General Instructions.)
Terrorism, per 28 CFR §0.85 General Functions, includes the unlawful use of
force and violence against persons or property to intimidate or coerce a
government, the civilian population, or any segment thereof, in furtherance of
political or social objectives. Operators selecting this item are encouraged to also
notify the FBI.
Theft of commodity or Theft of equipment means damage by any individual or
entity, by any mechanism, specifically to steal, or attempt to steal, the transported
gas or facility/plant equipment.
Indicate if a breach of security occurred in conjunction with the incident.
Other
Describe in the space provided and, if necessary, provide additional
explanation in PART G – Narrative Description of the Incident.
Other Outside Force Damage. Select this sub-cause for types of Other Outside Force Damage
not included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART G – Narrative Description of the Incident.
F5 – Material Failure of Pipe or Weld
Use this section to report material failures only if “Item involved in Incident” (PART B,
Question 4) is “In-plant Piping” or “Weld.” Indicate how the sub-cause was determined or if
the sub-cause is still being investigated.

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Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

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 inplant piping), including welding or other activities performed at the facility. Included are releases
from or failures of field welds and damage sustained in transportation to the construction or
fabrication site. Not included are failures due to seam defects, which are to be reported as
Original Manufacturing-related (see below).
Original Manufacturing-related (NOT girth welds or other welds formed in the field)
includes a release or failure caused by a defect or anomaly introduced during the process of
manufacturing the pipe used in in-plant piping, including seam defects and defects in the pipe
body. This option is not appropriate for field welds, girth welds, or other joints fabricated in the
field. Use this option for failures such as those due to defects or inclusions in the pipe body.
Low Temperature Embrittlement (due to a process fluid) means a release in or failure of inplant piping or weld due to the effect of handling cryogenic fluids. Embrittlement failure of
equipment other than in-plant piping or weld, including a failure due to the effects of spilled or
leaking cryogenic fluids, is to 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.
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 a control or alarm device; malfunction of a
relief valve; valves failing to open or close on command; or valves which opened or closed when
not commanded to do so. If overpressurization or some other aspect of this incident was caused
by incorrect operation, the incident is to be reported under F7 - Incorrect Operation.

Page 19 of 21

Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

Other Equipment Failure. Select this sub-cause for types of Equipment Failure not included
otherwise, and describe in the space provided. If necessary, provide additional explanation in
PART G – Narrative Description of the Incident.
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. Select this sub-cause for types of Incorrect Operation not included
otherwise, and describe in the space provided. If necessary, provide additional explanation in
PART G – Narrative Description of the Incident.
F8 – Other Incident Cause
This section is provided for incidents whose cause is currently unknown, or where investigation
into the cause has been exhausted and the final judgment as to the cause remains unknown, or
where a cause has been determined which does not fit into any of the main cause categories
listed in sections F1 thru F7.
If the incident cause is known but doesn’t fit into any category in sections F1 thru F7, select
Miscellaneous and enter a description of the incident cause, continuing with a more thorough
explanation in PART G - Narrative Description of the Incident.
If the incident cause is unknown at the time of filing this report, select Unknown in this section
and specify one reason from the accompanying two choices. Once the operator’s investigation
into the incident cause is completed, the operator is to file a Supplemental Report as soon as
practicable either reporting the apparent cause or stating definitively that the cause remains
Unknown, along with any other new, updated, and/or corrected information pertaining to the
incident. This Supplemental Report is to include all new, updated, and/or corrected information
pertaining to all portions of the report form known at the time, and not only that information
related to the apparent cause.
Important Note: Whether the investigation is completed or not, or if the cause continues to be
unknown, Supplemental Reports are to be filed reflecting new, updated, and/or corrected
information as and when this information becomes available. In those cases in which
investigations are ongoing for an extended period of time, operators are to file a Supplemental
Page 20 of 21

Instructions (rev xy-201?) for Form PHMSA F 7100.3 (rev xy-201?)
INCIDENT REPORT – LIQUEFIED NATURAL GAS (LNG) FACILITIES

Report within one year of their last report for the incident even in those instances where no new,
updated, and/or corrected information has been obtained, with an explanation that the cause
remains under investigation in PART H – Narrative Description of Incident. Additionally, final
determination of the apparent cause and/or closure of the investigation does NOT preclude the
need for the operator’s filing of additional Supplemental Reports as and when new, updated,
and/or corrected information becomes available.

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

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 and to explain any estimated data.
If you selected Miscellaneous in section F8, the narrative is to describe the incident in detail,
including all known or suspected causes and possible contributing factors.

PART H – PREPARER AND AUTHORIZED PERSON
The Preparer is the person who compiled the data and prepared the responses to the report and
who is to be contacted for more information (preferably the person most knowledgeable about
the information in the report or who knows how to contact the person or persons most
knowledgeable). Enter the Preparer’s e-mail address if the Preparer has one, and the phone and
fax numbers used by the Preparer.
The Authorized Person is responsible for assuring the accuracy and completeness of the reported
data. In addition to their title, a phone number and email address are to be provided for the
Authorized Person.

Page 21 of 21

File Type	application/pdf
Author	Debbie
File Modified	2016-12-27
File Created	2016-12-27