Phmsa F 7100-1 Accident Report – Hazardous Liquid And Carbon Dioxide Pi

Transportation of Hazardous Liquids by Pipeline: Record keeping and Accident Reporting

HL Accident Form and Instructions - PHMSA F 7000-1 (rev 7-2020) Clean

OMB: 2137-0047

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2137-0047 can be found here:

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NOTICE: This report is required by 49 CFR Part 195. Failure to report can result in a civil penalty not to exceed
$100,000 for each violation for each day that such violation persists except that the maximum civil penalty shall not
exceed $1,000,000 as provided in 49 USC 60122.

OMB NO: 2137-0047
EXPIRATION DATE1 /31/2023

ACCIDENT REPORT – HAZARDOUS LIQUID AND
CARBON DIOXIDE PIPELINE SYSTEMS

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

Report Date
No.

(DOT Use Only)

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays
a current valid OMB Control Number. The OMB Control Number for this information collection is 2137-0047. 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 https://www.phmsa.dot.gov/pipeline/library/forms.
PART A – KEY REPORT INFORMATION
Report Type: (select all that apply)  Original  Supplemental  Final
A1. Operator’s OPS-issued Operator Identification Number (OPID):

A2. Name of Operator: _____auto-populated based on OPID_______________________________________________
A3. Address of Operator:
A3a. _ auto-populated based on OPID ______________________________________________________________________
(Street Address)

A3b. __ auto-populated based on OPID _________________________________________________
(City)

A3c. State: auto-populated based on OPID /

A3d. Zip Code: auto-populated based on OPID /

/ - /

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

Hour

Month

Day

Year

A4a. Time Zone for local time (select only one)  Alaska
A4b. Daylight Saving in effect?  Yes  No
A5. Location of Accident:
Latitude:
/ / / . / /
Longitude: - / / / / . /

/
/

 Eastern  Central  Hawaii-Aleutian

 Mountain  Pacific.

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

 Crude Oil
 Refined and/or Petroleum Product (non-HVL) which is a Liquid at Ambient Conditions
 Gasoline (non-Ethanol)
 Diesel, Fuel Oil, Kerosene, Jet Fuel
 Mixture of Refined Products (transmix or other mixture)
 Other  Name: __________________________________
 HVL or Other Flammable or Toxic Fluid which is a Gas at Ambient Conditions
 Anhydrous Ammonia
 LPG (Liquefied Petroleum Gas) / NGL (Natural Gas Liquid)
 Other HVL  Name: _______________________________
 CO2 (Carbon Dioxide)
 Biofuel / Alternative Fuel (including ethanol blends)
 Fuel Grade Ethanol
 Biodiesel  Blend (e.g. B2, B20, B100): B/___/___/___/
A7.

 Ethanol Blend  % Ethanol: /___/___/
 Other  Name: _______________________

Estimated volume of commodity released unintentionally:

/,/

/./

/ Barrels

A8. Estimated volume of intentional and/or controlled release/blowdown:
(only reported for HVL and CO2 Commodities)

/,/

/./

/ Barrels

A9. Estimated volume of commodity recovered

/,/

/./

/ Barrels

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 1 of 22

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

A11. Were there injuries requiring inpatient hospitalization?
If Yes, specify the number in each category:

 Yes  No

A10a. Operator employees

A11a. Operator employees

A10b. Contractor employees
working for the Operator

A11b. Contractor employees
working for the Operator

A10c. Non-Operator
emergency responders

A11c. Non-Operator
emergency responders

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

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

A10e. General public

A11e. General public

A10f. Total fatalities (sum of above)

calculated

A11f. Total injuries (sum of above)

calculated

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 2 of 22

A12. formerly E8. What was the Operator’s initial indication of the Failure? (select only one)

 CPM leak detection system
 SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations)
 Static Shut-in Test or Other Pressure or Leak Test
 Controller
 Local Operating Personnel, including contractors
 Air Patrol
 Ground Patrol by Operator or its contractor
 Notification from Public
 Notification from Emergency Responder
 Notification from Third Party that caused the Accident
 Other _________________________________________________
A12a. formerly E8.a If “Controller”, “Local Operating Personnel, including contractors”, “Air Patrol”, or “Ground Patrol by Operator or its
contractor” is selected in Question 8, specify the following: (select only one)

 Operator employee

 Contractor working for the Operator

A13. Formerly A18.a Local time Operator identified failure

Hour

Month

A14. formerly C2 Part of system involved in Accident: (select only one)
 Onshore Breakout Tank or Storage Vessel, Including Attached Appurtenances
 Onshore Terminal/Tank Farm Equipment and Piping
 Onshore Equipment and Piping Associated with Belowground Storage
 Onshore Pump/Meter Station Equipment and Piping
 Onshore Pipeline, Including Valve Sites
 Offshore Platform/Deepwater Port, Including Platform-mounted Equipment and Piping
 Offshore Pipeline, Including Riser and Riser Bend

Day

Year

A15. formerly B1 Auto-populated based on A14 Was the origin of the Accident onshore?
 Yes (Complete Questions B3-B12)  No (Complete Questions B13-B15)
A16. Operational Status at time Operator identified failure (select only one)
 Post-Construction Commissioning
 Post-Maintenance/Repair
 Routine Start-Up
 Routine Shutdown
 Normal Operation, include pauses between batches and during maintenance
 Idle
A17. formerly A14. If Operational Status = Routine Start-Up or Normal Operation, was the pipeline/facility shut down due to the Accident?
 Yes  No  Explain: ______________________________________________________________________________
If Yes, complete Questions A17.a and A17.b: (use local time, 24-hr clock)
A17a. formerly A14.a Local time and date of shutdown

A17b. formerly A14.b Local time pipeline/facility restarted

Hour
Hour

Month
Month

Day
Day

Year
Year

 Still shut down*

*Supplemental Report required

If A12 = Notification from Emergency Responder, skip A18.a through A18.c.
A18a. Did the operator communicate with Local, State, or Federal Emergency Responders about the accident?

 Yes

 No

If No, skip A18b. and A18c
A18b. Which party initiated communication about the accident?

 Operator

 Local/State/Federal Emergency Responder

A18c. Local time of initial Operator and Local/State/Federal Emergency Responder communication
/ / / / /
/
Hour

A19. formerly A18.b Local time Operator responders arrived on site
A20. Local time of confirmed discovery

/ /
Hour

/ / /
Month

Month

Hour

/ /
Day

/
/

Day

Month

/
/

Year

Day

/ /
Year

A21a. formerly A7. Local time (24-hr clock) and date of initial operator report to the National Response Center :
/

Hour

Month

Day

Year

A21b. formerly A6. Initial Operator National Response Center Report Number OR
 NRC Notification Required But Not Made

 NRC Notification Not Required OR

A21c. Additional NRC Report numbers submitted by the operator:_____________________
A22. formerly A15. Did the commodity ignite?
Form PHMSA F 7000-1 (rev ??-201?)

 Yes

 No If Yes, answer A22.a through d:

Reproduction of this form is permitted

Page 3 of 22

Year

A22a. Local time of ignition

Hour

Month

Day

A22b. How was the fire extinguished?
 Operator/Contractor  Local/State/Federal Emergency Responder

 Yes

Year

 Allowed to burn out

A22c. Estimated volume of commodity consumed by fire (barrels):
A22d. formerly A16. Did the commodity explode?

 Other, specify:_________

(must be less than or equal to A7)

 No

If A14. is “Onshore Pipeline, Including Valve Sites” OR “Offshore Pipeline, Including Riser and Riser Bend”, answer A23a through f:
A23a. Initial action taken to control flow upstream of failure location
If Valve Closure, answer A23b and c:
A23b. Local time of valve closure
/ / /

 Valve Closure  Operational Control - mandatory text field

Hour

Month

Day

A23c. formerly E5a Type of upstream valve used to initially isolate release source:
 Manual  Automatic
 Remotely Controlled
A23d. Initial action taken to control flow downstream of failure location
If Valve Closure, answer A23.e and f:
A23e. Local time of valve closure
/ / /

Hour

Year

 Valve Closure  Operational Control - mandatory text field
/

Month

Day

Year

A23f. formerly E5b Type of downstream valve used to initially isolate release source:
 Manual  Automatic
 Remotely Controlled  Check Valve
If A6 = Crude Oil , Refined and/or Petroleum Product (non-HVL) which is a Liquid at Ambient Conditions, or Biofuel / Alternative Fuel (including
ethanol blends) AND A15. is Onshore, answer questions A24a and c:
A24a. Did the operator notify a “qualified individual” in the Onshore Oil Spill Response Plan?
 Yes  No
If Yes, answer A24b.
A24b. Local time the “qualified individual” was notified.
/ / / / /
/ / /
/ / /
/ / /
Hour

A24e. Local time OSRO arrived on site
A25. formerly A17. Number of general public evacuated: /

Form PHMSA F 7000-1 (rev ??-201?)

/
/

/,/

Hour

/
/

Day

Year

 Yes  No

A24c. Did the operator activate an Oil Spill Removal Organization (OSRO)?
If Yes, answer A24d and e:
A24d. Local time operator activated OSRO
/ / / /
Hour

Month

Month
Month

Day
Day

Year
Year

Reproduction of this form is permitted

Page 4 of 22

PART B – ADDITIONAL LOCATION INFORMATION
B1. formerly B7. Pipeline/Facility name: _______________________________
B2. formerly B8. Segment name/ID: __________________________________
If Onshore:
B3. State: /

B4. Zip Code: /

B5.____________________
City

/ - /

B6._______________________
County or Parish

 Milepost (specify in shaded area below)
 Survey Station No. (specify in shaded area below)

B7. Operator-designated location: (select only one)

B8 /___/___/___/___/___/___/___/___/___/___/___/___/___/
B9. Was this onshore Accident on Federal land?

 Yes

 No

B10. Location of Accident: (select only one)

 Totally contained on Operator-controlled property  Pipeline right-of-way
 Originated on Operator-controlled property, but then flowed or migrated off the property
B11. Area of Accident (as found): (select only one)

 Tank, including attached appurtenances
 Underground  Specify:
 Under soil  Under a building  Under pavement  Exposed due to excavation
 Exposed due to loss of cover  In underground enclosed space (e.g., vault)  Other ______
B11a. Depth-of-Cover (in): /

/,/

/ OR

 Unknown

 Aboveground  Specify:

 Typical aboveground facility piping or appurtenance  Overhead crossing  Inside a building
 In or spanning an open ditch  Inside other enclosed space  Other ______
 Transition Area  Specify:  Soil/air interface  Wall sleeve  Pipe support or other close contact area  Other _____
 Yes  No If B12 is Yes, specify type:
Bridge crossing Specify:  Cased  Uncased
Railroad crossing (select all that apply)  Cased
 Uncased
 Bored/drilled
Road crossing (select all that apply)  Cased
 Uncased
 Bored/drilled
Water crossing
Specify:  Cased
 Uncased
Name of body of water, if commonly known: _____________________________________
Approx. water depth (ft) at the point of the Accident: /
/,/
/
/
/ OR  Unknown
(select only one of the following)
 Shoreline/Bank/Marsh crossing
Below water, pipe buried below bottom (NOT in bored/drilled crossing)
 Below water, pipe in bored/drilled crossing
Below water, pipe on or above bottom

B12. Did the Accident occur in a crossing?:





Is this water crossing 100 feet or more in length from high water mark to high water mark?

 Yes

 No

If Offshore:
B13. Approximate water depth (ft.) at the point of the Accident: /
B14. Origin of Accident:

 In State waters
Specify: State:

/,/

Area: _____ Block/Tract #: /___/___/___/___/ Nearest County/Parish: ________

 On the Outer Continental Shelf (OCS) (select only one)  OCS – Alaska
 OCS-Gulf of Mexico
Specify: Area: ________

Block/Tract #: /___/___/___/___/

 OCS- Atlantic
 OCS – Pacific

B15. Area of Accident: (select only one)








Shoreline/Bank/Marsh crossing or shore approach
Below water, pipe buried or jetted below seabed
Below water, pipe on or above seabed
Splash Zone of riser
Portion of riser outside of Splash Zone, including riser bend
Platform

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 5 of 22

PART C – ADDITIONAL FACILITY INFORMATION
C1. Is the pipeline or facility:
 Interstate
 Intrastate
C2. reserved
C3. Item involved in Accident: (select only one)
 Pipe  Specify:  Pipe Body
 Pipe Seam
If Pipe Body: Was this a puddle/spot weld?  Yes
C3a. Nominal Pipe Size:

/./

 No

C3.b Wall thickness (in):

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

C3d. Pipe specification: _____________________________

/,/

/
/

/./

 Unknown

 Specify:  ERW - High Frequency  Single SAW  Flash Welded
 ERW - Low Frequency  DSAW  Continuous Welded  Longitudinal ERW – Unknown Frequency
 Furnace Butt Welded  Spiral Welded  Lap Welded  Seamless
 Other, describe: ________________________
C3e. Pipe Seam

C3f. Pipe manufacturer: _______________________________

 Unknown

C3g formerly C3.h Pipeline coating type at point of Accident
 Specify:  Fusion Bonded Epoxy (FBE)

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

C3h. Coating field applied?

 No

 Unknown

 Weld, including heat-affected zone  Specify:  Pipe Girth Weld  Other Butt Weld  Fillet Weld

If Pipe Girth Weld is selected, complete items C3a through h above. Are any of the C3b though h values different on either side of the
girth weld?  Yes  No
If Yes, enter the different value(s) below:
C3i. Wall thickness (in):

/./

C3j. SMYS (Specified Minimum Yield Strength) of pipe (psi):
C3k. Pipe specification: _____________________________

/
OR

/,/

 Unknown

C3l. Pipe Seam  Specify:  ERW - High Frequency  Single SAW  Flash Welded
 ERW - Low Frequency  DSAW  Continuous Welded  ERW – Unknown Frequency
 Furnace Butt Welded  Spiral Welded  Lap Welded  Seamless
 Other, describe: ________________________
C3m. Pipe manufacturer: _______________________________

 Unknown

C3n. Pipeline coating type at point of Accident
 Specify:  Fusion Bonded Epoxy (FBE)

 Coal Tar  Asphalt  Polyolefin  Extruded Polyethylene
 Epoxy other than FBE  Cold Applied Tape  Paint  Composite  None  Other, describe: _______________
C3o. Coating field applied?

