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2018-05-07-J01Q Natural Gas Emergency Response Plan
J1Q Revised 03.18 City of Waukee Utility GAS SYSTEM EMERGENCY PLAN & PROCEDURES NOTE: Recommended that a copy of this Emergency Plan & Procedures manual be kept in all Gas Utility vehicles as well as in all appropriate office locations. Adopted: March 15, 2018 Revised 03.18 Page 1 EMERGENCY PLAN & PROCEDURES TABLE OF CONTENTS 1.1 Emergency Procedures (General) .............................................................................................................................1 1.2 Emergency Response Coordinator ...........................................................................................................................2 1.3 Review and Distribution ...........................................................................................................................................2 1.4 Identification and Classification of Emergencies .....................................................................................................3 Emergency Notification Procedures……………………………………………………..………………………....4 One-Call Notification Procedures……………………………………………………...…………………………...5 1.5 Emergency Notification List ....................................................................................................................................5 1.6 Key Valves ............................................................................................................................................................. 10 1.7 System History and Construction Records ............................................................................................................. 10 1.8 Emergency Equipment ........................................................................................................................................... 11 1.9 Responding to Leak Reports and Interruptions of Service ..................................................................................... 11 1.10 Line Hits ................................................................................................................................................................. 18 1.11 Carbon Monoxide Emergency Procedures ............................................................................................................. 20 1.12 Interruptions in Gas Supply .................................................................................................................................... 20 1.13 Town Border Station Emergency ........................................................................................................................... 20 1.14 Variations from Normal Operations ....................................................................................................................... 20 1.15 Reporting Accidents, Leaks, and Outages .............................................................................................................. 21 1.16 Reporting Safety Related Conditions ..................................................................................................................... 25 1.17 Restoration of Service Due to Outage .................................................................................................................... 28 1.18 Employee Emergency Training .............................................................................................................................. 29 1.19 Police, Fire, First Responder & Public Officials Emergency Training .................................................................. 30 1.20 Public Education .................................................................................................................................................... 31 1.21 Investigations of Accidents and Failures ................................................................................................................ 31 Appendix A IUB Contact Phone List ................................................................................................... ………...32 Quick Reference Guide to PHMSA Reports & Forms……………………………………………………………33 Quick Guide to Reporting Gas Incidents, Leaks, & Outages……………………………………………………..34 Recordkeeping & Documentation Forms Table of Contents……………………………………………………..36 1.1 EMERGENCY PROCEDURES (GENERAL) The Emergency Plan & Procedures contain procedures for preventing accidents and responding quickly and effectively should accidents occur or should emergency conditions exist. Remember to protect life first and then property. An emergency condition exists when the gas operator determines that extraordinary procedures, equipment, manpower, and/or supplies must be used to protect the public from existing or potential hazards. These hazards include, but are not limited to: 1.Under pressure on the system 2.Over pressurization in the system 3.Large amounts of escaping gas 4.Fire or explosion near or directly involving a pipeline facility 5.Any leak considered hazardous 6.Danger to major segment(s) of the system 7.Natural disasters (flood, tornado, hurricane, earthquake, etc.) 8.Civil disturbances (riot, etc.) 9.Load reduction conditions (result in voluntary or mandatory reduction of gas usage) Revised 03.18 Page 2 1.2 EMERGENCY RESPONSE COORDINATOR The following person shall be responsible for coordinating emergency response under these procedures (see also O&M Plan Administrator, Section 2.1): Title (preferred) or Name 1.3 REVIEW AND DISTRIBUTION The Emergency Response Coordinator shall review the information contained in this procedures manual at least once each year and shall maintain and update copies at the following locations: EMERGENCY PLAN LOCATIONS Gas Superintendent Office Employee Breakroom Reference: 49 CFR Part 192.615 Gas Superintendent Revised 03.18 Page 3 1.4 IDENTIFICATION AND CLASSIFICATION OF EMERGENCIES AND OTHER ABNORMAL OPERATING CONDITIONS Each call or report of a condition that presents the potential for an emergency will be treated as an emergency until it is determined otherwise. Prompt and effective response to the following conditions shall be made in accordance with procedures found in this division: gas leaks; interruptions of service; line hits; detection or suspicion of carbon monoxide in a building; and/or interruption in gas supply. The utility must have a procedure in which the public may call in a potential emergency; this includes after-hours emergency calls. The procedure would include setting up an after-hours on- call personnel rotation schedule to respond to emergencies and publicly available phone numbers. Some suggested procedures may include: contracting the local 911 center or police stations to forward calls, or giving the public an after-hour phone number to directly contact the on-call person. The utility must also have a procedure place for Iowa One-Call after hours emergency locate requests. Response to other emergency conditions or abnormal operating conditions shall be made in a manner consistent with procedures that are included in this Plan and that are intended to protect people first, then property. Examples of these other conditions include: the unintended closure of a valve or a shutdown, an increase or decrease in pressure or flow rate outside normal operating perimeters, loss of communications, failure of safety devices or any other malfunction of a component, deviation from normal operation, personnel error, fire or explosion near gas facilities, natural disaster or civil disturbance that poses a potential hazard to the people, property, or the integrity of the system. At a minimum, procedures for response to such conditions shall include: 1.Prompt reporting to appropriate operating personnel; 2.Continuous action to correct any condition that may pose a hazard to persons or property; 3.Where appropriate, coordination of the response with appropriate outside agencies and the public; 4.Where appropriate, checking variations from normal operation after abnormal operation has ended at sufficient critical locations in the system to determine continued integrity and safe operation; and 5.Investigation of the circumstances surrounding the incident, including the date and time it occurred or was first observed and reported, as well as a summary of actions taken to correct the condition, determine the cause, and prevent recurrence. Where areas are prone to flooding, operators should have a map indicating the key valve locations that may need to be shut off, controlling the affected area. REFERENCES: 49 CFR 192.615 Revised 03.18 Page 4 Emergency Notification Procedures Receiving, identifying & classifying notices that require prompt & effective response by the Operator: (list by location or job title) Information Dispatched To: How is the Emergency Contact Number communicated to the public? (PA Plan, newsletters, etc..) After Hours Procedures: Current Daytime Emergency Phone Number: Incoming Calls Received By: Working Hours Procedures: (list qualified personnel & their contact #'s) Note: If additional space is needed for line items, print off and attach additional form Primary After Hours Emergency Number: Incoming Calls Received By: (list by dispatch center or job title) Information Dispatched To: (if emergency # directs callers to dial additional #, list all relevant #'s) (list qualified personnel & their contact #'s) Gas Safety Brochure (bi-yearly), city website, social media and New Resident Packet Lisa Bauman Beth Richardson Kathy Ostring Tonja Parish Dave Dezeeuw 515-707-5014 Tim Royer 515-707-5003 Chris Keller 515-707-5017 Justin Dodge 515-707-5018 Josh Manning 515-473-2226 515-978-7920 Public Works 515-978-5502 City Hall 515-249-1212 On Call Phone 515-707-5003 Tim Royer On Call Phone 515-249-1212 Dave Dezeeuw 515-707-5014 Tim Royer 515-707-5003 Chris Keller 515-707-5017 Justin Dodge 515-707-5018 Josh Manning 515-473-2226 Revised 03.18 Page 5 ONE-CALL NOTIFICATION PROCEDURES FOR EMERGENCY LOCATE REQUESTS After Hours/Emergency Locate Request Procedures Emergency # provided to One-Call: (list all #'s provided to One-Call as emergency contacts) Does the Emergency # direct One-Call to a dispatch center or directly to the Operator? Fax#: Email: Pager # (if applicable): List of on-call qualified locating personnel and contact phone #'s: 1.5 EMERGENCY NOTIFICATION LIST The following personnel, agencies, departments, and businesses may be called upon in response to an emergency: NOTE: The U. S. Department of Transportation requires that all persons performing regulated operation, maintenance, and emergency response functions covered in 49 CFR Part 192 shall be included in a drug testing program pursuant to 49 CFR 199. Division 12 contains the operators’ drug and alcohol plan. The Public Awareness Program can also be used to fulfill various training requirements. 