Gas Distribution Pressure Test Report

Inspection template for documenting gas distribution strength and leak tests in accordance with 49 CFR 192.503, including test medium, test pressure, duration, chart recorder data, and operator-qualified technician sign-off.

Inspection Identification

• Test record identifies pipeline section, location, and work order
  Record the pipeline segment, station or street location, project/work order number, and any tie-in or repair reference.
• Test date and start/end times recorded
  Capture the date and the actual start and completion times for the pressure test.
• Test purpose documented
  Select the reason for the test.
• Applicable standard referenced on record
  Document the governing requirement used for the test record, such as 49 CFR 192.503.

Test Medium and Equipment

• Test medium identified
  Select the medium used for the pressure test.
• Test medium compatible with pipeline materials and test method
  Confirm the selected medium is suitable for the pipeline materials, fittings, and test procedure.
• Pressure test equipment calibrated and within certification date
  Verify gauges, recorders, and related instruments were calibrated and in date before use.
• Test equipment identification numbers recorded
  Enter the gauge, chart recorder, data logger, and other instrument IDs used for the test.

Pressure and Duration Requirements

• Test pressure recorded
  Enter the actual test pressure achieved and maintained during the test.
• Required test pressure documented
  Enter the minimum required test pressure for this segment or procedure.
• Test duration recorded
  Enter the total duration of the test hold period.
• Pressure held within acceptable limits for full duration
  Confirm the test pressure remained within the required range for the entire hold period.

Chart Recorder and Leak Observations

• Chart recorder or electronic log attached
  Attach the chart recorder chart, digital trend output, or equivalent test record evidence.
• Pressure trend shows no unexplained loss during test
  Review the chart or electronic log for pressure stability and any unexplained drop.
• Visible leaks, odor, or abnormal conditions observed
  Record whether any leaks or abnormal conditions were observed during the test.
• Leak location and corrective action documented
  If any leak, abnormal condition, or failure occurred, document the location, repair, retest, and disposition.

Final Verification and Sign-Off

• Test passed all required acceptance criteria
  Confirm the test met the required pressure, duration, and leak-free criteria.
• Operator-qualified technician sign-off
  Signature of the operator-qualified technician or authorized representative responsible for the test record.
• Reviewer or supervisor verification
  Signature of the reviewing supervisor, inspector, or compliance representative, if required by procedure.
• Retention and filing location recorded
  Document where the completed test record, chart, and supporting evidence are filed for compliance retention.