 Valve

 Yes

 No

 Unknown

 Mainline  Specify:  Butterfly  Check

 Gate

 Plug

 Ball  Globe  Other, describe: ______

C3p. formerly C3.i Mainline valve manufacturer: ______________________________

 Unknown

 Relief Valve – including thermal and pressure. Report tank relief valves under the Tank/Vessel, Relief Valve
 Auxiliary or Other Valve – report auxiliary valves on tanks under Tank/Vessel, Appurtenance

 Pump, including auxiliary piping, connections, and equipment, but excluding product drain lines and tubing.
C3q. Type of pump
Positive displacement
Centrifugal
Gear
Other (specify): _____________________
C3r. Type of service
Mainline
Injection
Truck rack (if on terminal side of truck rack canopy)
Other (specify): _________________

 Meter/Prover, including auxiliary piping, connections, and equipment, but excluding product drain lines and tubing.
 Scraper/Pig Trap, including auxiliary piping, connections, and equipment, but excluding product drain lines and tubing.
 Sump, including auxiliary piping, connections, and equipment, but excluding product drain lines and tubing.
Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 6 of 22













Filter, Strainer, Separator, including auxiliary piping, connections, and equipment, but excluding product drain lines and tubing.
Repair Sleeve or Clamp
Tapping Equipment
Tap Fitting (stopple, thread-o-ring, weld-o-let, etc.)
Flange Assembly, including Gaskets
Relief Lines and Relief Equipment
Drain Lines
Tubing, including Fittings
C3s. Tubing material
Stainless steel
Carbon steel
Copper
Other
C3t. Type of tubing
Rigid
Flexible
Instrumentation, including Programmable Logic Controllers and Controls
Tank/Vessel  C3u. Specify:  Single Bottom System  Double Bottom System  Tank Shell  Chime  Roof/Roof Seal

 Roof Drain System  Mixer  Pressure Vessel Head or Wall  Appurtenance
 Relief Valve
 Other, describe: ________________
C3v. formerly part of C2. Tank Type  Atmospheric
 Pressurized

If C3v. = Pressurized:
C3v1. Tank Maximum Operating Pressure
C3v2. What is the set point of the primary pressure relief device on the tank? ________
C3v3. Did the thermal or pressure relief valve activate?  Yes  No
C3v4. Was the MOP of the tank exceeded?  Yes  No
If C3v = Atmospheric or Low Pressure:
C3v5. Safe-Fill-Level (in feet) at the time of the accident? ______
C3v6. Was the SafeFill-Level exceeded?  Yes  No
C3v7. formerly G1, 14.a Year of most recent API Std 653 Out-of-Service Inspection /
/
/
/
/ OR  None
C3v8. formerly G1, 14.b API Std 653 In-Service Inspection /
/
/
/
/ OR  No In-Service Inspection completed

 Other ___________mandatory text field______________________
C4. Year item involved in Accident was installed:

C4a. Year item involved in Accident was manufactured:

/
/

 Unknown

OR
/

 Unknown

C5. Material involved in Accident: (select only one)
 Carbon Steel
 Material other than Carbon Steel  Specify: ____________________________________________
C6. Type of Accident involved: (select only one)
 Mechanical Puncture  Approx. size: /__/__/__/__/./__/in. (axial) by /__/__/__/__/./__/in. (circumferential)

 Leak  Select Type:  Pinhole
 Crack
 Rupture  Select Orientation:  Circumferential

 Connection Failure
 Seal or Packing
 Other
 Longitudinal
 Other ________________________________

Approx. size: /__/__/__/__/./__/ in. (widest opening) by /__/__/__/__/__/./__/in. (length circumferentially or axially)

 Overfill or Overflow
 Other  Describe: _______________________________________________________________________________________
PART D – ADDITIONAL CONSEQUENCE INFORMATION
D1. Wildlife impact:
 Yes  No
D1a If Yes, specify all that apply:
 Fish/aquatic

 Birds
 Terrestrial
D2. Soil contamination:

 Yes  No

D3. Long term impact assessment performed or planned:
D4. Anticipated remediation:  Yes  No (not needed)
D4a. If Yes, specify all that apply:
 Surface water  Groundwater  Soil
D5. Water contamination:

 Yes



 Yes  No
 Vegetation

(Complete 5a – 5c below)

 Wildlife
 No

D5a. Specify all that apply:
 Ocean/Seawater
Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 7 of 22

 Surface
 Groundwater
 Drinking water



(Select one or both)

 Private Well  Public Water Intake

D5b. Estimated amount released in or reaching water:

/,/

/___/./___/___/ Barrels

D5c. Name of body of water, if commonly known: __________________________________________
D6. At the location of this Accident, had the pipeline segment or facility been identified as one that “could affect” a High Consequence Area
(HCA) as determined in the Operator’s Integrity Management Program?
 Yes  No

 Yes  No

D7. Did the released commodity reach or occur in one or more High Consequence Area (HCA)?
D7a. If Yes, specify HCA type(s): (select all that apply)

 Commercially Navigable Waterway

Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
 Yes  No

 High Population Area

Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
 Yes  No

 Other Populated Area

Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
 Yes  No

 Unusually Sensitive Area (USA) – Drinking Water

Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
 Yes  No

 Unusually Sensitive Area (USA) – Ecological

Was this HCA identified in the “could affect” determination for this Accident site in the Operator’s Integrity Management Program?
 Yes  No

D8. Estimated Property Damage:
D8a. Estimated cost of public and non-Operator private property damage

/,/

D8b. Estimated cost of commodity lost

/,/

D8c. Estimated cost of Operator’s property damage & repairs

/,/

D8d. Estimated cost of emergency response

/,/

D8e. Estimated cost of environmental remediation

D8f. Estimated other costs

/
$/

/,/
/,/

/
/,/

Describe ___________________________________________________
D8g. Total estimated property damage (sum of above)

$ calculated

Injured Persons not included in A11 The number of persons injured, admitted to a hospital, and remaining in the hospital for at least one
overnight are reported in A11. If a person is included in A11, do not include them in D9.
D9. Estimated number of persons with injuries requiring treatment in a medical facility but not requiring overnight in-patient hospitalization:
If a person is included in D9, do not include them in D10.
D10. Estimated number of persons with injuries requiring treatment by EMTs at the site of accident:
Buildings Affected
D11. Number of residential buildings affected (evacuated or required repair):
D12. Number of business buildings affected (evacuated or required repair):

PART E – ADDITIONAL OPERATING INFORMATION

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 8 of 22

E1. Estimated pressure at the point and time of the Accident (psig):

/,/

If C3. Is Tank/Vessel and C3v. is Atmospheric, do not answer E2. and E3.
E2. Maximum Operating Pressure (MOP) at the point and time of the Accident (psig) :

/,/

E2a. Limiting factor establishing MOP (select only one):
 Internal Design Pressure
 Component Design Pressure
 SubPart E Pressure Test
 Excepted Component Pressure Test
 Four Hour Test or Operation
 Other; describe: _________________

§195.406(a)(1)
§195.406(a)(2)
§195.406(a)(3)
§195.406(a)(4)
§195.406(a)(5)

E2b. Date MOP established __________
E2c. Was the MOP established in conjunction with a reversal of flow direction?

 Yes  No

 Bi-Directional

If E2c = Yes, E2d. What is the date of the most recent surge analysis performed at the point of the Accident? ________
E3. Describe the pressure on the system or facility relating to the Accident: (calculated)
 Pressure did not exceed MOP
 Pressure exceeded MOP, but did not exceed 110% of MOP
 Pressure exceeded 110% of MOP
E4. Was the system or facility relating to the Accident operating under an established pressure restriction with pressure limits below those
normally allowed by the MOP?

 No
 Yes

 (Complete 4.a and 4.b below)

E4a. Did the pressure exceed this established pressure restriction?

 Yes

 No

E4b. Was this pressure restriction mandated by PHMSA or the State?

 PHMSA

 State

 Not mandated

If A14. is “Onshore Pipeline, Including Valve Sites” OR “Offshore Pipeline, Including Riser and Riser Bend”, complete E5 through E7
E5. formerly E5.c Answer E5 only when both A23a and A23d are Valve Closure
Length of segment initially isolated between valves (ft): /
/
/
/
E6. formerly E5.d Is the pipeline configured to accommodate internal inspection tools?

 Yes
 No  Which physical features limit tool accommodation? (select all that apply)
 Changes in line pipe diameter
 Presence of unsuitable mainline valves
 Tight or mitered pipe bends
 Other passage restrictions (i.e. unbarred tee’s, projecting instrumentation, etc.)
 Extra thick pipe wall (applicable only for magnetic flux leakage internal inspection tools)
 Other  Describe:__________________________________________________________________
E7. formerly E5.e For this pipeline, are there operational factors which significantly complicate the execution of an internal inspection tool run?

 No
 Yes

 Which operational factors complicate execution?






(select all that apply)

Excessive debris or scale, wax, or other wall build-up
Low operating pressure(s)
Low flow or absence of flow
Incompatible commodity
Other  Describe:__________________________________________________________________

E8. formerly E5.f Function of pipeline system: (select only one)
 > 20% SMYS Regulated Transmission
 > 20% SMYS Regulated Gathering
 ≤ 20% SMYS Regulated Transmission
 ≤ 20% SMYS Regulated Gathering

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 9 of 22

E9. Was a Supervisory Control and Data Acquisition (SCADA)-based system in place on the pipeline or facility involved in the Accident?
 No
 Yes  E9a. Was it operating at the time of the Accident?
 Yes
 No

 Yes
 No
E9b. Was it fully functional at the time of the Accident?
E9c. Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist with the initial
indication of the Accident?
 Yes
 No
E9d. Did SCADA-based information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist with the
confirmed discovery of the Accident?
 Yes
 No
E10. Was a CPM leak detection system in place on the pipeline or facility involved in the Accident?

 No
 Yes



E10a. Was it operating at the time of the Accident?

 Yes

 No

 Yes
 No
E10b. Was it fully functional at the time of the Accident?
E10c. Did CPM leak detection system information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist
with the initial indication of the Accident?
 Yes
 No
E10d. Did CPM leak detection system information (such as alarm(s), alert(s), event(s), and/or volume calculations) assist
with the confirmed discovery of the Accident?
 Yes
 No
E11. Was an investigation initiated into whether or not the controller(s) or control room issues were the cause of or a contributing factor to the
Accident? (select only one)

 Yes, but the investigation of the control room and/or controller actions has not yet been completed by the Operator (Supplemental
Report required)
 No, the facility was not monitored by a controller(s) at the time of the Accident
 No, the Operator did not find that an investigation of the controller(s) actions or control room issues was necessary due to:
(provide an explanation for why the Operator did not investigate)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
 Yes, specify investigation result(s): (select all that apply)
 Investigation reviewed work schedule rotations, continuous hours of service (while working for the Operator) and other
factors associated with fatigue
 Investigation did NOT review work schedule rotations, continuous hours of service (while working for the Operator) and
other factors associated with fatigue (provide an explanation for why not)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
 Investigation identified no control room issues
 Investigation identified no controller issues
 Investigation identified incorrect controller action or controller error
 Investigation identified that fatigue may have affected the controller(s) involved or impacted the involved controller(s)
response
 Investigation identified incorrect procedures
 Investigation identified incorrect control room equipment operation
 Investigation identified maintenance activities that affected control room operations, procedures, and/or controller
response
 Investigation identified areas other than those above  Describe: ___________

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 10 of 22

PART F – DRUG & ALCOHOL TESTING INFORMATION
F1. As a result of this Accident, were any Operator employees tested under the post-accident drug and alcohol testing requirements of DOT’s
Drug & Alcohol Testing regulations?

 No
 Yes



F1a. Specify how many were tested:

F1b. Specify how many failed:

F2. As a result of this Accident, were any Operator contractor employees tested under the post-accident drug and alcohol testing requirements
of DOT’s Drug & Alcohol Testing regulations?

 No
 Yes



F2a. Specify how many were tested:
F2b. Specify how many failed:

PART G – APPARENT CAUSE

/
/

Select only one box from PART G in the shaded column on the left representing the
APPARENT Cause of the Accident, and answer the questions on the right. Describe
secondary, contributing, or root causes of the Accident in the narrative (PART H).

G1 - Corrosion Failure – *only one sub-cause can be picked from shaded left-hand column
 External Corrosion

1. Results of visual examination:
 Localized Pitting  General Corrosion
 Other _______________________________________________
2. Type of corrosion: (select all that apply)
 Galvanic  Atmospheric  Stray Current  Microbiological  Selective Seam
 Other ________________________________________________
2a. If 2 is Stray Current, specify  Alternating Current  Direct Current AND
2b. Describe the stray current source: _______________________
3. The type(s) of corrosion selected in Question 2 is based on the following: (select all that
apply)
 Field examination
 Determined by metallurgical analysis
 Other _____________________________________________________________
4. Was the failed item buried or submerged?
 Yes  4a. Was failed item considered to be under cathodic protection at the time of
the Accident?
 Yes  Year protection started: / / / / /

 No

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

 Yes, Close Interval Survey  Most recent year conducted: /
 Yes, Other CP Survey  Most recent year conducted:
/
 No
 No 

Describe other CP survey ____________________

4d. Was the failed item externally coated or painted?