515-249-1212 Directly to Operator Daniel Laughridge 515-330-9181 Shawn Aldrich 515-423-5830 Dave Dezeeuw 515-707-5014 Chris Keller 515-707-5017 Justin Dodge 515-707-5018 Revised 03.18 Page 6 1.UTILITY OPERATING PERSONNEL (Emergency Response Coordinator, Manager, Operators, key personnel from other city departments) Title Communication Utilized Including Channel, Frequency, or Number Radio Telephone Gas Superintendent Dave DeZeeuw Cell 515-707-5014 Gas Laborer II Chris Keller Cell 515-707-5017 Gas Laborer II Justin Dodge Cell 515-707-5018 Gas Service Technician Josh Manning Cell 515-473-2226 Asst. Public Works Director Tim Royer Cell 515-707-5003 Public Works Director John Gibson Cell 515-707-5002 Fire Department “911” or 515-978-7998 Police Department “911” or 515-978-7979 West Com Dispatch 515-222-3321 2.REGULATORY AGENCIES described in Section 1.15 of this manual. 3.Personnel from other utilities through MUTUAL AID agreements. Check, here if the utility is a member of a Mutual Aid program with other gas utilities and attach appropriate instructions. Note: Insert a copy of the IAMU Mutual Aid Program guide, or have it readily available for quick reference. You can also refer to the Mutual Aid section of the IAMU website or the IAMU Connect Mutual Aid website 4.The utility's GAS SUPPLIER or pipeline operator. Title Communication Utilized Including Channel, Frequency, or Number Radio Telephone Northern Natural Gas 1-888-367-6671 X Revised 03.18 Page 7 5.LAW ENFORCEMENT AGENCIES (Police, Sheriff, State Patrol, 911) Title Communication Utilized Including Channel, Frequency, or Number Radio Telephone Waukee Fire “911” or 515-978-7998 Waukee Police “911” or 515-978-7979 West Come Dispatch “911” or 515-222-3321 Fire Chief – Cell # 515-371-1483 6.Personnel from the FIRE DEPARTMENT and other municipal departments: Title Communication Utilized Including Channel, Frequency, or Number Radio Telephone Clint Robinson – Chief 515-978-7998 Tommie Tysdal – Captain 515-978-7998 Justin Fredrick - Inspector 515-978-7982 7.The CIVIL DEFENSE Coordinator (County Emergency Management Coordinator) or others responsible for emergency response. Title Communication Utilized Including Channel, Frequency, or Number Radio Telephone Dallas County Emergency Management 515-993-2134 Revised 03.18 Page 8 8.GAS APPLIANCE DEALERS AND CONTRACTORS Name/Address Phone 9.EMERGENCY MEDICAL FACILITIES/AMBULANCE SERVICE (Local/Regional) Facility/Address Phone Mercy Waukee Medical 25 Hickman Road Waukee, IA 50263 515-643-7000 Iowa Clinic Waukee 120 NE Dartmoor Drive Waukee, IA 50263 515-875-9000 UnityPoint Clinic 30 E. Hickman Road Waukee, IA 50263 515-987-3447 The Iowa Clinic Urgent Care 5950 University Avenue West Des Moines, IA 50266 515-875-9070 UnityPoint Clinic 6000 University Avenue #101 West Des Moines, IA 50266 515-241-2600 Unity Point Clinic 1152 SE Ashworth Road Waukee, IA 50263 515-264-2200 Revised 03.18 Page 9 10.BURN CENTERS Facility/Address Phone Iowa Methodist Burn Center 1200 Pleasant Street Des Moines, IA 50309 515-241-5042 University of Iowa Burn Treatment Center University of Iowa Hospital and Clinics 200 Hawkins Dr., 8JCP Iowa City, IA 52242-1086 319-356-2496 St. Luke’s Burn Center 2720 Stone Park Blvd. Sioux City, IA 51104 712-279-3440 11.OTHER BUSINESSES that may provide communications or personnel support include: a.Radio and TV stations (for emergency advisories) b.Gas Stations c.Restaurants/food service Facility/Address Phone Who TV 13 515-242-3500 KCCI TV 8 515-247-8888 WOI TV 5 515-457-9645 KDSM 515-287-1717 REFERENCES: 49 CFR 192.615 Revised 03.18 Page 10 1.6 KEY VALVES The gas distribution system is a network of interconnected mains. For purposes of sectionalizing, valves have been installed throughout the system. All main valves are clearly marked on system maps. Key Valve locations are determined in accordance with ANSI/ASC Z380. NOTE: Copies are available from the American Gas Association: 400 North Capital Street NW, Suite 400, Washington DC, 20001. 1.Improper operation of a valve may create a hazardous condition, or make a hazardous condition worse. ONLY authorized utility personnel should operate valves. Fire, Police, and other officials are not authorized to operate valves (except meter shut-off valves). 2.The utility has designated various valves as key valves. Valves located at the town border station can isolate the entire system from the utility's gas supplier. Other key valves are shown on system map(s). REFERENCES: 49 CFR 192.181 COMPLETE SYSTEM MAPS ARE LOCATED: Location Phone Public Works Building 805 University Avenue Waukee, IA 50263 515-978-7920 1.7 SYSTEM HISTORY AND CONSTRUCTION RECORDS In addition to maintaining maps at these locations, pertinent data concerning construction and historical records shall be kept and made available to appropriate operating personnel. REFERENCE: 49 CFR 192.605(b)(3) Revised 03.18 Page 11 1.8 EMERGENCY EQUIPMENT The Emergency Response Coordinator shall be responsible for the adequacy, availability and condition of emergency equipment. 1.LOCATION -- Emergency Procedures Manual, valve keys and wrenches, leak detection and repair equipment, fire extinguisher and other hand tools likely to be needed in an emergency shall be maintained at the utility operations center or in utility service trucks. 2.ADDITIONAL VEHICLES AND EQUIPMENT -- Additional vehicles and equipment shall be assigned by the Emergency Response Coordinator or his/her designees. Additional equipment may also be obtained through the Mutual Aid program (see section 1.5). 3.A sufficient number of portable radios, tuned to the normal utility frequency, should be made available at all times to provide 2-way communications in the event of loss of base and/or other fixed communication facilities. 1.9 RESPONDING TO LEAK REPORTS AND INTERRUPTIONS OF SERVICE All leaks shall be classified, investigated and reported. Remember to protect life first and then property. Gas leak detection equipment must be calibrated according to the manufacturer’s recommended procedures for that specific instrument. Any instrument without a valid calibration shall not be used for any type of gas detection until the instrument has been calibrated DOCUMENTATION: Leak Investigation & Repair, Mechanical Fitting Failure Report 1.LEAK REPORT PRIORITY -- Leak reports, including line hits (whether a leak is evident or not), shall: a. Take priority over any other type of work. b. Be answered expeditiously. c. Be investigated, even if forced entry with police assistance is required. d. Be classified according to the criteria in this subsection. Revised 03.18 Page 12 2.LEAK CLASSIFICATION CRITERIA -- Leaks shall be classified and responded to in accordance with the following criteria: GRADE 1 -- A leak that represents an existing or probable hazard to persons or property and requires immediate repair or continuous action until the conditions are no longer hazardous. Grade 1 leaks require prompt action to protect life first and then property, which must continue until conditions are no longer hazardous. Examples of Grade 1 leaks include: a.A leak regarded by operating personnel as posing an immediate hazard. b.Ignition of escaping gas. c.Indication that gas has migrated into or under a building or tunnel. d.Gas at the outside wall of a building or likely to migrate to an outside wall. e.A 60% L.E.L. or greater in a confined space (other than structures and facilities of the distribution system). f.A leak that can be seen, heard, or felt and which is in a location that may endanger the general public or property. GRADE 2 -- A leak that, while recognized as being non-hazardous at the time of detection, poses a probability of future hazard sufficient to warrant scheduled repair. Grade 2 leaks should be repaired within one calendar year, but no later than 15 months from the date, it was reported. In determining repair priority, consideration should be given such factors as amount and migration of gas; proximity of gas to buildings and subsurface structures; extent of pavement; and soil type (considered with such conditions as frost cap, moisture, and natural venting). Reevaluation of grade 2 leaks should be made not less than once every 3 months. Examples of Grade 2 leaks include: a.Leaks which are likely to migrate to the outside wall of a building if not repaired before freezing of the ground or other adverse changes in venting conditions b.A 40% L.E.L. or greater under a sidewalk in a wall-to-wall paved area that does not qualify as a Grade 1 leak. c.A 100% L.E.L. or greater under a street in a wall-to-wall paved area with significant gas migration but not qualifying as a Grade 1 leak. d.An L.E.L. less than 60% in a small substructure (not part of the gas system) from which gas is likely to migrate creating a probable future hazard. e.An L.E.L. less than 60% in a confined space. f.Any leak on pipeline operating at 30% SMYS or greater in Class 3 or 4 locations, which is not a Grade 1 leak. g.An 80% L.E.L. or greater in a gas associated substructure. h.Other leaks determined by operating personnel to justify scheduled repair. Revised 03.18 Page 13 GRADE 3 -- A leak that is non-hazardous at the time of detection and can be reasonably expected to remain non-hazardous. Grade 3 leaks should be rechecked within 3 months and, if not re-graded, at each succeeding survey (not exceeding 15 months) until the leak is repaired, re-graded or no longer results in a reading. Examples of Grade 3 leaks include: a.An L.E.L. less than 80% in a small gas associated substructure. b.A reading under a street in areas without wall-to-wall paving, where gas migration to the outside wall of a building is unlikely. 