PHMSA Pipeline Damage Notification

Operator notification form for excavation damage to a gas or hazardous-liquid pipeline, structured to capture the details needed for PHMSA reporting timelines under 49 CFR Part 191.

Incident Overview

• Date of Damage
  Select the date the pipeline was damaged or first discovered to be damaged.
• Time of Damage or Discovery
  Enter the approximate time the damage occurred or was discovered.
• Type of Damage
  Choose the best match for the observed damage.
• Affected Asset Type
  Identify the type of pipeline involved.
• Discovered By
  Select who identified the damage first.
• Brief Incident Summary
  Provide a concise summary of what happened, including the excavation activity and visible damage.

Location and Asset Details

• State
  Enter the U.S. state where the damage occurred.
• County
  Enter the county or parish, if known.
• Nearest City or Community
  Enter the nearest city, town, or community.
• Location Description
  Describe the location using milepost, address, cross street, GPS, landmark, or other operational reference.
• Pipeline Operator
  Enter the operator name for the affected pipeline.
• Asset or Line Identifier
  Enter the line name, segment ID, station name, or other internal asset identifier if available.

Damage Impact and Immediate Actions

• Did anyone sustain an injury?
  Select whether the event caused any injury.
• Was there a product release?
  Select whether gas or hazardous liquid was released.
• Did the damage interrupt service?
  Select whether pipeline service was interrupted or pressure was reduced.
• Immediate Actions Taken
  Select all actions taken immediately after the damage was identified.
• Injury Details
  Describe the injury, including the number of people affected and whether medical attention was provided. Do not include unnecessary PII.
• Release Details
  Describe the product released, estimated quantity, and whether the release was contained.
• Service Interruption Details
  Describe the duration, affected customers or area, and any operational restrictions.

Excavation and Contractor Information

• Excavator or Contractor Name
  Enter the company name of the excavator or contractor, if known.
• Excavation Activity Type
  Select the type of excavation or ground-disturbing activity involved.
• One-Call Ticket Number
  Enter the locate ticket number, if available.
• Was a locate request made before work began?
  Indicate whether the excavator requested utility locates before excavation.
• Excavator Contact Method
  Select all known methods used to contact the excavator.

Reporting and Review

• Reported to Operator At
  Enter the date and time the incident was reported to the operator.
• Was the reporting timeline met?
  Indicate whether the event was reported within the required timeline for internal escalation and PHMSA follow-up.
• Requires PHMSA Follow-Up Review
  Check this box if the event may require additional regulatory review or reporting.
• Compliance Review Notes
  Add internal review notes, next steps, or references to supporting documents.
• Submitter Acknowledgment
  I confirm the information provided is accurate to the best of my knowledge and is submitted for compliance and safety follow-up.