 Yes  No

5. Was there observable damage to the coating or paint in the vicinity of the corrosion?
 Yes  No  N/A Bare/Ineffectively Coated Pipe

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 11 of 22

6. Results of visual examination:
 Localized Pitting
 General Corrosion
 Not cut open
 Other _______________________________________________

 Internal Corrosion

7. Cause of corrosion: (select all that apply)
 Corrosive Commodity  Water drop-out/Acid  Microbiological
 Other ________________________________________________

 Erosion

8. The cause(s) of corrosion selected in Question 7 is based on the following: (select all that
apply)
 Field examination
 Determined by metallurgical analysis
 Other _____________________________________________
9. Location of corrosion: (select all that apply)
 Low point in pipe  Elbow
 Dead-Leg

 Other________________

10. Was the commodity treated with corrosion inhibitors or biocides?
11. Was the interior coated or lined with protective coating?

 Yes  No

12. Were cleaning/dewatering pigs (or other operations) routinely utilized?
 Not applicable - Not mainline pipe
 Yes
 No
13. Were corrosion coupons routinely utilized?
 Not applicable - Not mainline pipe
 Yes

 No

G2 - Natural Force Damage - *only one sub-cause can be picked from shaded left-hand column
 Earth Movement, NOT due to

1. Specify:

 Earthquake  Subsidence  Landslide
 Other ____________________

 Heavy Rains/Floods

2. Specify:

 Washout/Scouring  Flotation  Mudslide  Other _________________

 Lightning

3. Specify:

 Direct hit

 Temperature

4. Specify:

 Thermal Stress
 Frozen Components

Heavy Rains/Floods

 Secondary impact such as resulting nearby fires
 Frost Heave
 Other ________________________________

 High Winds
 Tree/Vegetation Root
 Snow/Ice impact or
Accumulation

 Other Natural Force Damage

5. Describe: ____________

Complete the following if any Natural Force Damage sub-cause is selected.
6. Were the natural forces causing the Accident generated in conjunction with an extreme weather event?

 Yes

 No

 Hurricane
 Tropical Storm
 Tornado
 Other ______________________________

6a. If Yes, specify: (select all that apply)

G3 – Excavation Damage - *only one sub-cause can be picked from shaded left-hand column
 Excavation Damage by Operator
(First Party)

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

 Excavation Damage by Third Party
 Previous Damage due to Excavation
Activity

Complete the following if Excavation Damage by Third Party is selected as the sub-cause.
1. Did the Operator get prior notification of the excavation activity?
Form PHMSA F 7000-1 (rev ??-201?)

 Yes  No

Reproduction of this form is permitted

Page 12 of 22

1a. If Yes, Notification received from: (select all that apply)  One-Call System
 Excavator  Contractor
1b. Per the primary Accident Investigator results, did State law exempt the excavator from notifying the one-call center?
 Yes  No  Unknown
If yes, answer 1c through 1e.
1c. select one of the following:
 Excavator is exempt
 Activity is exempt and did not exceed the limits of the exemption
 Activity is exempt and exceeded the limits of the exemption
 Other mandatory text field:
1d. Exempting authority:
1e. Exempting criteria:

 Landowner

Complete the following mandatory CGA-DIRT Program questions if any Excavation Damage sub-cause is selected.
2. Do you want PHMSA to upload the following information to CGA-DIRT (www.cga-dirt.com)?

Yes

 No

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

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

 Other

 No
 No

6. Measured Depth from Grade

 Embedded in Concrete/Asphalt Pavement  <18” /46 cm
 Measured depth From Grade __________ in/cm

 18” – 36” /46 cm – 91 cm

 > 36” / 91 cm

7. Type of excavator: (select only one)

 Contractor
 Railroad

 County
 State

 Developer
 Utility

 Farmer

 Municipality
 Occupant
 Unknown/Other

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

 Auger
 Explosives
 Probing Device

 Backhoe/Trackhoe
 Farm Equipment
 Trencher

 Boring
 Grader/Scraper
 Vacuum Equipment

 Drilling
 Directional Drilling
 Hand Tools
 Milling Equipment
 Bulldozer  Unknown/Other

9. Type of work performed: (select only one)

 Agriculture
 Drainage
 Grading
 Natural Gas
 Sewer (Sanitary/Storm)
 Telecommunications
 Data not collected

 Cable TV
 Curb/Sidewalk
 Driveway
 Electric
 Irrigation
 Landscaping
 Pole
 Public Transit Authority
 Site Development
 Steam
Traffic Signal
 Traffic Sign
 Unknown/Other

10. Was the One-Call Center notified?

 Yes

*10a. If Yes, specify ticket number: /

 Building Construction
 Engineering/Surveying
 Liquid Pipeline
 Railroad Maintenance
 Storm Drain/Culvert
 Water

 Building Demolition
 Fencing
 Milling
 Road Work
Street Light
 Waterway Improvement

 No If No, skip to question 11
/

*10b. If this is a State where more than a single One-Call Center exists, list the name of the One-Call Center notified:
*10 c. Was work area white lined?
 No
 Yes
 Unknown
____________________________________________________________
11. Type of Locator:

 Facility Owner

 Contract Locator

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

 No

 Yes

13. Did the damage cause an interruption in service?

 No

 Yes

11a. If Yes, specify duration of the interruption:

 Unknown/Other
 Unknown/
 Unknown/Other

/___/___/___/___/ hours

14. Description of the CGA-DIRT Root Cause (select only the one predominant first level CGA-DIRT Root Cause and then, where available
as a choice, the one predominant second level CGA-DIRT Root Cause as well):
Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 13 of 22

Notification Issue
 No notification made to the One-Call Center/811
☐ Excavator dug outside area described on ticket
☐ Excavator dug prior to valid start date/time
☐ Excavator dug after valid ticket expired
☐ Excavator provided incorrect notification information

Excavation Issue
☐ Excavator dug prior to verifying marks by test-hole (pothole)
☐ Excavator failed to maintain clearance after verifying marks
☐ Excavator failed to protect/shore/support facilities
☐ Improper backfilling practices
☐ Marks faded or not maintained
☐ Improper excavation practice not listed above

Locating Issue

Facility not marked due to:
☐ Abandoned facility
☐ Incorrect facility records/maps
☐ Locator error
☐ No response from operator/contract locator
☐ Incomplete marks at damage location
☐Tracer wire issue
☐ Unlocatable Facility
Facility marked inaccurately due to:
☐ Abandoned facility
☐ Incorrect facility records/maps
☐ Locator error
☐ Tracer wire issue

Miscellaneous Root Causes
☐ Deteriorated facility
☐ One Call Center Error
☐ Previous damage
☐ Root Cause not listed (comment required)

_________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________

G4 - Other Outside Force Damage - *only one sub-cause can be picked from shaded left-hand column
 Nearby Industrial, Man-made, or Other
Fire/Explosion as Primary Cause of
Accident

 Damage by Car, Truck, or Other

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

 Damage by Boats, Barges, Drilling

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

Motorized Vehicle/Equipment NOT
Engaged in Excavation

Rigs, or Other Maritime Equipment or
Vessels Set Adrift or Which Have
Otherwise Lost Their Mooring

 Routine or Normal Fishing or Other
Maritime Activity NOT Engaged in
Excavation

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 14 of 22

 Electrical Arcing from Other
Equipment or Facility

 Previous Mechanical Damage NOT
Related to Excavation

 Intentional Damage

3. Specify:

 Other Outside Force Damage

4. Describe: _________________________________________________________

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

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

 Yes

 No  Unknown

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

 Motorcycle/ATV

 Passenger Car  Small Truck  Bus  Large Truck

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

 Loading Dock

 Off-Road

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

 Yes

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

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 15 of 22

 No

G5 - Material Failure of Pipe or Weld

Use this section to report material failures ONLY IF the “Item Involved in
Accident” (from PART C, Question 3) is “Pipe” or “Weld.”
*Only one sub-cause can be picked from shaded left-hand column

1. The sub-cause selected below is based on the following: (select all that apply)
 Field Examination

 Determined by Metallurgical Analysis

 Other Analysis__________________________

 Sub-cause is Tentative or Suspected; Still Under Investigation (Supplemental Report required)

 Design-, Construction-, Installation-,
or Fabrication-related

 Original Manufacturing-related

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

 Environmental Cracking-related

2. List contributing factors: (select all that apply)
 Fatigue- or Vibration-related:
 Mechanically-induced prior to installation (such as during transport of pipe)
 Mechanical Vibration
 Pressure-related
 Thermal
 Other __________________________________
 Mechanical Stress
 Other __________________________________
3. Specify:  Stress Corrosion Cracking
 Hydrogen Stress Cracking
 Other ______________________________

 Sulfide Stress Cracking
 Hard Spot

Complete the following if any Material Failure of Pipe or Weld sub-cause is selected.
4. Additional factors: (select all that apply)  Dent  Gouge  Pipe Bend
 Lamination
 Buckle
 Wrinkle
 Misalignment
 Other __________________________________

Form PHMSA F 7000-1 (rev ??-201?)

 Arc Burn  Crack
 Burnt Steel

Reproduction of this form is permitted

 Lack of Fusion

Page 16 of 22

G6 - Equipment Failure - *only one sub-cause can be picked from shaded left-hand column
 Malfunction of Control/Relief

1. Specify: (select all that apply)
 Control Valve
 Instrumentation
 SCADA
 Communications  Block Valve
 Check Valve
 Relief Valve
 Power Failure
 Stopple/Control Fitting
 ESD System Failure
 Other ________________________________________________________

 Pump or Pump-related Equipment

2. Specify:  Seal/Packing Failure
 Body Failure
 Crack in Body
 Appurtenance Failure
 Other ________________________________________________________

 Threaded Connection/Coupling

3. Specify:

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

 Non-threaded Connection Failure

4. Specify:

 O-Ring
 Gasket
 Seal (NOT pump seal) or Packing
 Other ________________________________________________________

Equipment

Failure

 Defective or Loose Tubing or Fitting
 Failure of Equipment Body (except

Pump), Tank Plate, or other Material

 Other Equipment Failure

5. Describe: ___________________________________________________________
_______________________________________________________________________

Complete the following if any Equipment Failure sub-cause is selected.
6. Additional factors that contributed to the equipment failure: (select all that apply)
 Excessive vibration

 Overpressurization
 No support or loss of support
 Manufacturing defect
 Loss of electricity
 Improper installation
 Improper maintenance
 Mismatched items (different manufacturer for tubing and tubing fittings)
 Dissimilar metals
 Breakdown of soft goods due to compatibility issues with transported commodity
 Valve vault or valve can contributed to the release
 Alarm/status failure
 Misalignment
 Thermal stress
 Erosion/Abnormal Wear
 Other _______________________________________________________

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 17 of 22

G7 - Incorrect Operation - *only one sub-cause can be picked from shaded left-hand column
 Damage by Operator or Operator’s
Contractor NOT Related to
Excavation and NOT due to
Motorized Vehicle/Equipment
Damage

 Tank, Vessel, or Sump/Separator
Allowed or Caused to Overfill or
Overflow

1. Specify:

 Valve misalignment
 Incorrect reference data/calculation
 Miscommunication
 Inadequate monitoring
 Other ____________________________________

 Valve Left or Placed in Wrong

Position, but NOT Resulting in a
Tank, Vessel, or Sump/Separator
Overflow or Facility Overpressure

 Pipeline or Equipment
Overpressured

 Equipment Not Installed Properly
 Wrong Equipment Specified or
Installed

 Other Incorrect Operation

2. Describe: __________________________________________________

Complete the following if any Incorrect Operation sub-cause is selected.
3. Was this Accident related to: (select all that apply)
 Inadequate procedure
 No procedure established
 Failure to follow procedure
 Other: ______________________________________________________
4. What category type was the activity that caused the Accident:
 Construction
 Commissioning
 Decommissioning
 Right-of-Way activities
 Routine maintenance
 Other maintenance
 Normal operating conditions
 Non-routine operating conditions (abnormal operations or emergencies)
5. Was the task(s) that led to the Accident identified as a covered task in your Operator Qualification Program?  Yes

 No

5a. If Yes, were the individuals performing the task(s) qualified for the task(s)?

 Yes, they were qualified for the task(s)
 No, but they were performing the task(s) under the direction and observation of a qualified individual
 No, they were not qualified for the task(s) nor were they performing the task(s) under the direction and observation of a
qualified individual

G8 – Other Accident Cause - *only one sub-cause can be picked from shaded left-hand column
 Miscellaneous

1. Describe: ___________________________________________________________

 Unknown

2. Specify:
 Investigation complete, cause of Accident unknown. Mandatory
comment field: _______________________________________________________
 Still under investigation, cause of Accident to be determined*
(*Supplemental Report required)

PART J – COMPLETED INTEGRITY INSPECTIONS

Form PHMSA F 7000-1 (rev ??-201?)