3. LEAK CALL INFORMATION -- Utility personnel likely to receive telephonic reports of gas leaks shall be trained in gathering information and providing essential customer advice, including the following: a.No one is to turn electrical switches ON or OFF. b.No one is to ring doorbells or use the phone. c.Leave telephone in position found. d.Extinguish all open flames. No smoking. e.Ventilate building (if suspecting carbon monoxide). f.Turn off gas supply, if feasible. g.Evacuate building and remain a safe distance away. h.Go on foot -- no engines or sparks. Continued next page Revised 03.18 Page 14 4. INSIDE LEAK INVESTIGATIONS -- The steps outlined in this subsection are to be followed in investigating reported gas leaks inside a building. The steps should generally be followed in the order listed until the leak is identified. The investigation may stop at that point ONLY if the investigator is satisfied that there are no more leaks. Leak Investigation Steps: a.Upon arrival at customer's premises, beepers, cell phones, and any other unsafe devices that may cause a spark are to be left outside of the building. b.Prepare gas detection equipment for use. Take sample of outside air and calibrate unit. c.KNOCK. Do not use doorbell. d.Upon admittance to customer premises, test free air immediately. (First test near ceiling.) e.Ask customer probable location of leak. Instruct customer to use no light switch, etc., until a determination has been made that there is no explosive condition. f.Test air at top of basement stairwell (if any), as natural gas is lighter than air and this is an area for potential collection. This check is essential to do as soon as possible after gaining admittance. g.If customer specifically locates the leak, proceed directly to that area. If not, proceed with step (h). h.Using gas detection equipment, take samples at cracks in basement walls, joists, dead air spaces in block walls, crawl spaces, sewer openings, basement floor at stairs, all underground entrances of gas, water, electricity, telephone, TV cable, customer piping and appliances, or any other location where gas might accumulate. Check floor for possibility of gasoline or propane. i.Check all above ground utility facilities. If the meter is outside, complete step (k) first. j. Start vented gas appliances or advise customer to contact appliance dealer or contractor to determine if flue conditions are good. CAUTION: this step should be done after gas free condition has been confirmed. k. Probe by riser within 1 foot of basement wall and twice on every wall around the house. Checking shall include any outside appliances such as lights, grill, incinerator, etc. Probe risers on walls of adjacent buildings. l. If leak is still not evident, perform a manometer gas meter shut-in test on house piping and appliances. m. If it is not possible to identify gas as the source of odor at this point and all possible checks have been made, attempt to identify source of any related odors. n. When leaving customer's premises, assure customer that their complaint has not been a nuisance and that any future incidence of gas odor should be reported. Revised 03.18 Page 15 5. INSIDE EMERGENCY PROCEDURE -- The following procedures are to be taken when an inside emergency -- evidenced by strong odor, large gas concentrations, fire or explosion – has been found to exist: a.Evacuate building. b.Close valve at meter or curb and call qualified personnel for disconnection of electricity, telephone and other utilities that, if left in service, could provide a source of ignition. c.Ventilate building. Exercise extreme caution when gas concentration greater than the upper explosive limit is present, so that the ventilation process doesn't bring the concentration level back through the explosive envelope with ignition source present. d.Radio for emergency personnel (fire, police). e.Check surrounding buildings at utility service entries, basement wall cracks, sewer drains, etc. to determine limits of emergency area -- evacuate if necessary. f.If emergency area is widespread, evacuate all buildings, close appropriate valves to sectionalize emergency area (including key valves if citywide emergency is believed to exist). g.Identify leak source(s). h.Repair leak(s). i.Follow service restoration procedures. j.Complete documentation and telephonic report, as required. Continued next page Revised 03.18 Page 16 6. OUTSIDE LEAK INVESTIGATIONS – The steps outlined in this subsection are to be followed in investigating reported outside gas leaks. The steps should generally be followed in the order listed until the leak is identified. The investigation may stop at that point ONLY if the investigator is satisfied that there are no more leaks. Leak Investigation Steps: a.Upon arrival at customer's premises, prepare gas detection equipment for use. b.KNOCK. Do not use doorbell. c.Upon admittance to customer premises, test free air immediately near ceiling. d. Ask customer probable location of leak. Instruct customer to use no light switch, etc., until a determination has been made that there is no explosive condition. e.Test air at top of basement stairwell. As natural gas is lighter than air, this is an area for potential collection. This check is essential to do as soon as possible after gaining admittance. f.If customer specifically locates the leak, proceed directly to that area. If not, proceed with step (g). g.Probe around riser and thoroughly probe all around foundation of building. h.Probe service line and/or customer's yard line every 10 feet until area of service line tap is reached. If main lays in front of building, probe both boulevards. i.Thoroughly probe all sides of the foundations of adjacent buildings. j.Check all manholes, catch basins, sewers, etc., in the area. k. Thoroughly probe all sides of foundation of buildings across street or alleys of building where complaint was registered. l. If odor is prominent, attempt to locate source by smell. m. Check all above ground utility facilities inside or outside. n. If outside leak is still not evident, reset gas detection equipment and complete inside investigation of cracks in basement walls, joists, dead air spaces in block walls, crawl spaces, sewer openings, basement floor at stairs, underground entrances for all utilities, and other locations where gas might accumulate. o. If it is not possible to identify gas as the source of odor at this point and all possible checks have been made, attempt to identify source of any related odors. p. When leaving customer's premises, assure customer that their complaint has not been a nuisance and that any future incidence of gas odor should be reported. Revised 03.18 Page 17 7. OUTSIDE EMERGENCY PROCEDURE FOR LARGE LEAKS -- The following procedures are to be taken when an outside emergency -- evidenced by strong odor, large gas concentrations or obvious physical damage to pipeline -- has been found to exist: a.Assess danger to people first, then property. b.Contact appropriate emergency personnel (fire, police). c.Eliminate sources of ignition and blockade area. d.Evacuate buildings and immediate area, if appropriate. e.Determine whether gas flow to the area should be shut off. If large leak is blowing gas, shut off gas as part of four (above). f.Check surrounding buildings at utility service entries, basement wall cracks, sewer drains, etc. to determine limits of emergency area -- probe as needed, evacuate if necessary. g.If emergency area is widespread, evacuate all buildings, close appropriate valves to sectionalize emergency area (including key valves if citywide emergency is believed to exist). h.Identify leak source(s). i.Repair leak(s). j.Follow service restoration procedures. k.Complete documentation and telephonic report, as required. 8. OUTSIDE EMERGENCY PROCEDURE FOR FIRE OR EXPLOSION -- The following procedures are to be taken when an outside emergency, evidenced by fire or explosion, has been found to exist: a.Contact appropriate emergency personnel (fire, police). b.Evacuate area. c.Blockade area. d.In the event of a fire or explosion, shutting off gas flow to area should be top priority. e.Fires should not be extinguished until gas flow is stopped. f.Check surrounding buildings at utility service entries, basement wall cracks, sewer drains, etc. to determine limits of emergency area -- evacuate if necessary. g.If emergency area is widespread, evacuate all buildings, close appropriate main valves to sectionalize emergency area (including key valves if citywide emergency is believed to exist). h.Identify leak source(s). i.Repair leak(s). j.Follow service restoration procedures. k.Complete documentation and telephonic report, as required. REFERENCE: Iowa Code 199-19.7 (7) and 199.19, 49 CFR 192.615, 192.703 Revised 03.18 Page 18 1.10 LINE HITS Line Hit Emergency Procedures -- If a line hit has resulted in a leak, fire or explosion; initiate the appropriate outside and/or inside emergency actions to protect life first and then property. All reported line hits, whether a leak is evident or not, shall be considered as leak reports and documented as such. All findings MUST be documented for verification. DOCUMENTATION: Leak Investigation & Repair, Dig-In-Report, Line Hit/Accident Investigation Follow-up Report 1. Line Hit Investigation Steps: a.Upon arrival, assess damage to line at and near point of impact. When a gas line is hit, “pullout” damage could occur well away from the site of the hit and the possibility of multiple leaks and the migration of gas must be considered. b.At minimum, when a service line is hit it should be checked for leaks at both the service riser and the connection to the main, plus at any known couplings. c.When a main is hit, it should be checked for leaks at any nearby branch connections or couplings. d.Bar hole testing shall be performed and mapped at a maximum of 10 ft. intervals from the point of impact in all directions until 0% gas is obtained. e.Locations that are susceptible to “pullout” forces from the line hit shall also be bar hole tested at a maximum of 10 ft. intervals in all directions until 0% gas is obtained. f.Bar hole testing shall also be performed and mapped at all nearby building foundations to verify that 0% gas is present. g.Check for the presence of gas inside of ALL nearby buildings, with gas detection equipment. h.Checks shall be made for gas with gas detection equipment in ALL manholes, catch basins, storm sewers and sanitary sewers within a close proximity to the line hit. 2.Line Hit/Accident Follow-up Report: The operator shall complete a follow-up report on the line hit/accident after all repairs have been made and all personnel have cleared the line hit/accident scene. The follow-up report shall be conducted with all involved personnel to determine the following: a.What was the cause of the line hit? b.Were ALL Emergency Procedures and Leak Investigation Procedures properly followed and documented? c.What can be done to minimize the possibility of recurrence? DOCUMENTATION: Line Hit/Accident Investigation Follow-up Report Revised 03.18 Page 19 THE FOLLOWING CHECKLIST MAY BE USED AS GUIDANCE MATERIAL DURING A LINE HIT OR ACCIDENT: EMERGENCY PROCEDURE CHECKLIST 1. Have people been evacuated and area blockaded? 