Formerly at multiple locations in Part G

Reproduction of this form is permitted

Page 18 of 22

Complete the following if the “Item Involved in Accident” (from PART C, Question 3) is Pipe or Weld and the “Cause” (from Part G) is:
Corrosion (any subCause in Part G1); or
Previous Damage due to Excavation Activity (subCause in Part G3); or
Previous Mechanical Damage NOT Related to Excavation (subCause in Part G4); or
Material Failure of Pipe or Weld (any subCause in Part G5)
J1. Have internal inspection tools collected data at the point of the Accident?
 Yes  No
J1a. If Yes, for each tool and technology used provide the information below for the most recent and previous tool runs:

 Axial Magnetic Flux Leakage
Most recent run Year:

 Free Swimming  Tethered
 Metal Loss  Hard Spots  Girth Weld Anomalies
 Other Describe:
If Metal Loss, specify (select only one):  High Resolution
 Standard Resolution
 Other Describe:

Most recent run Propulsion Method (select only one):
Most recent run Attuned to Detect (select only one):

Previous run Year:

Previous run Propulsion Method (select only one):
Previous run Attuned to Detect (select only one):

 Circumferential/Transverse Wave Magnetic Flux Leakage
Most recent run Year:

 Free Swimming  Tethered
 High Resolution  Standard Resolution
 Other Describe:

Most recent run Propulsion Method (select only one):
Most recent run Resolution (select only one):
Previous run Year:
Previous run Propulsion Method (select only one):
Previous run Resolution (select only one):

 Free Swimming  Tethered
 High Resolution  Standard Resolution
 Other Describe:

 Ultrasonic
Most recent run Year:

 Free Swimming  Tethered
 Wall Measurement  Crack
 Other Describe:

Most recent run Propulsion Method (select only one):
Most recent run Attuned to (select only one)

If Attuned to Wall Measurement, most recent run Metal Loss Resolution (select only one):

 Standard Resolution
Previous run Year:

 Other Describe:

Previous run Propulsion Method (select only one):
Most recent run Attuned to (select only one)

 Free Swimming  Tethered
 Wall Measurement  Crack
 Other Describe:

If Attuned to Wall Measurement, most recent run Metal Loss Resolution (select only one):

 Standard Resolution

 Other Describe:

 Geometry/Deformation
Most recent run Year:

 Free Swimming  Tethered
 High Resolution  Standard Resolution
Most recent run Resolution (select only one):
 Other Describe:
Most recent run Measurement Cups (select only one):  Inside ILI Cups
 No Cups
Most recent run Propulsion Method (select only one):

Previous run Year:

 Free Swimming  Tethered
 High Resolution  Standard Resolution
 Other Describe:
Previous run Measurement Cups (select only one):  Inside ILI Cups
 No Cups
Previous run Propulsion Method (select only one):
Previous run Resolution (select only one):

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 19 of 22

 Electromagnetic Acoustic Transducer (EMAT)
Most recent run Year:
Most recent run Propulsion Method (select only one):
Previous run Year:
Previous run Propulsion Method (select only one):

 Free Swimming  Tethered

 Cathodic Protection Current Measurement (CPCM)
Most recent run Year:
Most recent run Propulsion Method (select only one):
Previous run Year:
Previous run Propulsion Method (select only one):

 Free Swimming  Tethered

 Other, specify tool:
Most recent run Year:
Most recent run Propulsion Method (select only one):
Previous run Year:
Previous run Propulsion Method (select only one):

 Free Swimming  Tethered

Answer J1.b only when the cause is:
Previous Damage due to Excavation Activity (subCause in Part G3); or
Previous Mechanical Damage NOT Related to Excavation (subCause in Part G4)

 Yes  No

J1b. Do you have reason to believe that the internal inspection was completed BEFORE the damage was sustained?
J2. Has one or more hydrotest or other pressure test been conducted since original construction at the point of the Accident?
(initial post construction pressure test is NOT reported here)

 Yes  Most recent year tested: /
 No

Test pressure (psig): /

J3. Has Direct Assessment been conducted on the pipeline segment?
 Yes, and an investigative dig was conducted at the point of the Accident

 Yes, but the point of the Accident was not identified as a dig site
 No

 Most recent year conducted:
 Most recent year conducted:

If J3 is Yes, J3a. For each type, indicate the year of the most recent assessment:
External Corrosion Direct Assessment (ECDA)
/
/
/
/
/
Other, specify type:
/
/
/
/
/
J4. Has one or more non-destructive examination been conducted prior to the Accident at the point of the Accident since January 1, 2002?
 Yes  No
J4a. If Yes, for each examination conducted, select type of non-destructive examination and indicate most recent year the examination was
conducted:

 Radiography
 Guided Wave Ultrasonic
 Handheld Ultrasonic Tool
 Wet Magnetic Particle Test
 Dry Magnetic Particle Test
 Other, specify type _______________

/
/
/
/
/
/

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

Pipe/Weld Failure
 Design-related

 External Corrosion, Atmospheric
 External Corrosion, Stray Current Induced
 External Corrosion, Microbiologically Induced
 External Corrosion, Selective Seam
Internal Corrosion
 Internal Corrosion, Corrosive Commodity
 Internal Corrosion, Water drop-out/Acid
 Internal Corrosion, Microbiological
 Internal Corrosion, Erosion
Form PHMSA F 7000-1 (rev ??-201?)

 Construction-related
 Installation-related
 Fabrication-related
 Original Manufacturing-related
 Environmental Cracking-related, Stress Corrosion Cracking
 Environmental Cracking-related, Sulfide Stress Cracking
 Environmental Cracking-related, Hydrogen Stress Cracking
 Environmental Cracking-related, Hard Spot

Reproduction of this form is permitted

Page 20 of 22

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

Equipment Failure
 Malfunction of Control/Relief Equipment
 Pump or Pump-related Equipment

 Lightning

 Threaded Connection/Coupling Failure

 Temperature

 Non-threaded Connection Failure

 High Winds

 Defective or Loose Tubing or Fitting

 Tree/Vegetation Root
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
Other Outside Force
 Nearby Industrial, Man-made, or Other Fire/Explosion
 Damage by Car, Truck, or Other Motorized Vehicle/Equipment
NOT Engaged in Excavation

 Failure of Equipment Body (except Compressor), Vessel Plate,
or other Material
Incorrect Operation
 Damage by Operator or Operator’s Contractor NOT Excavation
and NOT Vehicle/Equipment Damage
 Tank, Vessel, or Sump/Separator Allowed or Caused to Overfill
or Overflow
 Valve Left or Placed in Wrong Position, but NOT Resulting in
Overpressure
 Pipeline or Equipment Overpressured

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

 Equipment Not Installed Properly

 Routine or Normal Fishing or Other Maritime Activity NOT
Engaged in Excavation

 Inadequate Procedure

 Electrical Arcing from Other Equipment or Facility

 Failure to follow procedures

 Previous Mechanical Damage NOT Related to Excavation

 Wrong Equipment Specified or Installed
 No procedure established

 Intentional Damage

Form PHMSA F 7000-1 (rev ??-201?)

Reproduction of this form is permitted

Page 21 of 22

PART H – NARRATIVE DESCRIPTION OF THE ACCIDENT
__________________________________________________________________________________________________________________

PART I – PREPARER AND AUTHORIZED SIGNATURE

Preparer's Name (type or print)

Preparer’s Telephone Number

Preparer's Title (type or print)
Preparer's E-mail Address

Preparer’s Facsimile Number

Local Contact Name: optional
Local Contact Email: optional
Local Contact Phone: optional

Authorized Signer’s Name

Date

Authorized Signer’s Title

Form PHMSA F 7000-1 (rev ??-201?)

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

Reproduction of this form is permitted

Page 22 of 22

Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

GENERAL INSTRUCTIONS
Each operator of a hazardous liquid or carbon dioxide pipeline system shall file Form
PHMSA F7000-1 for an accident that meets the criteria in 49 CFR §195.50 as soon as
practicable but not more than 30 days after discovery of the accident. Requirements for
submitting reports are in §195.54 and §195.58.
Releases during maintenance activities are not to be reported if the spill was less than 5
barrels, not otherwise reportable under 49 CFR §195.50, did not result in water pollution as
described by 49 CFR §195.52(a)(4), was confined to company property or pipeline rightof-way, and was cleaned up promptly. Any spill of 5 gallons or more to water during a
maintenance activity is required to be reported.
Form PHMSA F 7000-1 and these instructions can be found on
http://phmsa.dot.gov/pipeline/library/forms. The applicable documents are included in the
section titled Accidents/Incidents/Annual Reporting Forms.

ONLINE REPORTING REQUIREMENTS
Accident 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 “Hazardous Liquid”
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 Accident Report; or click
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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

“Save” which doesn’t submit the report to PHMSA but stores it in a draft status to
allow you to come back to complete your data entry and report submission at a later
time. Note: The “Save” feature will allow you to start a report and save a draft of
it which you can print out and/or save as a PDF to email to colleagues in order to
gather additional information and then come back to accurately complete your data
entry before submitting it to PHMSA.
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, and the report will not be submitted until all
required items are complete. 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 §195.58(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 accident in accordance with §195.54 (oftentimes referred to as
a 30-day written report) and upon subsequent investigation determines that the event did not
meet the criteria in §195.50 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 §195.52. If Supplemental
Reports were made to the NRC for the event, list all NRC report numbers
associated with the event.
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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS
e. Date of the event
f. Location of the event
g. A brief statement as to why the report should be retracted.

Note: PHMSA no longer requests that operators rescind erroneously reported “Immediate
Notices” filed with the NRC in accordance with §195.52 (oftentimes referred to as
“Telephonic Reports”).

SPECIAL INSTRUCTIONS
Certain data fields must be completed before an Original Report will be accepted. An
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 information becomes available.
5. If the question is not applicable, please 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 does not exist 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 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

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

PART A – GENERAL REPORT INFORMATION
Report Type: (select all that apply)
Select the appropriate report box or boxes to indicate the type of report being filed.
Depending on the descriptions below, the following combinations of boxes - and only one
of these combinations - may be selected:
•
•
•
•

Original Report only
Original Report plus Final Report
Supplemental Report only
Supplemental Report plus Final Report

 Original Report
Select if this is the FIRST report filed for this accident and you expect that additional or
updated information will be provided later.
 Original Report

plus

 Final Report

Select both Original Report and Final Report if ALL of the information requested is known
and can be provided at the time the initial report is filed, including final property damage
costs and apparent failure cause information. If new, updated, and/or corrected information
becomes available, you are still able to file a Supplemental Report.
 Supplemental Report
Select only if you have already filed an Original Report AND you are now providing new,
updated, and/or corrected information, but you are not yet ready to submit a Final Report.
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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

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 §195.54(b)15(c),
each Supplemental Report containing new, updated, and/or corrected information is to be
filed within 30 days. 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 within 30 days 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 cases where an accident results in long-term remediation, an operator may cease filing
Supplemental Reports in the following situations and, instead, file a Final Report even when
additional remediation costs and recovery of released commodity are still occurring:
1. When the accident response consists only of long-term remediation
and/or monitoring which is being conducted under the auspices of an
authorized governmental agency or entity.
2. When the estimated final costs and volume of commodity recovered can
be predicted with a reasonable degree of certainty.
3. When the volume of commodity recovered over time is consistently
decreasing to the point where an estimated total volume of commodity
recovered can be predicted with a reasonable degree of accuracy.
4. When the operator can justify (and explain in the Part H – Narrative) that
the continuation of Supplemental Report filings in the future will not
provide any essential information which will be critically different than
that contained in a Final Report filed currently.
In any of these cases, though, if the reported total volume of commodity released or other
previously reported data other than “Estimated cost of Operator’s environmental
remediation” or “Estimated volume of commodity recovered” is found to be inaccurate, a
Supplemental Report is still required.
For Supplemental Reports filed online, all data previously submitted will automatically
populate in the form. Page through the form to make edits and additions where needed.
 Supplemental Report

plus

 Final Report

If an Original Report has already been filed AND new, updated, and/or corrected
information is now being submitted via a Supplemental Report AND the operator is
reasonably certain that no further information will be forthcoming, then Final Report is to
also be selected along with Supplemental Report.
If you subsequently find that new, updated, and/or corrected information needs to be
provided, submit another Supplemental Report.

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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

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 202-366-8075 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
This is the headquarters address associated with the OPID. For online entries, the address
will automatically populate based on the OPID entered in A1. If the address that appears is
not correct, you need to change it in the online Contacts module.
A4. Earliest local time (24-hour clock) and date an accident reporting criteria was
met.
Enter the earliest local date/time an accident reporting criteria was met. In most cases this
time will be the same as when the operator identified the failure, which is reported in A13.
In some cases, this date/time will be prior to the operator’s identification of the failure and
must be estimated based on information gathered during the investigation. For example, if
a small leak was undetectable by SCADA or leak detection systems and was not identified
by the Operator until there were visible signs on the ground surface, the date/time a
reporting criteria was met must be estimated.
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 Accident occurred (select only one).
A4b. Select “Yes” if Daylight Saving was in effect at the time of the Accident, or
“No” if it was not.
A5. Location of Accident
The latitude and longitude of the accident are to be reported as Decimal Degrees with a
minimum of 5 decimal places (e.g. Lat: 38.89664 Long: -77.04327), using the WGS84
datums.

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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

If you have coordinates in degrees/minutes or degrees/minutes/seconds use the formula
below to convert to decimal degrees:
degrees + (minutes/60) + (seconds/3600) = decimal degrees
e.g. 38° 53' 47.904" = 38 + (53/60) + (47.904/3600) = 38.89664°
All locations in the United States will have a negative longitude coordinate, which has
already been included on the data entry form so that operators do not have to enter
the negative sign.
If you cannot locate the accident with a GPS or some other means, there are online tools
that may assist you at http://viewer.nationalmap.gov/viewer/.
A6. formerly A8. Commodity Released
Select only one primary description of the commodity and then, where applicable, the
secondary description of the commodity, based on the predominant volume released. Only
releases of transported commodities are reportable.
 Crude Oil
 Refined and/or Petroleum Product (non-HVL) which is a Liquid at
Ambient Conditions
Refined and/or Petroleum Product includes gasoline, diesel, jet fuel,
kerosene, fuel oils, or other refined or petroleum products which are a
liquid at ambient conditions. They are flammable, toxic, or corrosive
products obtained from distilling or processing of crude oil, unfinished
oils, natural gas liquids, blend stocks, and other miscellaneous
hydrocarbon compounds. For a non-HVL petrochemical feedstock, such
as propylene, report as “other” and specify the name of the commodity
(e.g., “propylene”) in the space provided.
 HVL or Other Flammable or Toxic Fluid which is a Gas at Ambient
Conditions
Highly Volatile Liquids (HVLs) are hazardous liquids or liquid mixtures
which will form a vapor cloud when released to the atmosphere and have
a vapor pressure exceeding (40 psia) 276 kPa at 37.8 C.
Other Flammable or Toxic Fluids are those defined under 49 CFR
173.120 Class 3—Definitions
Other flammable or toxic fluids which fall under this category include
gases at ambient conditions, such as anhydrous ammonia (NH3) and
propane. For a petrochemical feedstock, such as ethane or ethylene,
which is also classified as a highly volatile liquid, report as “Other HVL”
and specify the appropriate name (e.g., “ethane” or “ethylene”) in the
space provided.
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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

 CO2 (Carbon Dioxide)