2. Has 911 been called? 3. Has police department been notified? 4. Has repair crew been notified? 5. Have utility and other municipal officials been called? 6. Has communication been established? 7. Has outside (mutual aid) help been requested (if necessary)? 8. Has leak been shut off or brought under control? 9. Has civil defense been notified (if necessary)? 10. Have sectionalizing procedures been implemented? 11. Have all service valves been shut off in areas cut off from gas supply? 12. Is situation under control and possibility of recurrence eliminated? 13. Has surrounding area (including buildings adjacent to and across streets) been probed for the possibility of migrating gas? 14. Have proper tags been put on customer meters? 15. Has telephonic report to DOT been made if necessary? 16. Has telephonic report to Iowa Utilities Board been made if necessary? 17. Have Radio/TV instructions been given if necessary? Revised 03.18 Page 20 1.11 CARBON MONOXIDE EMERGENCY PROCEDURES The steps outlined in this subsection should be followed in the event that carbon monoxide is detected or suspected in a building: 1.Move occupants to fresh air outdoors. 2.Contact appropriate emergency help. 3.Ventilate building. 4.Shut off offending appliance (use air-pack if adequate ventilation cannot be provided). 5.Remedy problem, red tag appliance, or advise customer that appliance must not be used until a qualified gas appliance dealer or contractor repairs the faulty condition. 1.12 INTERRUPTIONS IN GAS SUPPLY An interruption in gas supply could be due to freezing of the regulators, a break in the line, sabotage, or supplier cut off. In the event of an interruption in supply, the following steps should be taken: 1.Call supplier to determine if interruption cause is known. If system is not already depressurized, initiate procedures to prevent under pressurizing of system. 2.Locate leak or other source of interruption. Initiate appropriate emergency procedures. 3.Correct or repair. 4.Follow service restoration procedures, if necessary. 5.Complete documentation and telephonic report, as required. REFERENCES: Iowa Code 199-19.7 (7) and 199.19 1.13 TOWN BORDER STATION EMERGENCY In the event of damage to facilities or failure of equipment at the gas supplier’s town border station (TBS), it may be necessary to bypass TBS pressure regulating and metering equipment. 1.14 VARIATION FROM NORMAL OPERATIONS After an abnormal operation has ended, the operator shall make checks at a sufficient number of locations in the system to determine the integrity of the system and guarantee continued safe operation. If the operator has determined that during certain circumstances a condition would be made less hazardous by operating at a lower pressure, the operator may re-set the primary working regulator to the desired pressure. REFERENCES: 49 CFR 192.605©(2), 192.605(a)(6), 192.615 Revised 03.18 Page 21 1.15 REPORTING ACCIDENTS, LEAKS, AND OUTAGES Under certain conditions, accidents, leaks and outages must be reported to the U.S. Department of Transportation (US DOT) and the State regulatory agency through their EFS system, in a timely manner. 1.TELEPHONIC REPORTS TO U.S. DEPARTMENT OF TRANSPORTATION – Division Definition: Confirmed Discovery - When it can be reasonably determined, based on information available to the operator at the time a reportable event has occurred, even if only based on a preliminary evaluation. At the earliest practicable moment following discovery, but no later than 1 hour after confirmed discovery, each operator must provide a telephonic notice to PHMSA of each incident as defined below in subparts a – e or as defined in 49 CFR 191.3. a.A release of gas from a pipeline (or LNG facility) resulting in a death or personal injury requiring in-patient hospitalization. b.Estimated damage to utility property or other property totaling $50,000 or more, but excluding the cost of gas lost in the release. c.An unintentional estimated gas loss of 3 million cubic feet or more. d.An event that results in the emergency shutdown of an LNG facility. e.An event that is significant in the judgement of the operator, even though it did not meet the reporting requirements. The report must be made by telephone to the National Response Center at 800-424- 8802 or the website at www.nrc.uscg.mil (Note that the toll-free number may be answered "U.S. Coast Guard.") This phone number should be posted in a conspicuous place. The report shall include the following information: f.The name and phone number of the operator and name and number of person making report. g.The location of the incident. h.The time of the incident. i.The fatalities and personal injuries, if any. j.All other significant facts that are known by the operator that is relevant to the cause of the leak or extent of the damage. k.The name and phone number of a person to be contacted for additional information. Within 48 hours after the confirmed discovery of an incident, to the extent practicable, an operator must revise or confirm its initial telephonic notice with an estimate of the amount of product released, an estimate of the number of fatalities and injuries, and all other significant facts that are known by the operator to be relevant to the cause of the incident or to the extent of the damages. If there are no changes or revisions to the initial report, the operator must confirm the estimates in its initial report. REFERENCE: 49 CFR 191.5 and 49 CFR 192.615 Revised 03.18 Page 22 2.WRITTEN REPORTS TO U.S. DEPARTMENT OF TRANSPORTATION – A written report must be made to US-DOT as soon as possible but no longer, than 30 days of any leak that was required to be reported under section 1.15. Once reports are filled out, all reports are to be submitted electronically to PHMSA at https://portal.phmsa.dot.gov/pipeline Note:A copy of all filed PHMSA reports must also be submitted to the IUB through their Electronic Filing System (EFS). Retracting a 30-day Written Notice: An operator who reports an incident in accordance with §191.9 or §191.15 (oftentimes referred to as a 30-day written report) and upon subsequent investigation determines that the event did not meet the criteria in §191.3 may request that the report be retracted. Requests to retract a 30-day written report are to be emailed to InformationResourcesManager@dot.gov. Requests are to include the following information: a.The Report ID (the unique 8-digit identifier assigned by PHMSA) b.Operator name c.PHMSA-issued OPID number d.The number assigned by the National Response Center (NRC) when an immediate notice was made in accordance with §191.5. If Supplemental Reports were made to the NRC for the event, list all NRC report numbers associated with the event. e.Date of the event f.Location of the event g.A brief statement as to why the report should be retracted. REFERENCE: The report should be made on DOT Form RSPA F 7100.1 (Distribution), or form RSPA 7100.2 (Transmission). Additional relevant information should be reported as soon as practicable with a clear reference to the date and subject of the original report. (Refer to 49 CFR 191.7, 191.9, 191.15). Continued next page Revised 03.18 Page 23 3.TELEPHONIC REPORTS TO IOWA UTILITIES BOARD (IUB)shall be given notice immediately, or as soon as practical (preferably within 1 hour of discovery), and also file additional telephonic reports if there are significant changes in the number of fatalities, injuries, product release estimates, or the extent of damages by phone of any event reportable to US DOT and any other event involving release of gas, failure of equipment, or interruption of facility operations which results in the following: a.A death or personal injury requiring in-patient hospitalization, b.Estimated property damage of $15,000 or more to the property of the utility or others including the cost of gas lost, c.Emergency shutdown of liquefied natural gas (LNG) facility, d.Any interruption of service which extinguishes the pilot lights of fifty or more customers in one segment of a distribution system, or e.Any other incident considered being significant by utility (will the media report it?) This includes exceeding the MAOP on distribution lines. Notify the Board Duty Officer by telephone at 515-745-2332. If the call goes to voicemail, leave a call-back number for a person who is knowledgeable about the incident. The other option is to report by e-mail to dutyofficer@iub.iowa.gov The caller shall leave a call-back number for a person who can provide the following information: a.The name of the utility, the name and telephone number of the person making the report, and the name and telephone number of a contact person knowledgeable about the incident. b. Location and time of incident. c. If any, the number of persons dead or injured and extent of injuries. d. Initial damage estimate. e. Number of services interrupted. f. A summary of the significant information available to the utility regarding the probable cause of the incident and extent of damages. g. Any oral or written report required by the U. S. Department of Transportation and the name of the person who made the oral or prepared the written report. Note: Although not required by rule, the IUB staff has requested telephone notice also be made to the Engineering staff: see Appendix A, this division, for the additional IUB phone contacts. These phone numbers should be posted in a conspicuous place. REFERENCE: 199 IAC 19.17(1)(2) Continued next page Revised 03.18 Page 24 4.WRITTEN REPORTS TO IOWA UTILITIES BOARD -- The IUB must be sent a written report within 30 days of the incident. The written report will include: a. The information required for telephone notice. b. The probable cause as determined by the utility. c. The number and cause of any deaths or personal injuries requiring in-patient hospitalization. d. A detailed description of property damage and the amount of monetary damages. If significant additional information becomes available at a later date, a supplemental report shall be filed. Copies of any written reports concerning an incident or safety- related condition filed with or submitted to the U.S. Department of Transportation or the National Transportation Safety Board shall also be provided to the board. Note: All reports must be submitted to the IUB through their EFS system, in a timely manner REFERENCE: 199 IAC 19.17(3) 5.TELEPHONIC REPORTS TO EMERGENCY RESPONSE AGENCIES -- Whenever a system operator or excavator hits a gas line that creates an emergency or badly damages the line, notification to emergency response agencies is required. Call 911 to notify these emergency response agencies. REFERENCE: Iowa Code 480.5 and 49 USC 60114 Revised 03.18 Page 25 1.16 REPORTING SAFETY RELATED CONDITIONS [49 CFR 191.23] The purpose of this section is to inform operators of how to recognize a safety related condition subject to reporting. 1.CONDITIONS TO BE REPORTED -- The existence of any of the following safety- related conditions involving facilities in service must be reported to the federal Office of Pipeline Safety and the state regulatory agency: a. In the case of the pipeline that operates at a hoop stress of 20 percent or more of its specified minimum yield strength, general corrosion that has reduced the wall thickness to less than that required for the maximum allowable operating pressure, and localized corrosion pitting to a degree where leakage might result, b. Unintended movement or abnormal loading by environmental causes, such as an earthquake, landslide, or flood, that impairs the serviceability of a pipeline, c. Any material defect or physical damage that impairs the serviceability of a pipeline operated at a hoop stress 20 percent or more of its specified minimum yield strength, d. Any malfunction or operating error that causes the pressure of a pipeline to rise above its maximum allowable operating pressure plus the build-up allowed for operation of pressure limiting or control devices, e. A leak in a pipeline that constitutes an emergency, or f. Any safety-related condition that could lead to an imminent hazard and that causes (either directly or indirectly by remedial action of the utility), for purposes other than abandonment, a 20 percent or more reduction in operating pressure or shutdown of operation of a pipeline. 2.REPORTING EXCEPTIONS -- A report is not required if the condition: a. Exists on a master meter system or a customer-owned service line, b. Exists on a pipeline that is more than 220 yards from any building intended for human occupancy or outdoor place of assembly, unless the condition is within the right-of-way of an active railroad, paved road, street, or highway, c. Is corrected by repair or replacement in accordance with applicable safety standards before the deadline for filing the safety-related condition report, except that reports are required when general corrosion has reduced the wall thickness of a pipeline, operated at a hoop stress of 20 percent or more of its specified minimum yield strength, to less than that required for maximum allowable operating pressure. NOTE: See additional reporting requirements for conditions in LNG facilities. Revised 03.18 Page 26 3.FILING SAFETY-RELATED CONDITION REPORTS -- Each report of a safety- related condition under 49 CFR 191.23 must be filed in writing within five working days (not including Saturday, Sunday, or federal holidays) after the day a representative of the utility first determines that the condition exists, but not later than 10 working days after the day a representative of the utility discovers the condition. Separate conditions may be described in a single report if they are closely related. Reports may be submitted to the Office of Pipeline Safety by email to InformationResourcesManager@dot.gov or by fax to 202/366-7128. The report must be headed "Safety-Related Condition Report" and provide the following information: a. Name and principal address of operator. b. Date of report. c. Name, job title, and business telephone number of person submitting the report. d.Name, job title, and business telephone number of person who determined that the condition exists. e, Date condition was discovered and date condition was first determined to exist. f. Location of condition, with reference to the state, town, city, or county or offshore site, and as appropriate nearest street address, offshore platform, survey station, mile-post, landmark, or name of pipeline. g. Description of the condition, including circumstances leading to its discovery, any significant effects of the condition on safety, and the name of the commodity transported or stored, and h. The corrective action taken (including reduction of pressure or shutdown) before the report is submitted and the planned follow-up future corrective action, including the anticipated schedule for starting and concluding such action. Continued next page Revised 03.18 Page 27 4.EXCEEDING MAOP ON TRANSMISSION LINES - If the pipeline pressure exceeds the maximum allowable operating pressure (MAOP) plus the build-up allowed for operation of pressure-limiting or control devices, then the operator must report the exceedances to PHMSA and to the IUB on or before the fifth day following the date of the occurrence (calendar days). The report must be submitted to PHMSA by emailing the information to InformationResourcesManager@dot.gov or by fax to 202-366-7128, and to the IUB through their EFS system. PHMSA is working to allow electronic filing in the future. When that is completed, then filings will be accepted in the same method as Safety-Related Condition Reports (SRCR). The report should be titled “Gas Transmission MAOP Exceedance” and provide the following information: a.The name and principal address of the operator, date of the report, name, job title, and business telephone number of the person submitting the report. b.The name, job title, and business telephone number of the person who determined the condition exists or existed. c.The date the condition was discovered and the date the condition was first determined to exist. d.The location of the condition, with reference to the town/city/county and state, and as appropriate, nearest street address, milepost, landmark, and the name if the commodity transported. e.Cause and the corrective action taken before the report was submitted and the planned follow-up or future corrective action, including the anticipated schedule for starting and concluding such action. Where additional related information is obtained after a written report is submitted, the operator shall make a supplemental report as soon as practical with a clear reference by date and subject to the original report. REFERENCES: 49 CFR 191.9(b) & 191.15(b), 191.23, 192.25, 192.605 Revised 03.18 Page 28 1.17 RESTORATION OF SERVICE DUE TO OUTAGE & SOFT CLOSE 1.When the supply of gas has been cut off to an area, no gas shall be turned on to the affected area until the individual service to each customer has been turned off. a.A house-to-house operation will be conducted, in which each customer's service will be turned off at the meter or at service valves. If the service valve cannot be located, the operator is required to turn off the valve at the customer’s appliances, until a new valve can be installed. b.In restoring service to an affected area, all gas piping and meters will be purged and appliances relit. Gas must not be turned on at the meter without access to ALL appliances on the customer piping. Relights must include the no-flow test. c.If a customer is not at home, a card will be left in a conspicuous location, requesting customer to call the utility to arrange for restoration of service. Extreme care will be taken in coordinating service restoration to ensure strict compliance with restoration procedures. d.Whenever service to a customer is interrupted or discontinued, one of the following must be complied with: i.The valve that is closed to prevent flow of gas to the customer must be provided with a locking device or other means designed to prevent the opening of the valve by persons other than those authorized by the operator. ii.A mechanical device or fitting that will prevent the flow of gas must be installed in the service line or in the meter assembly. iii.The customer’s piping must be physically disconnected from the gas supply and the open pipe ends sealed. e.A complete record of the incident will be maintained. 2.SOFT CLOSE - Whenever there is an ownership or a tenant change on a property that requires continued uninterrupted gas service (soft close); prior authorization has to be made with the gas utility or the gas will be shut off. Whenever gas service is not requested to be continued the gas utility will check with the water department to make sure water has been shut off prior to gas shut off during the winter moratorium, from November 1 – April 1, or if there is a chance of freezing weather, otherwise during summer months gas will just be shut off. When ownership is not known, the gas utilities may be left on for 15 working days, and then if no ownership has been determined, the gas utilities will be shut off. DOCUMENTATION: No Flow Test Report REFERENCE: 49 CFR 192.615, 192.727(d)(e)(f) Revised 03.18 Page 29 1.18 EMPLOYEE EMERGENCY TRAINING The utility shall conduct at least one documented training meeting each year in which employees shall receive training in those emergency training procedures within their individual responsibilities. 