 Biofuel/Alternate Fuel (including ethanol blends)
Fuel Grade Ethanol is denatured ethanol before it has been mixed with a
petroleum product or other hydrocarbon; sometimes also referred to as
neat ethanol.
Ethanol Blend is ethanol plus a petroleum product such as gasoline. Such
mixtures may be referred to as E10 or E85, for example, representing a
10% or 85% blend respectively. In the space provided, specify the
percentage of ethanol in the mixture. Blends greater than 95% ethanol
should be reported as Fuel Grade Ethanol.
Biodiesel is a diesel liquid distilled from biological feedstocks vs. crude
oil. Biodiesel is typically shipped as a blend mixed with a petroleum
product. Report the percentage biodiesel in the blend as shown. For pure
biodiesel, report 100.
General Information for Questions 7, 8, and 9:
Estimate volumes in barrels. Barrel means a unit of measurement equal to 42 U.S.
standard gallons. If less than 1 barrel, report to 1 decimal place using the conversion table
below. Small volumes, including but not limited to those which result in some form of
ignition, are to be reported as 0.1 barrels.
If estimated volume
is
<5
5-10
11-14
15-18
19-23

gallons
gallons
gallons
gallons
gallons

Report
0.1
0.2
0.3
0.4
0.5

barrels
barrels
barrels
barrels
barrels

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

gallons
gallons
gallons
gallons
gallons

Report
0.6
0.7
0.8
0.9
1.0

barrels
barrels
barrels
barrels
barrels

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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

A7. formerly A9. Estimated volume of commodity released unintentionally

Estimate the amount of commodity released from the pipeline system at the failure site. If
the product is consumed by fire inside a tank, do not include the volume consumed by fire
in the spill volume, but do include the cost of this commodity in D8. An estimate of the
volume released may be based on a variety and/or combination of inputs, including:
• calculations made by hydraulic engineers
• volume added to the pipeline segment to repack the line when the line is
placed back in service
• measured volume of free phase commodity recovered, with allowances for
commodity that is not recovered.
• volume calculated to be absorbed by soil or water
• volume calculated to have been lost to evaporation (e.g., for gasoline spills)
A8. formerly A10. Estimated volume of intentional and/or controlled
release/blowdown
This section is completed only for HVL and CO2 releases. Estimate the amount of
commodity that was released during any intentional release or controlled blowdown
conducted as part of responding to or recovering from the accident. Intentional and
controlled blowdown implies a level of control of the site and situation by the operator such
that the area and the public are protected during the controlled release.
A9. formerly A11. Estimated volume of commodity recovered
Recovered means the commodity is no longer in the environment. The commodity could
have been removed by: absorbent pads or similar mechanisms; transferring to temporary
storage such as a vacuum truck, a frac tank, or similar vessel; soil removal; bio-remediation;
or other similar means of removal or recovery. The volume recovered can be estimated
based on a variety or combination of the measurement of free phase commodity recovered,
the amount calculated to be absorbed by soil or water that was removed from the
environment, measurement of oil extracted from absorbent pads, etc.
A10. formerly A12. Were there fatalities?
If a person dies at the time of the accident or within 30 days of the initial accident date due
to injuries sustained as a result of the accident, report as a fatality. If a person dies
subsequent to an injury more than 30 days past the accident date, report as an injury. (Note:
This aligns with the Department of Transportation's general guidelines for all jurisdictional
transportation modes for reporting deaths and injuries.)
Select “Yes” or “No” and if “Yes” is selected, enter the category of person(s) and number
of fatalities resulting from the Accident.
Contractor employees working for the operator are individuals hired to work for or on
behalf of the operator of the pipeline. These individuals are not to be reported as “Operator
employees”.
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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

Non-Operator emergency responders are individuals responding to render professional
aid at the accident scene including on-duty and volunteer fire fighters, rescue workers,
EMTs, police officers, etc. “Good Samaritans” that stop to assist should be reported as
“General public.”
Workers Working on the Right of Way, but NOT Associated with this Operator means
people authorized to work in or near the right-of-way, but not hired by or working on
behalf of the operator of the pipeline. This includes all work conducted within the
right-of-way including work associated with other underground facilities sharing the
right-of-way, building/road construction in or across the right-of-way, or farming.
This category most often includes employees of other pipelines or underground
facilities operators, or their contractors, working in or near a shared right-of-way.
Workers performing work near, but not on, the right-of-way and who are affected
should be reported as “General public”.
A11. formerly A13. Were there injuries requiring inpatient hospitalization?
Injuries requiring inpatient hospitalization are injuries sustained as a result of the accident
which require both hospital admission and at least one overnight stay.
Select “Yes” or “No” and if “Yes” is selected, enter the category of person(s) injured, and
number of persons injured resulting from the Accident
See Question 12 for additional definitions that apply.
A12. formerly E8. What was the Operator’s initial indication of the Failure? (select
only one)
Select the option best describing how the operator first became aware of the failure
resulting in this accident report. When the selection in A12 is operator staff, indicate
whether the staff are employed by the operator or working as a contractor in A12a.
Controller per the definition in API RP 1168 means a qualified individual whose function
within a shift is to remotely monitor and/or control the operations of entire or multiple
sections of pipeline systems via a SCADA system from a pipeline control room, and who
has operational authority and accountability for the daily remote operational functions of
pipeline systems.
Local Operating Personnel including contractors means employees or contractors
working on behalf of the operator outside the control room.
A13. formerly A18a. Enter the date/time of the event reported in A12. The earliest
date/time than an accident reporting criteria was met is reported in item A4. In some cases,
the operator may become aware of a failure before an accident reporting criteria is met. In
other cases, one of more accident reporting criteria may be met before the operator becomes
aware of the failure.

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A14. formerly C2 Part of system involved in the Accident (select only one)
Select the best description of the part of the pipeline system that was involved in the
accident. Report pumps under the type of system powered. For example, tank booster
pumps are reported as “Onshore Terminal/Tank Farm Equipment and Piping.” For pumps
powering belowground storage, select “Onshore Equipment and Piping Associated with
Belowground Storage.”
A15. formerly B1. Was the origin of the accident onshore?
The answer to A14. will automatically populate this field with Yes or No.
A16. Operational Status at time Operator identified failure (select only one)
Select the best description of the operating status of the pipeline system at the date/time
reported in A4.
Post-Construction Commissioning means the introduction of product, testing and
commissioning of the pipeline prior to the start of commercial operations.
Post-Maintenance/Repair means purging and packing of the pipeline when returning it
to service from maintenance or repairs.
Routine Start-Up means the start-up of the pipeline, facility or system in normal
operations, or returning from maintenance or other idle status following a time of no flow,
but the where the pipeline remained liquid full, and the start-up was being conducted
under normal start-up procedures.
Routine Shutdown means the stoppage of equipment or the system from a normal
operation status.
Normal Operation, include pauses between batches and during maintenance means
the pipeline is operating normally, and any of the maintenance that is occurring does not
require product to be removed from the pipeline or system. Product sampling, inhibitor
injection, in-line inspection, installation of repairs, and other activities covered by the
operator’s Operation and Maintenance Procedures are examples of the maintenance
included in this category.
Idle means that the pipeline has been removed from service for commercial reasons or to
make repairs. The pipeline may contain product, an inert gas, or be empty. When residual
product accumulates in an excavation and ignites, Idle is the proper status.
A17. formerly A14. Sutdown
If A16. is Routine Start-Up or Normal Operation, was the pipeline/facility shut down
due to the Accident? Select Yes for any shutdowns that occur as a result of the
accident, including but not limited to those required for damage assessment, temporary
repair, permanent repair, and clean-up. Do not include equipment shutdowns that do
not affect the pipeline or system operation. For example, if a pump shutdown occurred
as part of the accident, but the pipeline was able to continue operating, select No. If No
is selected, explain the reason that no shutdown was needed in the space provided. A

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possible explanation for the example above would be “The pipeline continued to
operate through the station bypass piping and did not require a pipeline shutdown.”
If Yes is selected, complete questions 17a. and 17b.
17a. Local time (24hr clock) and date of shutdown
17b. Local time pipeline/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 accident was physically located. (See “Special Instructions”, numbers 9
and 10.) Enter the time and date the pipeline was isolated or equipment stopped in 17a.
The affected facilities may still contain commodity at this time. Enter the time and date of
restart in 17b. The intent with this data is to capture the total time that the pipeline or
facility is shutdown due to the accident. If the pipeline or facility has not been restarted at
the time of reporting, select “Still shut down” for Question 17b and then include the restart
time and date in a future Supplemental Report.
A18. Operator Communication with Local, State, or Federal Emergency
Responders
In an Advisory Bulletin dated October 11, 2012, PHMSA reminded Operators of the need
to communicate with Emergency Responders in the early stages of a potential Accident.
This is typically accomplished by contacting Public Safety Access Points (PSAPs) along
the pipeline route. The purpose of the communication is to assist in the identification,
location and planning for response to pipeline Accidents through coordination and
information sharing.
A18a. Select Yes if there was communication about the accident. If A12 is “Notification
from Emergency Responder”, A18a. will automatically populate with Yes.
If 18a. is no, skip 18b. and 18c.
A18b. Select the party initiating the communication. If A12. is “Notification from
Emergency Responder”, A18b. will automatically populate with “Local/State/Federal
Emergency Responder”.
A18c. Enter the local date and time of the initial communication. If A12. is “Notification
from Emergency Responder”, A18c. will automatically populate with the value in A13.
A19. formerly A18b. Enter the date/time operator responders, company or contract,
arrived on site. Chronologically, A19. must be concurrent with or later than A13. These
times are to be shown by 24-hour clock notation and reported in the time zone where the
accident occurred. (See “Special Instructions”, numbers 8 and 9.) PHMSA will use this
data to calculate accident response times.
A20. Enter local time and date of Confirmed Discovery as defined in 49 CFR §195.2
A21a. formerly A7. Local time (24-hr clock) and date of initial operator report to the
National Response Center
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Enter the time and date of the initial Immediate Notice of the accident to the NRC. The
time is to be shown by 24-hour clock notation in the time zone where the incident
occurred. All NRC Reports are time stamped for the eastern time zone. Be sure to
convert to local time if the accident did not occur in the eastern time zone. (See “Special
Instructions”, numbers 9 and 10.)
A21b. formerly A6. Initial Operator National Response Center (NRC) Report
Number
Accidents meeting the criteria outlined in §195.52 are to 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. Enter the number assigned to the operator’s initial
Immediate Notice (sometimes referred to as the “Telephonic Report”). If a NRC report was
not made, select the option that best describes why: NRC Notification Not Required or
NRC Notification Required But Not Made.
A21c. Additional NRC Report Numbers
If the operator made more than one call to the NRC, enter each additional NRC report
number.
A22. formerly A15. Did the Commodity Ignite?
If Yes, answer A22a. through A22d.
Ignite means the released commodity (including liquid vapors) caught fire (including
flash fires). If the answer is “Yes,” enter the time and date of the ignition in 22a. The
time is to be shown by 24-hour clock notation in the time zone where the accident
occurred. If the fire was extinguished, select “Operator/Contractor” or
“Local/State/Federal Emergency Responder,” to indicate who extinguished the fire, or
select “Allowed to Burn Out,” if it was not extinguished, in 22b.
Enter the estimated volume of commodity consumed by fire in thousand standard cubic
feet (mcf) in A22c.
If the accident resulted in an explosion, select Yes in A22d. formerly A16. Did the
Commodity Explode? Explode means ignition of the commodity, or its vapor, with a
sudden and violent release of energy.
A23. Flow Control formerly E5 Pipeline Glossary of terms, including valves are
available here
If A14. is “Onshore Pipeline, Including Valve Sites” OR “Offshore Pipeline, Including
Riser and Riser Bend”, answer A23a through f.
The initial response to pipeline emergencies is typically understood to be isolation of the
Accident location from the source of the commodity. However, sometimes there are
operational means other than valve closures to achieve this goal. These questions are
intended to understand the response actions and the time of valve closures intended to isolate
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the accident location. Valve data is for the first upstream or downstream valve selected by
the operator to minimize the release volume but may not be the closest to the accident site
or the one that was eventually used for the final isolation of the release site for repair.
Upstream of Failure - If an action other than valve closure was taken to isolate the accident
site from the upstream pipeline, select “Operational Control” for 23a. and provide a
description of the operation control employed.
If 23a. is “Valve Closure”, complete 23b. and 23c.
A23b. Enter the time of the valve closure that achieved isolation of the accident location
from upstream piping.
A23c. formerly E5a. Identify the type of valve used to initially isolate the release on the
upstream side.
Downstream of Failure - If an action other than valve closure was taken to isolate the
accident site from the downstream pipeline, select “Operational Control” for 23d. and
provide a description of the operation control employed.
If 23d. is “Valve Closure”, complete 23e. and 23f.
A23e. Enter the time of the valve closure that achieved isolation of the accident location
from downstream piping.
A23f. formerly E5b. Identify the type of valve used to initially isolate the release on the
downstream side.
A24. Oil Spill Response
If A6. is “Crude Oil”, “Refined and/or Petroleum Product (non-HVL) which is a Liquid at
Ambient Conditions”, or “Biofuel / Alternative Fuel (including ethanol blends)” AND
A15. is Onshore, answer questions A24a. and A24b.
A24a. Did the operator notify a “qualified individual” in the Onshore Oil Spill Response
Plan? Select Yes. Otherwise, select No. If Yes, suppy the Local time.
In accordance with §194.5 Qualified individual means an English-speaking representative
of an operator, located in the United States, available on a 24-hour basis, with full authority
to: activate and contract with required oil spill removal organization(s); activate personnel
and equipment maintained by the operator; act as liaison with the OSC; and obligate any
funds required to carry out all required or directed oil response activities.
A24b. Did the operator activate an Oil Spill Removal Organization (OSRO)?
If an Oil Spill Response Organization (OSRO) was activated in response to the accident,
select Yes. Otherwise, select No. If Yes, enter the time the OSRO was activated and the
time the OSRO arrived on site in A24c and A24d.
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A25. formerly 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).