1.Training shall include a review of procedures that ensure prompt and effective response to the following types of emergencies: a.Gas detected inside or near a building b.Fire located near or directly involving a pipeline facility c.Explosion occurring near or directly involving a pipeline facility d.Natural disaster 2.The following topics shall also be discussed and reviewed during the training session: a.Procedures for updating the Emergency Plan. b.A review of each employee's responsibility in an emergency, including the responsibility of all employees to adhere to utility guidelines for statements to the press and general public. c.A review of the location, use and periodic inspection of emergency equipment. d.A review of the location and use of system maps, main records, service records, valve records, regulator schematics, and properties of natural and LP-gas. e.Bypass procedures. f.A step-by-step review of procedures using a hypothetical emergency situation, including procedures for contact with public officials, fire, police and other agencies. g.Record keeping. h.Emergency reports (telephonic and written). DOCUMENTATION: Employee Emergency Training Record REFERENCES: 49 CFR 192.615 Revised 03.18 Page 30 1.19 POLICE, FIRE, FIRST RESPONDER & PUBLIC OFFICIALS EMERGENCY TRAINING Note: The utility shall conduct documented meetings, at least annually, with representatives of the police, fire, first responders, and public officials to train on the following: 1. Police, fire, first responder training shall include applicable procedures during each type of the following emergencies: a.Gas detected inside or near a building. b.Fire located near or directly involving a pipeline facility. c.Explosion occurring near or directly involving a pipeline facility. d.Natural disaster. e.The department’s contact of the utility in the event of gas related fires, physical damage to pipeline facilities, line hits, suspected leaks, etc. f.Respective responsibilities during gas related accidents. g.Rules when fighting gas-fed fires. h.Instruction on valves - where, who shuts off what, and when. 2. The following topics shall be reviewed and discussed with all organizations during the meeting to: a.Learn the responsibility and resources of each government organization that may respond to a gas pipeline emergency b.Acquaint the officials with the operator’s ability in responding to a gas pipeline emergency. c.Identify the types of gas pipeline emergencies of which the operator notifies the officials. d.Plan how the operator and officials can engage in mutual aid assistance to minimize hazards to life or property. e.Explain in training or provide instructional materials describing the basic properties of natural gas. DOCUMENTATION: Police, Fire, First Responder, & Public Official Emergency Training Record REFERENCES: 49 CFR 192.615 Revised 03.18 Page 31 1.20 PUBLIC EDUCATION The utility shall conduct a documented program of continuing education that enables customers, the public, appropriate governmental organizations, and persons engaged in excavation-related activities, to recognize and report gas emergencies. The program shall contain information about how to report emergencies to the utility or to the appropriate public officials (fire dept., police dept., etc.) If the utility has a significant non-English speaking population within its service area, then instructions and education will be provided in the prevalent language of this population. The system operators shall review their public education program for the appropriateness of information provided and for the effectiveness of the program. If deficiencies are observed the program shall be modified to assure the adequacy of the program. 1.21 INVESTIGATIONS OF ACCIDENTS, LINE HITS AND FAILURES The utility shall fully investigate each accident, incident, or failure for the purpose of determining causes and minimizing the possibility of reoccurrence. Physical evidence, including samples of the failed facility or equipment, shall be gathered for possible laboratory examination and shall be retained for a reasonable period of time. A written record of the investigation shall be made as well as a review of employee activities to determine if emergency procedures were followed. The appropriate forms can be found in Division 11. When there are dig-in damages, the operator shall fill out a Leak Investigation & Repair Report being sure to document/map all possible gas migration patterns until 0% gas is found in all directions and at nearby buildings. A Dig-In Report and a Line Hit/Accident Investigation Follow-up Report shall also be completed by the operator along with the Leak Investigation Report. Investigations should include when practical, photos, drawings, written description of incident, interviews and any pertinent information that could include lab reports. Document in leak and repair records the manufacturer, type and year installed of the pipe or component involved. REFERENCES: 49 CFR 192.605, 192.615, 192.617 Revised 03.18 Page 32 APPENDIX A IUB CONTACT PHONE LIST Duty Officer phone number 515-745-2332, if your call goes to voicemail; leave a call-back number for a person who is knowledgeable about the incident. The other option is to report by e- mail to dutyofficer@iub.iowa.gov be sure to leave call-back number. Safety and Engineering Staff (Gas): Beverly Ohman Utility Administrator 1 Office 515-725-7352 beverly.ohman@iub.iowa.gov Magid Yousif Utilities Regulation Engineer Office 515-725-7315 magid.yousif@iub.iowa.gov Gabe Tucker Utility Regulation Inspector Cellular 515-314-1452 gabe.tucker@iub.iowa.gov Mike McGehee Utility Regulation Inspector Cellular 515-681-5665 mike.mcgehee@iub.iowa.gov Dave McCann Utility Regulation Inspector Cellular 515-681-4110 dave.mccann@iub.iowa.gov Dan O’Connor Utility Regulation Inspector Cellular 563-219-3500 dan.oconnor@iub.iowa.gov Cynthia Munyon Utility Specialist/Paralegal Office 515-725-7338 cynthia.munyon@iub.iowa.gov Iowa Utilities Board 1375 E. Court Ave. RM 69 Des Moines, IA 50319-0069 www.state.ia.us/iub Revised 03.18 Page 33 QUICK REFERENCE GUIDE TO PHMSA REPORTS & FORMS These forms will not be found in this Plan. Once reports are filled out, all reports are to be submitted to PHMSA at https://portal.phmsa.dot.gov/pipeline A copy of all federally filed reports must be submitted to the Iowa Utilities Board through their EFS system, in a timely manner. Incident Report – Gas Distribution System (RSPA Form 7100.1) and Instructions: Distribution system operators are required to file this form within 30 days following the occurrence of an incident as defined in 49 CFR 191.3. See section 1.13 and 49 CFR 191.9. This incident report and instructions can be found at http://www.phmsa.dot.gov and more specifically at http://www.phmsa.dot.gov/pipeline/library/forms Annual Report – Gas Distributions System (RSPA Form 7100.1-1) and Instructions: Distribution system operators are required to file this form with the Research and Special Programs Administration of the Office of Pipeline Safety by March 15 of each year for the preceding calendar year. See 49 CFR 191.11. The number of excavation damages and request tickets are required on the PHMSA Annual Report. This annual report and instructions can be found at http://www.phmsa.dot.gov and more specifically at http://www.phmsa.dot.gov/pipeline/library/forms Mechanical Fitting Failure Report (RSPA Form 7100.1-2) and Instructions: Each operator of a gas distribution pipeline, except for the operators of master meter systems or small liquefied petroleum gas (LPG) operators, must submit a report for each mechanical fitting failure excluding those that result only in non-hazardous leaks on a separate Department of Transportation Form PHMSA F 7100.1-2 for the preceding calendar year no later than March 15. Operators are permitted to submit mechanical fitting failure report forms throughout the year. See 49 CFR 191.12 & 192.1009. This annual report and instructions can be found at http://www.phmsa.dot.gov and more specifically at http://www.phmsa.dot.gov/pipeline/library/forms Incident Report – Gas Transmission and Gathering Systems (RSPA Form 7100.2) and Instructions: Transmission line operators are required to file this form within 30 days following the occurrence of an incident as defined in 49 CFR 191.3. See section 1.13 and 49 CFR 191.7 & 191.15. This incident report and instructions can be found at http://www.phmsa.dot.gov and more specifically at http://www.phmsa.dot.gov/pipeline/library/forms Annual Report – Gas Transmission and Gathering System (RSPA Form 7100.2-1) and Instructions: Transmission line operators are required to file this form with the Research and Special Programs Administration of the Office of Pipeline Safety by March 15 of each year for the preceding calendar year. See 49 CFR 191.17. This annual report and instructions can be found at http://www.phmsa.dot.gov and more specifically at http://www.phmsa.dot.gov/pipeline/library/forms Revised 03.18 Page 34 QUICK GUIDE TO REPORTING GAS INCIDENTS, LEAKS, AND OUTAGES CALL THE NATIONAL RESPONSE CENTER – 800-424-8802 or the website www.nrc.uscg.mil Within 1 hour of confirmed discovery, and also file additional telephonic reports if there are significant changes in the number of fatalities, injuries, product release estimates, or the extent of damages (per advisory bulleting ADB 2013-01) of a reportable incident, call the Pipeline and Hazardous Materials Safety Administration (PHMSA) Emergency Response Center. A reportable incident is a release of gas resulting in: a death; personal injury requiring in-patient hospitalization; or involving estimated damage to property of utility and others (excluding cost of gas lost) totaling $50,000 or more; unintentional estimated gas loss of three million cubic feet or more. Or an event that, in the judgment of the utility, was significant even though it did not meet the above criteria. (Note that the toll-free number may be answered "U.S. Coast Guard"). CALL THE IOWA UTILITIES BOARD -- 515-745-2332. The IUB Duty Officer shall be given notice immediately, or as soon as practical (preferably within 1 hour of discovery), and also file additional telephonic reports if there are significant changes in the number of fatalities, injuries, product release estimates, or the extent of damages. Following the report of an incident to the federal Emergency Response Center, call the Iowa Utilities Board (IUB). The IUB Duty Officer must also be called when: a death; personal injury requiring in-patient hospitalization; or, estimated total property damage (including the value of lost gas) exceeds $15,000; or, when an interruption of service which extinguishes the pilot lights of at fifty (50) or more customers in one segment of a distribution system; or, any other incident considered being significant by the utility (this includes exceeding the MAOP on distribution lines). If the call to the Duty Officer goes to voicemail; leave a call-back number for person who is knowledgeable about the incident. The other option is to report by e-mail dutyofficer@iub.iowa.gov be sure to include a call-back contact number. Major emergencies also require a call to 911. Note: Although not required by rule, the IUB has requested telephone notice also be made to the Engineering staff. See Appendix A. BE PREPARED TO PROVIDE THE FOLLOWING INFORMATION: 1.The name of the utility, the name and telephone number of the person making the report, and the name and telephone number of a contact person knowledgeable about the incident. 2.Location and time of incident. 3.If any, the number of persons dead or injured and extent of injuries. 4.Initial damage estimate. 5.Number of services interrupted. 6.A summary of the significant information available to the utility regarding the probable cause of the incident and extent of damages. 7.Any oral or written report required by the U. S. Department of Transportation and the name of the person who made the oral or prepared the written report. Revised 03.18 Page 35 (Page Intentionally Left Blank) Revised 03.18 Page 36 EMERGENCY PLAN & PROCEDURES RECORDING KEEPING & DOCUMENTATION FORMS TABLE OF CONTENTS Leak Investigation & Repair…………...………………………………………….37 Electronic CGI Calibration Record………………………………………….…….39 Dig-In Report…………………………..………………………………….………40 Mechanical Fitting Failure Report…………..………………………….…………42 Line-Hit/Accident Investigation Follow-up Report…………..……….……….….43 No-Flow Test Report…………………………………………..……….….………44 Employee Emergency Training Record………………………..………….………45 First Responder & Public Officials Emergency Training Record………….……...46 Pipeline Accident Investigation Checklist…………………………….……….…..48 Revised 03.18 Page 37 LEAK INVESTIGATION & REPAIR Utility:__________________________________________________________________ REPORT OF LEAK Date Reported:_________________________Time:___________________ AM PM Reported by:_______________________________Address:_____________________________________________ City/State/Zip:_____________________________________________Phone No.:___________________________ Person reporting is: Customer General Public Other:_____________________________________ Reason for suspected leakage:_____________________________________________________________________ Location of suspected leakage:____________________________________________________________________ DISPATCHED Person receiving leak call:________________________________________________________________________ Date:_________________________Time:_______________________ AM PM Person dispatched to:___________________________________Title:_____________________________________ LEAK INVESTIGATION Time arrived at leak location:_________________________________ AM PM Leak found: In House Outside ABOVE Ground Outside BELOW Ground NO LEAK Leak Classification: 1 2 3 Classified with a CGI: Yes No Gas % found:______________ CO % found:_________________ Completed bar-holes Yes No If underground leak, map of leak migration pattern completed: Yes No (see reverse side for leak map) REPAIR Date repair started:_______________________Date finished:____________________________ Leak location: Meter Set House piping Service Line Main Other:____________________ Repairs made:____________________________________________________________________ ______________________________________________________________________________ Conducted No Flow Test: Yes No Start Time:______________Stop Time:________________ Any movement of the ½ ft or 2 ft hand? Yes No Signature:________________________________________________ Revised 03.18 Page 38 MAP OF LEAKAGE AREA (Bar-hole mapping is required for all underground leaks) NOTE: Map information should include at a minimum, bar-hole locations with CGI readings to determine the boundaries of the spread migration. Revised 03.18 Page 39 Utility ELECTRONIC CGI CALIBRATION RECORD SERIAL NUMBER: NOTE: Calibration on each CGI is to be performed per the manufacturers recommended procedures. The following table is to be completed each time calibration is performed. The table is to be completed with a "GO", "NO GO" or "NA" response to each of the 5 calibration items. If a "GO" response is entered, calibration was successful. If a "NO GO" response is entered, calibration was not successful and should be addressed in the comments section. If an "NA" response is entered, that calibration item is "not applicable" to your machine. CALIBRATION ITEMS DATE OPERATOR LEL UEL CO H2S PROPANE COMMENTS Revised 03.18 Page 40 Part A – Who is Submitting This Information Who is providing the information? Electric Engineer/Design Equipment Manufacturer Excavator Insurance Liquid Pipeline Locator Natural Gas One-Call Center Private Water Public Works Railroad Road Builders State Regulator Telecommunications Unknown/Other Name of the person providing the information: Part B - Date and Location of Event *Date of Event:(MM/DD/YYYY) *Country *State *County City Street address Nearest Intersection *Right of Way where event occurred Public: City Street State Highway County Road Interstate Highway Public-Other Private: Private Business Private Land Owner Private Easement Pipeline Power /Transmission Line Dedicated Public Utility Easement Federal Land Railroad Data not collected Unknown/Other Part C – Affected Facility Information *What type of facility operation was affected? Cable Television Electric Natural Gas Liquid Pipeline Sewer (Sanitary Sewer) Steam Telecommunications Water Unknown/Other *What type of facility was affected? Distribution Gathering Service/Drop Transmission Unknown/Other Was the facility part of a joint trench? Unknown Yes No Was the facility owner a member of One-Call Center? Unknown Yes No Part D – Excavation Information *Type of Excavator Contractor County Developer Farmer Municipality Occupant Railroad State Utility Data not collected Unknown/Other *Type of Excavation Equipment Auger Backhoe/Trackhoe Boring Bulldozer Cable Plow Directional Drilling Explosives Farm Equipment Grader/Scraper Hand Tools Milling Equipment Probing Device Trencher Vacuum Equipment Data Not Collected Unknown/Other *Type of Work Performed Agriculture Cable Television Curb/Sidewalk Bldg. Construction Bldg. Demolition Drainage Driveway Electric Engineering/Survey Fencing Grading Irrigation Landscaping Liquid Pipeline Milling Natural Gas Pole Public Transit Auth. Railroad Maint. Road Work Sewer (San/Storm) Site Development Steam Storm Drain/Culvert Street Light Telecommunication Traffic Signal Traffic Sign Water Waterway Improvement Data Not Collected Unknown/Other Part E – Notification *Was the One-Call Center notified? Yes (If Yes, Part F is required) No (If No, Skip Part F) If Yes, which One-Call Center? If Yes, please provide the ticket number Part F - Locating and Marking *Type of Locator Utility Owner Contract Locator Data Not Collected Unknown/Other *Were facility marks visible in the area of excavation? Yes No Data Not Collected Unknown/Other *Were facilities marked correctly? Yes No Data Not Collected Unknown/Other DIG-IN REPORT Revised 03.18 Page 41 Part G – Excavator Downtime Did Excavator incur down time? Yes No If yes, how much time? Unknown Less than 1 hour 1 hour 2 hours 3 or more hours Exact Value ______ Estimated cost of down time? Unknown $0 $1 to 500 $501 to 1,000 $1,001 to 2,500 $2,501 to 5,000 $5,001 to 25,000 $25,001 to 50,000 $50,001 and over Exact Value ______ Part H – Description of Damage *Was there damage to a facility? Yes No (i.e. near miss) *Did the damage cause an interruption in service? Yes No Data Not Collected Unknown/Other If yes, duration of interruption Unknown Less than 1 hour 1 to 2 hrs 2 to 4 hrs 4 to 8 hrs 8 to 12 hrs 12 to 24 hrs 1 to 2 days 2 to 3 days 3 or more days Data Not Collected Exact Value _______ Approximately how many customers were affected? Unknown 0 1 2 to 10 11 to 50 51 or more Exact Value _______ Estimated cost of damage / repair/restoration Unknown $0 $1 to 500 $501 to 1,000 $1,001 to 2,500 $2,501 to 5,000 $5,001 to 25,000 $25,001 to 50,000 $50,001 and over Exact Value ______ Number of people injured Unknown 0 1 2 to 9 10 to 19 20 to 49 50 to 99 100 or more Exact Value _______ Number of fatalities Unknown 0 1 2 to 9 10 to 19 20 to 49 50 to 99 100 or more Exact Value _______ Part I – Description of The Root Cause **Please choose one One-Call Notification Practices Not Sufficient Locating Practices Not Sufficient No notification made to the One-Call Center │ Facility could not be found or located Notification to one-call center made, but not sufficient │ Facility marking or location not sufficient Wrong information provided to One Call Center │ Facility was not located or marked │ │ Incorrect facility records/maps Excavation Practices Not Sufficient │ Miscellaneous Root Causes Failure to maintain marks One-Call Center error Failure to support exposed facilities │ Abandoned facility Failure to use hand tools where required Deteriorated facility Failure to test-hole (pot-hole) │ Previous damage Improper backfilling practices │ Data Not Collected Failure to maintain clearance │ Other Other insufficient excavation practices │ –Additional Comments Revised 03.18 Page 42 MECHANICAL FITTING FAILURE REPORT Date __________________ Time _____________________ By ____________________________ ADDRESS OR GENERAL LOCATION -- Sketch Location of Leak . . . . . . . . . ____________________________________ . . . . . . . . . ____________________________________ . . . . . . . . . ____________________________________ . . . . . . . . . INVESTIGATION Leak Classification 1 2 3 (NOTE: Only Class 1 hazardous leaks are required to be reported to PHMSA) Nominal Pipe Size _____” Material Type ____________________ Fitting Manufacturer ______________ Lot Number __________ Date of Manufacture ___________________ Date of Installation _______________ Any Other Markings on Failed Fitting ________________________________________________________ Nature of Failure (including pipeline environment): _______________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Other Observations: ________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Repairs made: ____________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ This form is used to collect mechanical fitting failures that resulted in hazardous leaks that will be reported annually on the Mechanical Fitting Failure Report F 7100.1-2 or may be submitted throughout the year. NOTE: This form will be filled out and attached to the Leak Investigation & Repair Report, and Exposed Pipe/Bellhole Report for all mechanical fitting failures. Revised 03.18 Page 43 LINE HIT/ ACCIDENT INVESTIGATION FOLLOW-UP REPORT Note: This report shall be completed after a line hit or accident has occurred with or without the release of natural gas. Utility: ______________________________________________________________________ Follow-up Report conducted by:___________________________________________________ Date:_____________________________ Date of Line Hit/Accident:_______________________________ Did the line hit/accident involve the release of gas?____________________________________ Were there any injuries or fatalities?________________________________________________ Was there any property damage?___________________________________________________ What was the cause of the line hit/accident?__________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Were Emergency Procedures followed and properly documented?_________________________ ______________________________________________________________________________ Were all leak investigations properly conducted and documented?