PART B – ADDITIONAL LOCATION INFORMATION
B1. formerly B7. Pipeline/Facility Name
Multiple pipeline systems and/or facilities are often operated by a single operator. This
information identifies the particular pipeline system or pipeline facility name commonly
used by the operator on which the accident occurred, for example, the “West Line 24”
Pipeline”, or “Gulf Coast Pipeline”, or “Wooster Terminal”.
B2. formerly B8. Segment name/ID
Within a given pipeline system and/or facility, there are typically multiple segment or
station identifiers, names, or ID’s which are commonly used by the operator. The
information reported here helps locate and/or record the more precise accident location, for
example, “Segment 4-32”, or “MP 4.5 to Wayne County Line”, or “Dublin Pump Station”,
or “Witte Meter Station”. Preferably, report the segement name that is reported to
PHMSA’s National Pipeline Mapping System (NPMS).
If Onshore
B3. – B6. Accident Location
Provide the state, zip code, city, and county/parish in which the accident occurred. If the
accident did not occur within a municipality, select Not Within Municipality in the City
field.
B7. and B8. formerly B6. Operator-designated Location
This is intended to be the designation that the operator would use to identify the location of
the accident on its pipeline system. Enter the appropriate milepost, survey station number,
or site name. This designator is intended to allow PHMSA personnel to refer to the physical
location of the accident using the operator’s maps and records.
B9. Was this onshore Accident on Federal Land?
Federal Lands means all lands the United States owns, including military reservations,
except lands in National Parks and lands held in trust for Native Americans. Accidents at
Federal buildings, such as Federal Court Houses, Custom Houses, and other Federal office
buildings and warehouses, are NOT to be reported as being on Federal Lands.
B10. Location of Accident (select only one)
Operator-controlled Property would normally apply to an operator’s facility, which may
or may not have controlled access, but which is often fenced or otherwise marked with
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discernible boundaries. This “operator-controlled property” does not refer to the pipeline
right-of-way, which is a separate choice for this question.
B11. Area of Accident (as found)
This refers to the location on the pipeline at which commodity was released, resulting in the
accident. It does not refer to adjacent locations in which released commodity may have
accumulated or ignited.
Underground means pipe, components, or other facilities installed below the natural
ground level, road bed, or below the underwater natural bottom.
Under pavement includes under streets, sidewalks, paved roads, driveways, and parking
lots.
Exposed due to Excavation means that a normally buried pipeline had been exposed by
any party (operator, operator’s contractor, or third party) preparatory to or as a result of
excavation. The cause of the release, however, may or may not necessarily be related to
excavation damage. This category could include a corrosion leak not previously evidenced
by stained vegetation, but found during an ILI dig, or a release caused by a non-excavation
vehicle where contact happened to occur while the pipeline was exposed for a repair or
examination. Natural forces might also damage a pipeline that happened to be temporarily
exposed. In each case, the cause should be appropriately reported in PART G of this form.
Exposed due to loss of cover means that erosion, flooding, farming or some other action
has removed the cover that was previously over the pipeline, leaving it exposed. This loss
of cover may be previously known or unknown by the pipeline operator, but is to be reported
in this category if it is believed to have been exposed immediately prior to the Accident.
Loss of cover solely as a result of the Accident should not be reported under this
category. For example – if a pipeline was buried below ground immediately prior to a
failure, and the force of the failure unearthed the pipeline – it should still be reported as
“Under soil” in this report.
B11a. Report the depth of cover in inches that was over the pipeline at the time of the
Accident, which may have to be estimated in some cases.
Aboveground means pipe, components, or other facilities that are above the natural grade.
Typical aboveground facility piping includes any pipe or components installed
aboveground such as those at pump stations, storage facilities, valve sites, and breakout tank
farms.
Transition area means the junction of differing material or media between pipes,
components, or facilities such as those installed at a belowground-aboveground junction
(soil/air interface), another environmental interface, or in close contact to supporting
elements such as those at water crossings, pump stations, launchers and receivers, and break
out tank farms.
B12. Did Accident occur in a crossing?
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If Yes, select the type of crossing.

Use Bridge Crossing if the pipeline is suspended above a body of water or roadway,
railroad right-of-way, etc., either on a separately designed pipeline bridge or as a part of or
connected to a road, railroad, or passenger bridge.
Use Railroad Crossing or Road Crossing, as appropriate, if the pipeline is buried beneath
rail bed or road bed.
Use Water Crossing if the pipeline is in the water, beneath the water, in contact with the
natural ground of the lake bed, etc., or buried beneath the bed of a lake, reservoir, stream or
creek, whether the crossing happens to be flowing water at the time of the accident or not.
If Water Crossing is selected, answer the remaining questions about the crossing. The name
of the body of water should be provided if it is commonly known and understood among
the local population. The purpose of this information is to allow persons familiar with the
area in which the accident occurred to identify the location and understand it in its local
context. Research to identify names that are not commonly used is not necessary since such
names would not fulfill the intended purpose. If a body of water does not have a name that
is commonly used and understood in the local area, this field may be left blank. For
Approximate Water Depth (ft) of the lake, reservoir, etc., estimate the typical water depth
at the location of the accident, ignoring seasonal, weather-related, and other factors which
may affect the water depth from time to time. Pick the best description of the failure location
within the water crossing. If the water crossing is 100 ft or more from high water mark to
high water mark, indicate yes for the last question.
If Offshore
B13. Approximate water depth (ft.), at the point of the Accident
This is be the estimated depth from the surface of the water to the seabed at the point of the
accident regardless of whether the pipeline is below/on the bottom, underwater but
suspended above the bottom, or above the surface (e.g., on a platform).
B14. Origin of the Accident
Area and Tract/Block numbers are to be provided for either State or OCS waters, whichever
is applicable. For Nearest County/Parish the data collected is intended to allow persons
familiar with the area in which the accident occurred to identify the location and understand
it in its local context. Accordingly, it is not necessary to take measurements to determine
which county/parish is “nearest” in cases where the accident location is approximately
equidistant from two (or more). In such cases, the name of one of the nearby
counties/parishes is to be provided. For accidents on the Outer Continental Shelf (OCS)
identify the region where the accident occurred by selecting one of the four options listed.
B15. Area of the Accident
For all Offshore Accidents, specify the area of the Accident by selecting the best
description of the area.

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PART C – ADDITIONAL FACILITY INFORMATION

C1. Is the pipeline or facility [Interstate or Intrastate]?
As defined in section 195.2, Interstate pipeline means a pipeline or that part of a pipeline
that is used in transportation of hazardous liquids or carbon dioxide in interstate or foreign
commerce. A pipeline may be entirely within a single state and be interstate. As defined
in section 195.2, Intrastate pipeline means a pipeline or that part of a pipeline to which
Part 195 applies that is not an interstate pipeline. Operators may refer to Appendix A of
Part 195 for further guidance. The value reported here should match both the Annual
Report and NPMS submittal value.
C2. Reserved
C3. Item involved in Accident
Pipe (whether pipe body or pipe seam) means the pipe through which the commodity is
transported, not including auxiliary piping, tubing or instrumentation.
Nominal pipe size. It is the diameter in whole number inches (except for pipe less than 5”)
used to describe the pipe size; for example, 8-5/8” outside diameter pipe has a nominal pipe
size of 8 Decimals are unnecessary for this measure (except for pipe with an outside
diameter
less
than
5”).
For
more
details,
see
http://en.wikipedia.org/wiki/Nominal_Pipe_Size
Enter pipe wall thickness in inches. Wall thickness is typically less than an inch.
Accordingly, use three decimal places to report wall thickness: 0.312, 0.281, etc.
SMYS means specified minimum yield strength and is the yield strength prescribed by the
specification under which the material is purchased from the manufacturer. If the SMYS is
unknown, and the Operator has designated it as 24,000 for the purposes of MAOP
calculations, enter 24,000.
Pipe Specification is the specification to which the pipe was manufactured, such as API 5L
or ASTM A106.
Pipe seam means the longitudinal seam (longitudinal or spiral weld) created during
manufacture of the joint of pipe.
Pipe Seam Type Abbreviations
SAW means submerged arc weld
ERW means electric-resistance weld
DSAW means double submerged arc weld
If the frequency of the ERW pipe seam is unknown, and the pipe was manufactured after
1980, select Longitudinal ERW – High Frequency. Almost all ERW pipe manufactured
prior to 1960 is Low Frequency, and both High and Low Frequency ERW pipe was
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manufactured between 1960 and 1980. If the pipe seam type is ERW, and the manufacture
date is unknown, select “Longitudinal ERW – Unknown Frequency” for the seam type.
If a Girth Weld failure occurs, enter the pipe properties in 3b thru 3h. If a Girth Weld failure
occurs between two different pipe materials, enter the first set of pipe properties in 3b thru
3h and any different values in 3i through 3o.
If the accident occurred on an item not listed in this section, select “Other” and specify
the item that failed in the space provided. Make every effort to find an item category
and avoid the use of “Other” when reporting the Type of Item involved in the
accident.
C4. Year Item Involved Installed
Enter the year the item was installed or select Unknown. In C4a, enter the year the
item involved was manufactured or select Unknown.
C5. Material involved in Accident
Enter the material involved in the accident. If the material is other than Carbon Steel or
Plastic, select “Material other than Carbon Steel or Plastic” and specify the type of material
in the space provided.
C6. Type of Accident involved (select only one)
Mechanical puncture means a puncture of the pipeline, typically by a piece of equipment
such as would occur if the pipeline were pierced by directional drilling or a backhoe bucket
tooth. Not all excavation-related damage will be a “mechanical puncture.” (Precise
measurement of size – e.g., micrometer – is not needed. Approximate measurements can
be provided in inches and one decimal.)
Leak means a failure resulting in an unintentional release of the transported commodity
that is often small in size, usually resulting in a low flow release of low volume, although
large volume leaks can and do occur on occasion. A leak may be a hole or a crack, and
includes separation of materials, pullout and loose connections. Typically, a Leak can be
repaired, whereas a Rupture results in the complete failure of the pipeline.
Rupture means the pipeline facility has burst, split, or broken and the operation of the
pipeline facility is immediately impaired and no longer serviceable. The terms
“circumferential” and “longitudinal” refer to the general direction or orientation of the
rupture relative to the pipe’s axis. For example; a rupture of a girth weld would be
circumferential, whereas a split that followed the length of the pipe (whteher in the seam,
or not) would be longitudinal. (Precise measurement of size – e.g., micrometer – is not
needed. Approximate measurements can be provided in inches and one decimal.)

PART D – ADDITIONAL CONSEQUENCE INFORMATION

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High Consequence Area is defined in §195.450.
D1. If wildlife was impacted, select Yes and indicate the type in D1a. Otherwise, select
No.
D2. If the spill contaminated soil, select Yes. Otherwise, select No.
D3. If a long-term impact assessment is planned or perfomed, select Yes. Otherwise,
select No.
D4. If remediation is anticipated, select Yes and select all of the types of remediation
anticipated in D4.a. Otherwise, select No.
D5. If water was contaminated, select Yes and answer D5.a through D5.c. Otherwise,
select No. Surface water can be intermittent, especially in arid portions of the country. If
a surface waterbody were dry and spilled product entered the surface body, the operator
should report no water contamination. Rain water caught in a berm is not a surface
waterbody.
D5a. Select all of the types of water contaminated. If “Drinking water” is selected,
indicate the subtype(s) contaminated.
D5b. Estimated amount released in or reaching water
An estimate of the volume released in or reaching water may be based on a variety and/or
combination of inputs, including those mentioned above for PART A, Questions 7 and 8.
D5c. Name of body of water, if commonly known:
The name of the body of water should be provided if it is commonly known and understood
among the local population. The purpose of this information is to allow persons familiar
with the area in which the accident occurred to identify the location and understand it in its
local context. Research to identify names that are not commonly used is not necessary since
such names would not fulfill the intended purpose. If a body of water does not have a name
that is commonly used and understood in the local area, this field should be left blank.
D6. At the location of this Accident, had the pipeline segment or facility been identified
as one that “could affect” a High Consequence Area (HCA) as determined in the
Operator’s Integrity Management Program?
This question should be answered based on the classification of the involved segment in the
operator’s integrity management (IM) program at the time of the accident, whether or not
consequences to an HCA ensued. It is possible that a release on a pipeline segment that
“could affect” an HCA might not actually affect an HCA. It is also possible that releases
from segments thought not able to affect an HCA might have such an affect. This could
indicate a deficiency in the operator’s IM program for identifying segments that can affect
HCAs, and all of this information is useful for PHMSA’s overall evaluations concerning the
efficacy of IM regulation.