_________________________ ______________________________________________________________________________ ______________________________________________________________________________ Was Mutual Aid assistance needed?_________________________________________________ If so, was the work performed by the Mutual Aid assistance properly documented?___________ ______________________________________________________________________________ What can be done to minimize the possibility of this type of line hit/accident from recurring? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Signature:___________________________________________________ Revised 03.18 Page 44 NO-FLOW TEST REPORT Location Address______________________________________________________________ Meter Make: ______________________ Size: ___________________________ Serial Number: ___________________________ TEST: Time Start: _______________________________ Stop: ___________________________ Reading Start: _____________________________ Stop: ___________________________ Regulator Pressure Setting as Found and as Left: __________________ Lock Up: _________________________________ Comments: BY: ______________________________________________ DATE: ___________________________ Revised 03.18 Page 45 EMPLOYEE EMERGENCY TRAINING RECORD Note: Employee emergency training shall be conducted at least annually and documented with all dispatch, on-call, and operating personnel to ensure prompt and effective response to each of the following type of emergencies. 1.Training shall include a review of procedures that ensure prompt and effective response to the following types of emergencies: a.Gas detected inside or near a building b.Fire located near or directly involving a pipeline facility c.Explosion occurring near or directly involving a pipeline facility d.Natural disaster 2.The following topics shall also be discussed and reviewed during the training session: a.Annual review of the Emergency Plan. b.A review of each employee's responsibility in an emergency, including the responsibility of all employees to adhere to utility guidelines for statements to the press and general public. c.A review of the location, use and periodic inspection of emergency equipment. d.A review of the location and use of system maps, main records, service records, valve records, regulator schematics, and properties of natural and LP-gas. e.Bypass procedures. f.A step-by-step review of procedures using a hypothetical emergency situation, including procedures for contact with public officials, fire, police and other agencies. g.Record keeping. h.Emergency reports (telephonic and written). Date of training:________________________ Trainer:____________________________________________________ Location of training:______________________________________________________ PRINT NAME SIGNATURE TITLE Revised 03.18 Page 46 POLICE, FIRE, FIRST RESPONDER, & PUBLIC OFFICIAL EMERGENCY TRAINING RECORD Note: The utility shall conduct documented meetings, at least annually, with representatives of the police, fire, first responder, and public official. 1. Police, fire, first responder training shall include applicable procedures during each type of the following emergencies: a.Gas detected inside or near a building. b.Fire located near or directly involving a pipeline facility. c.Explosion occurring near or directly involving a pipeline facility. d.Natural disaster. e.The department’s contact of the utility in the event of gas related fires, physical damage to pipeline facilities, line hits, suspected leaks, etc. f.Respective responsibilities during gas related accidents. g.Rules when fighting gas-fed fires. h.Instruction on valves - where, who shuts off what, and when. 2. The following topics shall be reviewed and discussed during the meeting to: a.Learn the responsibility and resources of each government organization that may respond to a gas pipeline emergency b.Acquaint the officials with the operator’s ability in responding to a gas pipeline emergency. c.Identify the types of gas pipeline emergencies of which the operator notifies the officials. d.Plan how the operator and officials can engage in mutual aid assistance to minimize hazards to life or property. e.Explain in training or provide instructional materials describing the basic properties of natural gas. Date of training:__________________________ Trainer:________________________________________________ Training Location:________________________________________________ PRINT NAME SIGNATURE ORGANIZATION Revised 03.18 Page 47 PRINT NAME SIGNATURE ORGANIZATION Revised 03.18 Page 48 PIPELINE ACCIDENT INVESTIGATION CHECKLIST U.S. DEPT. OF TRANSPORTATION SAFETY INSTITUTE 1. TIME REPORTED______________________ 2. DATE________________________ 3. REPORTED TO NRC: YES____ NO_____ DATE & TIME:________________________ 4. REPORTED BY:________________________________ 5. TITLE__________________________ 6. WHERE ACCIDENT OCCURRED:____________________________________________________ _____________________________________________________________________________________ 7. WHEN ACCIDENT OCCURRED:_____________________________________________________ 8. APPARENT CAUSE: (See attachemet______)___________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 9. EXPLOSION: YES_______ NO________ 10. FIRE: YES_______ NO_________ 11. DEATHS: YES_______ NO________ 12. INJURIES: YES_______ NO________ 13. LINE SIZE:___________________ 14. OPERATING PRESSURE_______________________ 15. TRANSMISSION:_________ 16. DISTRIBUTION:___________ 17. SERVICE:____________ 18. NUMBER OF CUSTOMERS AFFECTED BY OUTAGE:__________________________________ 19. DURATION OF OUTAGE:___________________________________________________________ 20. DAMAGE TO SYSTEM & OTHER PROPERTIES: (See attachment_____) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 21. ESTMIATED SYSTEM REPAIR COST:_________________________________________ Revised 03.18 Page 49 22. INJURIES: Name, Age, Nature of Injury (See attachment_____) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 23. DEATHS: Name, Age, Cause of Death (See attachment_____) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 24. NAME OF PROPERTY OWNER: (See attachment______) ______________________________________________________________________________ 25. ADDRESS OF PROPERTY OWNER: (See attachment______) ______________________________________________________________________________ ______________________________________________________________________________ 26. TIME ORDER WAS RECEIVED BY OPERATOR:________________________________ 27. TIME ORDER WAS DISPATCHED BY OPERATOR:______________________________ 28. NAME OF EMPLOYEES DISPATCHED & TIME OF THEIR ARRIVAL: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 29. TIME NATURAL GAS WAS CUT OFF & METHOD USED TO DO SO: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 30. DESCRIPTION OF BUILDING INVOLVED:_____________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Revised 03.18 Page 50 31. TYPE & AMOUNT OF DAMAGE TO BUILDING OR OTHER PROPERTY: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 32. PICTURES OF BUILDING & CONTENTS: YES_____ NO_____ (See attachment_____) 33. DIAGRAM OF ACCIDENT SCENE: YES____ NO____ (See attachment_____) 34. PRESSURE TESTED OR BAR TESTED SERVICE LINE: (See attachment_____) YES______ NO______ 35. BAR TESTED MAIN IN FRONT & ADJACENT TO LOCATION: (See attachment_____) YES______ NO______ 36. BAR TESTED AREA AROUND BUILDING: (See attachment_____) YES______ NO______ 37. SAMPLE OF GAS FROM BAR HOLE & PIPELINE REQUIRED: (See attachment____) YES______ NO______ 38. SAMPLE OF FLAMMABLE LIQUID IF FOUND: YES______ NO_______ 39. NAME OF OFFICERS IN CHARGE OF FIRE DEPT, POLICE DEPT, & OTHER PUBLIC OFFICIALS AT THE SCENE: (See attachment)______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 40. NAMES OF TELEVISION STATIONS, RADIO STATIONS & REPORTERS WHO WERE PRESENT, IF APPLICABLE: (See attachment____)____________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 41. STATEMENTS FROM GAS COMPANY EMPLOYEES WHO WERE AT THIS ADDRESS PRIOR TO ACCIDENT OR AT TIME OF ACCIDENT, IF APPLICABLE: (When and what were their actions?) (See attachment______) Revised 03.18 Page 51 42. STATEMENT FROM WITNESS OR A BRIEF DESCRIPTION OF WHAT WAS SAID: (See attachment______)__________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 43. METER # AND INDEX READING AT TIME OF ACCIDENT, IF APPLICABLE: ______________________________________________________________________________ 44. SEARCH OF GAS COMPANY RECORDS FOR ANY INFORMATION RELATING TO ADDRESS INVOLVED PRIOR TO ACCIDENT: (See attachment______) ______________________________________________________________________________ 45. METER HISTORY—DATE OF TURN ON, LAST METER/INDEX READING AT THAT TIME: (See attachment____)______________________________________________________ 46. DOT 20-DAY LEAK REPORT REQUIRED? YES______ NO_______ (Attachment____) 47. COLLECT COPIES OF ORDERS, ROUTE SHEETS, ETC., RELATING TO INCIDENT THAT WE MIGHT BE CALLED ON TO PRODUCE AT A LATER DATE: (Attachment____) 48. METALLURGICAL ANALYSIS REQUIRED: YES______ NO_______ 49. SOIL TEST ANALYSIS REQUIRED: YES_____ NO______ 50. COMPLETE WEATHER REPORT REQUIRED: YES_____ NO_____ 51. INVESTIGATION REPORT COMPLETED: (Attachment____) Non-Compliaces_________ RECOMMENDATIONS:_________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ OTHER REMARKS:____________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Revised 03.18 Page 52 GAS SYSTEM EMERGENCY PLAN & PROCEDURES A Model Plan from the IOWA ASSOCIATION OF MUNICIPAL UTILITIES 1735 NE 70th Avenue Ankeny, Iowa 50021-9353 515/289-1999 Disclaimer of Warranty and Limitation of Liability This model plan has been developed by the Iowa Association of Municipal Utilities to promote the safe operation and maintenance of municipal gas systems and compliance with federal regulation of gas pipeline operators. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is furnished with the understanding that neither the Association nor its licensed agent is engaged in rendering legal or other professional service. If legal advice or other professional or expert assistance is required, the services of a competent professional person should be sought. This publication is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. The entire risk as to the quality, performance, and accuracy of the manual is with the holder. © Iowa Association of Municipal Utilities, Revised 2018