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D7. Did the released commodity reach or occur in one or more High Consequence
Area (HCA)?
Generally, a spilled commodity will have “reached” an HCA if the spill zone intersects the
boundaries of the HCA polygon as mapped by the National Pipeline Mapping System. The
HCA maps should be available as a part of each operator’s Integrity Management Program
as per §195.452.
Guidance from the Pipeline Performance Tracking System (PPTS) is available at
http://www.api.org/oil-and-natural-gas-overview/transporting-oil-and-naturalgas/pipeline-performance-ppts/ppts-related-files.aspx, specifically PPTS Advisory 2004-1.
7a. HCA Type (select all that apply)
Refer to the definitions in §195.450 listed at the start of Part D. Leave this question
blank if the released commodity did not reach or occur in a High Consequence Area.
D8. Estimated Property Damage
All relevant costs available at the time of submission must be included on the initial written
Accident 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, commodity lost, facility repair and replacement, and environmental
cleanup and damage. Do NOT include costs incurred for facility repair, replacement, or
change that are NOT related to the accident and which are typically done solely for
convenience. An example of doing work solely for convenience is working on non-leaking
facilities unearthed because of the accident. Litigation and other legal expenses related to
the accident 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 (30 days, per §195.54). The best available estimate of these
costs should be included in the initial report. For convenience, this estimate can be revised,
if needed, when Supplemental Reports are filed for other reasons, however, when no other
changes are forthcoming, Supplemental Reports 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 environmental 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 accident.
Cost of commodity lost includes the cost of the commodity not recovered and/or the cost
of recovered commodity downgraded to a lower value or re-processed, and is to be based
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on the volume reported in PART A, Questions 7 and 9. The volume of commodity
consumed by fire inside a tank is not included in A7, but the cost of the commodity should
be included in this section.
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 damaged pipe, coating, component, materials, or equipment due to the accident,
excluding litigation and other legal expenses related to the accident.
When estimating the Cost of repairs to company facilities, the standard shall be the cost
necessary to safely restore pipeline facilities to the pre-accident level of service. Cost of
repairs include the cost to access, excavate, and repair the pipeline using methods, materials,
and labor necessary to re-establish operations. These costs may include the cost of repair
sleeves or clamps, re-routing of piping, or the removal from service of an appurtenance,
tank, or pipeline component. When more comprehensive repairs or improvements are
justified but not required for continued operation, the cost of such repairs or replacement is
not attributable to the accident. Costs associated with improvements to the pipeline or other
facilities to mitigate the risk of future failures are not included.
Estimated costs of emergency response include emergency response operations necessary
to return the accident site to a safe state, actions to minimize the volume of commodity
released, conduct reconnaissance, identify the extent of accident impacts, and contain,
control, mitigate, recover, and remove the commodity from the environment, to the
maximum extent practicable. They include materials, supplies, labor, and benefits. Costs
related to stakeholder outreach, media response, etc. are not to be included. The estimated
costs of long-term remediation activities should be included in Environmental Remediation
estimates.
Environmental remediation includes the estimated cost to remediate a site such as those
associated with engineering, scientists, laboratory costs, and the installation, operation, and
maintenance of long-term recovery systems, etc.
Other costs are to include any and all costs which are not included above. 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.
Injured persons not included in A11. The number of persons injured, admitted to a
hospital, and remaining in the hospital for at least one overnight are reported in A11. If a
person is included in A11, do not include them in D9.
D9. Estimated number of persons with injuries requiring treatment in a medical facility but
not requiring overnight in-patient hospitalization.
If a person is included in D9, do not include them in D10.
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D10. Estimated number of persons with injuries requiring treatment by EMTs at the site of
accident.
Buildings Affected
required repair.

The term ‘affected’ means the building was either evacuated or

D11. Enter the number of residential buildings affected.
D12. Enter the number of commercial and industrial buildings affected.

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PART E – ADDITIONAL OPERATING INFORMATION

E1. Estimated Pressure
Enter the operating pressure, in psig, at the location and time of the accident.
E2. Maximum Operating Pressure (MOP)
Enter the MOP, in psig, at the point and time of the accident. E2a. Select the response from
§195.406(a) that describes the limiting factor for establishing the MOP at the accident site.
E2b. Enter the date MOP was established.
E2c. If the MOP was established in conjunction with a flow direction reversal, select Yes.
If the system is designed for bi-directional flow, select Bi-Directional.. Otherwise, select
No.
If E2c is Yes, enter the year of the most recent surge analysis in E2d.
E3. Pressure Description
The online reporting software will select the appropriate value for E3 based upon the
responses to E1 and E2.
E4. Was the system or facility relating to the Accident operating under an established
pressure restriction with pressure limits below those normally allowed by the MOP?
Consider both voluntary and mandated pressure restrictions. A pressure restriction is to be
considered mandated by PHMSA or a state regulator if it was required by an Order,
enforcement action, or other formal correspondence from PHMSA.
An “established pressure restriction” is defined as a temporary reduction in the MOP that
also requires a revision to the setpoints in the operator’s safety devices, processes or controls
to ensure the pressure restriction is not exceeded.
Pressure reductions taken by the operator as a result of a procedural or regulatory
requirement, e.g., pipeline repairs, movement, investigations, or a pressure reduction taken
because an anomaly identified during an IM assessment could not be repaired within the
required schedule (§195.452(h)(3)), are not considered “mandated by PHMSA.”
E5. Length of segment isolated between valves (ft)
If A23.a and A23.d are both “Valve Closure”, enter the length in feet between the valves.
E6. and E7. Respond to the questions about internal inspection tools.

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E8. formerly E5.f. Function of pipeline system

Gathering means a crude oil pipeline 8-5/8 inches or less nominal outside diameter that
transports petroleum from a production facility.
Transmission means all other pipeline assets not meeting the gathering definition.
% SMYS means at the maximum operating pressure, the hoop stress created as a percentage
of the specified minimum yield strength (SMYS) of the pipe.
E9. formerly E6. Was a Supervisory Control and Data Acquisition (SCADA)-based
system in place on the pipeline or facility involved in the Accident?
This does not mean a system designed or used exclusively for leak detection.
E9a. Was it operating at the time of the Accident?
Was the SCADA system in operation at the time of the accident?
E9b. Was it fully functional at the time of the Accident?
Was the SCADA system capable of performing all of its functions, whether or not
it was actually in operation at the time of the accident? If No, describe functions
that were not operational in PART H – Narrative Description of the Accident.
E9c and d. Did SCADA-based information (such as alarm(s), alert(s), event(s),
and/or volume calculations) assist with the initial indication (or confirmed
discovery) of the Accident?
Select Yes if SCADA-based information was used for confirmed discovery of the
accident even if the initial indication may have come from other sources. Use of
SCADA data for subsequent estimation of amount of commodity lost, etc. is not
considered use to confirm the accident.
Select No if SCADA-based information was not used to assist with identification of
the accident.
E10. formerly E7. Was a CPM leak detection system in place on the pipeline or facility
involved in the Accident?
This means a system designed and used exclusively for leak detection.
Follow instructions for E9. above.
E11. formerly E9. Was an investigation initiated into whether or not the controller(s)
or control room issues were the cause of or a contributing factor to the Accident?

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Select only one of the choices to indicate whether an investigation was/is being conducted
(Yes) or was not conducted (No). If an investigation has been completed, select all the
factors that apply in describing the results of the investigation.
Cause means an action or lack of action that directly led to or resulted in the pipeline
accident.
Contributing factor means an action or lack of action that when added to the existing
pipeline circumstances heightened the likelihood of the release or added to the impact of the
release.
Controller Error means that the controller failed to identify a circumstance indicative of a
release event, such as an abnormal operating condition, alarm, pressure drop, change in flow
rate, or other similar event.
Incorrect Controller action means that the controller errantly operated the means for
controlling an event. Examples include opening or closing the wrong valve, or hitting the
wrong switch or button.

PART F – DRUG & ALCOHOL TESTING INFORMATION
Requirements for post-accident drug and alcohol tests are in 49 CFR §199.105 and §199.225
respectively. If the accident circumstances were such that tests were not required by 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 number of contractors working
for the operator who were tested and the number of each that failed such tests.

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PART G – APPARENT CAUSE

PART G – Apparent Cause
Select the one, single sub-cause listed under sections G1 thru G8 that best describes
the apparent cause of the Accident. 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 enter any secondary,
contributing, or root causes of the Accident in Part K – Contributing Factors. Make
every effort to find a category that fits the Accident’s Apparent Cause and avoid the
use of Other and Unknown when possible. Use of Unknown as an Apparent Cause
will require the submittal of a Supplemental Report to revise the Apparent Cause
when it becomes known.
G1 – Corrosion Failure
Corrosion includes a release or failure caused by galvanic, atmospheric, stray current,
microbiological, selective seam, or other corrosive action. A corrosion release or failure is
not limited to a hole in the pipe or other piece of equipment. If the bonnet or packing gland
on a valve or flange on piping deteriorates or becomes loose and leaks due to corrosion and
failure of bolts, it is to be classified as Corrosion. (Note: If the bonnet, packing, or other
gasket has deteriorated to failure, whether before or after the end of its expected life, but not
due to corrosive action, it is to be classified under G6 - Equipment Failure.)
External Corrosion
2. Type of corrosion – NOTE: Stress Corrosion Cracking (SCC) is no longer an option for
the type of corrosion. SCC failures are to be reported under cause G5, with a sub-cause of
Environmental Cracking-related.
If Stray Current corrosion is selected, specify whether alternating or direct current was
involved and describe the source of the stray current.
4a. Under cathodic protection means cathodic protection in accordance with §195.563 or
§195.573(b). Recognizing that older pipelines may have had cathodic protection added over
a number of years, provide an estimate if the exact year cathodic protection started is
unknown.
Internal Corrosion
9. Location of corrosion
A low point in pipe includes portions of the pipe contour in which water might settle out.
This includes, but is not limited to, the low point of vertical bends at a crossing of a foreign
line or road/railroad, etc., an elbow, a drop out or low point drain.
10. Was the commodity treated with corrosion inhibitors or biocides?
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Select Yes if corrosion inhibitors or biocides were included in the commodities transported.
12. Were cleaning/dewatering pigs (or other operations) routinely utilized?
13. Were corrosion coupons routinely utilized?
For purposes of these Questions 12 and 13, “routinely” refers to an action that is performed
on more than a sporadic or one-time basis as part of a regular program with the intent to
ensure that water build-up and/or settling and internal corrosion do not occur.
G2 – Natural Force Damage
Natural Force Damage includes an accident 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 accidents caused by land
shifts such as earthquakes, subsidence, or landslides, 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 a result of heavy rains or
floods.
Lightning includes both damage and/or fire caused by a direct lighting strike and damage
and/or fire as a secondary effect from a lightning strike in the area. An example of such a
secondary effect would be a forest fire started by lightning that results in damage to a
pipeline system asset which results in an accident.
Temperature includes weather-related temperature and thermal stress effects, either heat
or cold, where temperature was the initiating cause.
Thermal stress refers to mechanical stress induced in a pipe or
component when some or all of its parts are not free to expand or contract
in response to changes in temperature.
Frozen components would include accidents where components are
inoperable because of freezing and those due to cracking of a piece of
equipment due to expansion of water during a freeze cycle.
High Winds includes damage caused by wind-induced forces. Select this category if the
damage is due to the force of the wind itself. Damage caused by impact from objects blown
by wind would be reported under G4 - Other Outside Force Damage.
Tree/Vegetation Root includes damages caused by tree and vegetation roots.
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Snow/Ice impact or Accumulation should be indicated when snow and/or ice caused
damage to the hazardous liquid pipeline asset which results in an accident.
Other Natural Force Damage. Select this sub-cause for types of Natural Force Damage
not included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
Answer Questions 6 and 6a if the accident 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.

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G3 – Excavation Damage

Excavation Damage includes a release or failure resulting directly from excavation damage
by operator's personnel (oftentimes referred to as “first party” excavation damage) or by the
operator’s contractor (oftentimes referred to as “second party” excavation damage) or by
people or contractors not associated with the operator (oftentimes referred to as “third party”
excavation damage). Also, this section includes a release or failure determined to have
resulted from previous damage due to excavation activity. For damage from outside forces
OTHER than excavation which results in a release, use G2 - Natural Force Damage or G4 Other Outside Force, as appropriate. Also, for a strike, physical contact, or other damage
to a pipeline or facility that apparently was NOT related to excavation and that results in a
delayed or eventual release, report the accident under G4 as “Previous Mechanical Damage
NOT related to Excavation.”
Excavation Damage by Operator (First Party) refers to accidents caused as a result of
excavation by a direct employee of the operator.
Excavation Damage by Operator’s Contractor (Second Party) refers to accidents 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 accidents 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 accidents 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.
If Excavation Damage by Third Party is selected, answer question 1
1. and 1a. Prior Notification Indicate whether you received prior notification of the
excavation activity. If yes, indicate all of the notification sources.
1b. through 1e. One-Call State Law Exemptions Per the primary Accident Investigator
results, indicate whether State law exempted the excavator from notifying a one-call center.
If yes, select the type of exemption from the list. If “Other” is selected, enter text describing
the exemption. Describe the exempting authority and exempting criteria.
2. – 14. Complete these questions for any excavation damage sub-cause. Instructions for
answering these questions can be found at CGA’s web site, https://www.cgadirt.com/dr/html/userGuide.html
NOTE: If you have or will be reporting the information in questions 2 thru 14 to CGADIRT, select “No” in question 2 to avoid duplication of data submitted to CGA.
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G4 – Other Outside Force Damage
Other Outside Force Damage includes, but is not limited to, a release or failure resulting
from non-excavation-related outside forces, such as nearby industrial, man-made, or other
fire or explosion; damage by vehicles or other equipment; failures due to mechanical
damage; and, intentional damage including vandalism and terrorism.
Nearby Industrial, Man-made or other Fire/Explosion as Primary Cause of Accident
applies to situations where the fire occurred before - and caused - the release. Examples of
such an accident would be an explosion or fire at a neighboring facility or installation
(chemical plant, tank farm, other industrial facility) or structure, debris, or brush/trees that
results in a release at the operator’s pipeline or facility. This includes forest, brush, or
ground fires that are caused by human activity. If the fire, however, is known to have been
started as a result of a lightning strike, the accident’s cause is to be classified under G2 Natural Force Damage. Arson events directed at harming the pipeline or the operator should
be reported as G4 - Intentional Damage (see below).
Damage by Car, Truck, or Other Motorized Vehicle/Equipment NOT Engaged in
Excavation. An example of this sub-cause would be a stopple tee that releases commodity
when damaged by a pickup truck maneuvering near the pipeline. Other motorized vehicles
or equipment include tractors, backhoes, bulldozers and other tracked vehicles, and heavy
equipment that can move. Include under this sub-cause accidents caused by vehicles
operated by the pipeline operator, the pipeline operator’s contractor, or a third party, and
specify the vehicle/equipment operator’s affiliation from one of these three groups. Pipeline
accidents resulting from vehicular traffic loading or other contact should also be reported in
this category. If the activity that caused the release involved digging, drilling, boring,
grading, cultivation or similar activities, report under G3 - Excavation Damage.
Damage by Boats, Barges, Drilling Rigs, or Other Maritime Equipment or Vessels Set
Adrift or Which Have Otherwise Lost Their Mooring. This sub-cause includes impacts
by maritime equipment or vessels (including their anchors or anchor chains or other attached
equipment) that have lost their moorings and are carried into the pipeline facility by the
current. This sub-cause also includes maritime equipment or vessels set adrift as a result of
severe weather events and carried into the pipeline facility by waves, currents, or high
winds. In such cases, also indicate the type of severe weather event. Do NOT report in this
sub-cause accidents which are caused by the impact of maritime equipment or vessels while
they are engaged in their normal or routine activities; such accidents are to be reported as
“Routine or Normal Fishing or Other Maritime Activity NOT Engaged in Excavation”
under this section G4 (see below) so long as those activities are not excavation activities. If
those activities are excavation activities such as dredging or bank stabilization or renewal,
the accident is to be reported under G3 - Excavation Damage.
Routine or Normal Fishing or Other Maritime Activity NOT Engaged in Excavation.
This sub-cause includes accidents due to shrimping, purse seining, oil drilling, or oilfield
workover rigs, including anchor strikes, and other routine or normal maritime-related
activities UNLESS the movement of the maritime asset was due to a severe weather event
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(this type of accident should be reported under “Damage by Boats, Barges, Drilling Rigs,
or Other Maritime Equipment or Vessels Set Adrift or Which Have Otherwise Lost Their
Mooring” in this section G4); or the accident was caused by excavation activity such as
dredging of waterways or bodies of water (this type of accident is to be reported under G3
- Excavation Damage).
Electrical Arcing from Other Equipment or Facility such as a pole transformer or
adjacent facility’s electrical equipment.
Previous Mechanical Damage NOT Related to Excavation. This sub-cause covers
accidents 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. Accidents resulting from previous damage sustained during construction,
installation, or fabrication of the pipe or weld from which the release eventually occurred
are to be reported under G5 - Material Failure of Pipe or Weld. (See this sub-cause for
typical indications of previous construction, installation, or fabrication damage.) Accidents
resulting from previous damage sustained as a result of excavation activities should be
reported under G3 – Previous Damage due to Excavation Activity. (See this sub-cause for
typical indications of prior excavation activity.)
Intentional Damage
Vandalism means willful or malicious destruction of the operator’s pipeline
facility or equipment. This category would include arson, pranks, systematic
damage inflicted to harass the operator, motor vehicle damage that was inflicted
intentionally, and a variety of other intentional acts.
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
commodity or pipeline equipment.
Other Describe in the space provided and, if necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
Other Outside Force Damage. Select this sub-cause for types of Other Outside Force
Damage not included otherwise, and describe in the space provided. If necessary, provide
additional explanation in PART H – Narrative Description of the Accident.
5 – 11 Additional Data for Damage by Car, Truck, or Other Motorized
Vehicle/Equipment NOT Engaged in Excavation

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When answering the questions, include information that can be substantiated from police
reports or other investigative reports.
The following definitions apply for reporting the type of motorized vehicle in Question 10:
Motorcycle/All-Terrain Vehicle (ATV) - All two or three-wheeled motorized vehicles,
and some four-wheeled vehicles are to be reported in this category. Typical vehicles in
this category have saddle type seats and are steered by handlebars rather than steering
wheels. This category includes motorcycles, motor scooters, mopeds, motor-powered
bicycles, and three-wheel motorcycles. Additionally, four-wheeled off-road and all-terrain
vehicles (sometimes referred to as “four-wheelers”) are to be reported under this category.
Passenger Car -- All sedans, coupes, and station wagons manufactured primarily for the
purpose of carrying passengers and including those passenger cars pulling recreational or
other light trailers.
Small Truck - All two-axle, four-tire, vehicles, other than passenger cars. Included in this
classification are pickups, panels, vans, and other vehicles such as campers, motor homes,
ambulances, hearses, carryalls, and minibuses.
Bus - All vehicles manufactured as traditional passenger-carrying buses with two axles
and six tires or three or more axles. This category includes only traditional buses
(including school buses) functioning as passenger-carrying vehicles. Modified buses
should be considered to be a truck and should be appropriately classified.
Large Truck - All vehicles on a single frame including trucks, camping and recreational
vehicles, motor homes, etc., with two or more axles and at least two rear wheels on each
side
When specifying the type of protection in Question 13; select the category “Barricades” for
Jersey barriers, fencing, and other structures that are other than Guard Rails or
Bollards/Guard Posts. If “Other” is selected, enter text describing the protection.
G5 – Material Failure of Pipe or Weld
Use this section to report material failures only if “Item Involved in accident” (PART C,
Question 3) is “Pipe” (whether “Pipe Body” or “Pipe Seam”) or “Weld.” Indicate how
the sub-cause was determined or if the sub-cause is still being investigated.
This section includes releases in or failures from defects or anomalies within the material
of the pipe body or within the pipe seam or other weld due to manufacturing processes,
material imperfections, defects resulting from poor construction, installation, or fabrication
practices, and in-service stresses such as vibration, fatigue, and environmental cracking.
Design-, Construction-, Installation-, or Fabrication-related includes a release or failure
caused by improper design practices, a dent, gouge, excessive stress, or some other defect
or anomaly introduced during the process of constructing, installing, or fabricating pipe and
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pipe welds in the field, including welding or other activities performed at the construction
job site. Included are releases from or failures of wrinkle bends, field welds, and damage
sustained in transportation to the construction or fabrication site. Not included are failures
due to seam defects, which are to be reported as Original Manufacturing-related (see below).
If a river crossing were directionally drilled and tied into a buried pipeline without adequate
accommodation for expansion and contraction of the pipe in the drill hole and the pipeline
facility fails at the tie-in, this represents an improper design practice. Select “Design-,
Construction-, Installation-, or Fabrication-related” as the sub-cause.
Original Manufacturing-related (NOT girth weld or other welds formed in the field)
includes a release or failure caused by a defect or anomaly introduced during the process of
manufacturing pipe, including manufacturing and handling of the plate materials, seam
defects and defects in the pipe body. This option is not appropriate for wrinkle bends, field
welds, girth welds, or other joints fabricated in the field. Use this option for failures such as
those due to defects of the longitudinal weld or inclusions in the pipe body. If the girth
welds were completed at the pipe mill (such as in the case of double joints welded prior to
delivery to the jobsite) report those failures in this category.
Environmental Cracking-related includes failures by Stress Corrosion Cracking, Sulfide
Stress Cracking, Hydrogen Stress Cracking, Hard Spots or other environmental cracking
mechanism.
If Design-, Construction, Installation, Fabrication-related or Original Manufacturingrelated is selected, then select any contributing factors. Examples of Mechanical Stress
include failures related to overburden or loss of support.
G6 – Equipment Failure
This section applies to failures of items other than “Pipe” (“Pipe Body” or “Pipe
Seam”) or “Weld”.
Equipment Failure includes a release or failure resulting from: malfunction of
control/relief equipment including valves, regulators, or other instrumentation; failures of
compressors, or compressor-related equipment; failures of various types of connectors,
connections, and appurtenances; failures of the body of equipment, vessel plate, or other
material (including those caused by construction-, installation-, or fabrication-related and
original manufacturing-related defects or anomalies); and, all other equipment-related
failures.
Malfunction of Control/Relief Equipment. Examples of this type of accident cause
include: overpressurization resulting from malfunction of a control or alarm device; relief
valve malfunction; valves failing to open or close on command; or valves which opened or
closed when not commanded to do so. If overpressurization or some other aspect of this
accident was caused by incorrect operation involving human error, the accident should be
reported under G7 - Incorrect Operation.
ESD System Failure means failure of an emergency shutdown system.
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Other Equipment Failure. Select this sub-cause for types of Equipment Failure not
included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
G7 – Incorrect Operation
Incorrect Operation includes a release or failure resulting from operating, maintenance,
repair, or other errors by facility personnel or pipeline controllers, including, but not limited
to improper valve selection or operation, inadvertent overpressurization, or improper
selection or installation of equipment in the field. If the failure occurs in the pipe body or
weld, and is a result of inadequate design or a design error, the accident is to be reported
under G5 – Material Failure of Pipe or Weld, Design-, Construction-, Installation-, or
Fabrication-related.
Other Incorrect Operation. Select this sub-cause for types of Incorrect Operation not
included otherwise, and describe in the space provided. If necessary, provide additional
explanation in PART H – Narrative Description of the Accident.
G8 – Other Accident Cause
This section is provided for accidents whose cause is currently unknown, or where
investigation into the cause has been exhausted and the final judgment as to the cause
remains unknown, or where a cause has been determined which does not fit into any of the
main cause categories listed in sections G1 thru G7. PHMSA will review all G-8 cause
selections and determine if it meets the definition of any category listed in G1 thru G7 before
a Final Report is accepted for closure. All sub cause categories of “Unknown” require a
Supplemental Report to be filed before being accepted as Final.
If the accident cause is known but doesn’t fit into any category in sections G1 thru G7, select
Miscellaneous and enter a description of the accident cause, continuing with a more
thorough explanation in PART H - Narrative Description of the Accident.
If the accident 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 accident 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 accident. This Supplemental Report is to include all new,
updated, and/or corrected information pertaining to all portions of the report form known at
this time, and not only that information related to the apparent cause.
Important Note: Whether the investigation is completed or not, or if the cause continues
to be unknown, Supplemental Reports are to be filed reflecting new, updated, and/or
corrected information as and when this information becomes available. In those cases in
which investigations are ongoing for an extended period of time, operators are to file a
Supplemental Report within one year of their last report for the accident even in those
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Instructions (rev 12-2020) for Form PHMSA F 7000-1 (rev 12-2020)
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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 Accident. 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 J – COMPLETED INTEGRITY INSPECTIONS
Complete the following if the “Item Involved in Accident” (from PART C, Question 3)
is Pipe or Weld and the “Cause” (from Part G) is:
Corrosion (any subCause in Part G1); or
Previous Damage due to Excavation Activity (subCause in Part G3); or
Previous Mechanical Damage NOT Related to Excavation (subCause in Part
G4); or
Material Failure of Pipe or Weld (any subCause in Part G5)
J1. Internal Inspection Tools
If Yes, for each tool and technolgy used, select type of internal inspection tool and
technology and indicate year of most recent and previous runs.
Axial Magnetic Flux Leakage (MFL) is an in-line inspection (ILI) tool that uses a nondestructive testing (NDT) method of imposing a magnetic flux in the steel pipe for the
detection of corrosion and pitting. The basic principle behind MFL ILI involves
magnetizing the steel pipe to a saturation level with a magnetic field. MFL ILI tools can be
either low- and high-resolution tools, with more modern tools being high-resolution MFL
ILI tools.
Circumferential/Transverse Wave Magnetic Flux Leakage (MFL) is an in-line
inspection (ILI) tool that induces the magnetic flux field into the steel pipe in the
circumferential direction, which allows the measurement of longitudinally oriented
anomalies such as tunnel corrosion and longitudinal weld anomalies.
Ultrasonic is an in-line inspection (ILI) tool that introduces a shear wave ultrasound beam
into the steel pipeline inspection area at an angle, which allows detection of abnormalities
based on the reflection and refraction of the beam. Can be used to detect and size planar
(crack and crack-like) anomalies or measure wall thickness and detect instances of wall loss.
Geometry/Deformation is an in-line inspection (ILI) tool designed to record mechanical
or geometric conditions such as changes in the pipe internal diameter, including dents,
ovalities, wrinkles, expansions, and misalignments.
Electromagnetic Acoustic Transducer (EMAT) is an in-line inspection (ILI) tool that
generates an ultrasonic pulse within the steel pipe without a liquid couplant. EMAT ILI
consists of a magnet and an electrical coil, which uses electro-magnetic forces to introduce
sound energy into the steel pipe. EMAT ILI is used to detect cracking flaws in steel pipe.

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ACCIDENT REPORT – HAZARDOUS LIQUID AND CARBON DIOXIDE PIPELINE
SYSTEMS

Cathodic Protection Current Measurement (CPCM) is an in-line inspection (ILI) tool
capable of reading and recording the magnitude and polarity of current supplied by cathodic
protection (CP). CPCM ILI measures direct current (DC) and alternating current (AC)
voltage gradients from CP current or induced AC as the CPCM ILI tool traverses along the
pipeline.
Complete J1b. only when the “Cause” (from Part G) is:
Previous Damage due to Excavation Activity (subCause in Part G3); or
Previous Mechanical Damage NOT Related to Excavation (subCause in Part
G4)
J1b. Indicate if you have reason to believe the internal inspections were completed before
the damage was sustained.
J2. Hydrotest
Has one or more hydrotest or other pressure test been conducted since original
construction at the point of the Accident?
Information from the initial post-construction hydrostatic test is NOT reported in J2.
J3. Direct Assessment
Has Direct Assessment been conducted on this segment?
This refers to direct assessment as defined in §195.553. Instances in which one or more
indirect monitoring tools (e.g., close interval survey, DCVG) have been used that might be
used as part of direct assessment but which were not used as part of the direct assessment
process defined in §195.553 do NOT constitute a Direct Assessment for purposes of this
question.
If J3 is yes, enter the year of the most recent assessment(s) in J3a.
J4. Non-destructive Examination
Indicate if one or more non-destructive examination been conducted prior to the Accident
at the point of the Accident since January 1, 2002. If Yes, enter the most recent year of the
examination(s) in J4a.

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

PART H – NARRATIVE DESCRIPTION OF THE ACCIDENT
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Concisely describe the accident, including the facts, circumstances, and conditions that may
have contributed directly or indirectly to causing the accident. Include secondary,
contributing, or root causes when possible, or any other factors associated with the cause
that are deemed pertinent. Use this section to clarify or explain unusual conditions and to
explain any estimated data.
If you selected Miscellaneous in section G8, the narrative is to describe the accident in
detail, including all known or suspected causes and possible contributing factors.

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

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File Type	application/pdf
Author	PHMSA
File Modified	2020-12-18
File Created	2020-12-18