OPS Forms:
Where to mail forms:
ATTN: Information Resources Manager
US DOT, Office of Pipeline Safety
1200 New Jersey Ave., SE
East Building, 2nd Floor, (PHP-10)
Room Number E22-321
Washington, DC 20590
Form Types
The following forms are provided in Word, Microsoft Word, PDF, and compressed format. The Word, Microsoft Word, and PDF format can be printed and filled out manually. The compressed format contains the Word template and may be stored on your hard drive. The PDF file may be saved directly to your hard drive by using the right mouse click over the link, and pick "save link as".
Adobe provides a free PDF document reader that can be used to view or print PDF files. Learn more about the Adobe Reader and how to download it.
Required Forms
The following forms are provided in Word, Microsoft
Word, PDF, and compressed format. The Word, Microsoft Word, and PDF format
can be printed and filled out manually. The compressed format contains the Word
template and may be stored on your hard drive. The PDF file may be saved directly
to your hard drive by using the right mouse click over the link, and pick "save
link as".
Adobe provides a free PDF document reader that can be used to view or print PDF files. Learn more about the Adobe Reader and how to download it.
| INTEGRITY MANGEMENT Forms |
Integrity Management Reporting
[back to top]
Gas Integrity Management Reporting Data Collection form
[Microsoft Word (52K)] [Acrobat (17K, PDF))]
Gas Integrity Management Reporting Instructions
[Microsoft Word (61K)] [Acrobat (49K, PDF)] |
| DRUG & ALCOHOL Forms |
Drug and Alcohol Testing
[back to top]
Drug Testing Management Information System (MIS) Data Collection Form
[Microsoft Word (52K)] [Acrobat (64K, PDF)]
Drug Testing Management Information System (MIS) Data Collection Instructions
[Microsoft Word (61K)] [Acrobat (108K, PDF)]
Pipeline and Hazardous Materials Safety Administration (PHMSA) Drug and Alcohol MIS Internet Reporting Instructions
[Microsoft Word (42K)] [Acrobat (42K, PDF)]
Final Rule: Procedures for Transportation Workplace Drug and Alcohol Testing Programs:
Drug and Alcohol Management Information System(MIS) Reporting
[Microsoft Word (75K)] [Acrobat (52K, PDF)]
|
HQ Drug Inspection Form - F 3.1.7 (These documents do not include recent changes to Part 199 and Part 40.)
[back to top]
Collection Site Procedures Inspection Form
[Microsoft Word (162K)]
HQ Inspection Form Anti-Drug Program
[Microsoft Word (128K)] |
HQ Alcohol Inspection Form - F 3.1.8 (These documents do not include recent
changes to Part 199 and Part 40.)
[back to top]
Collection Site Procedures Inspection Form
[Microsoft Word (94K)]
HQ Inspection Form Alcohol Misuse Prevention Program
[Microsoft Word (138K)] |
Field Drug Inspection Form - F 3.1.9 (These documents do not include recent changes to Part 199 and Part 40.)
[back to top]
Anti-Drug Program
[Microsoft Word (45K)] |
Field Alcohol Inspection Form - F 3.1.10 (These documents do not include recent changes to Part 199 and Part 40.)
[back to top]
Alcohol Misuse Prevention Program
[Microsoft Word (52K)] |
Self Assessment Form - F 3.1.11 (These documents do not include recent changes to Part 199 and Part 40.)
[back to top]
Anti-Drug & Alcohol Misuse Prevention Program
[Microsoft Word (49K)] |
| PHMSA/OPS Forms (accidents/incidents/annuals) |
- Hazardous Liquid Pipelines
|
|
|
|
|
| |
|
|
- Gas Transmission and Gathering Systems
|
|
| |
| PHMSA Forms (inspections/evaluation/qualification) |
PHMSA Form-1 (Standard Inspection Report of a Gas Transmission Pipeline)
[back to top]
Microsoft Word (1.5M) |
Acrobat (263K) Updated 07MAR08 |
PHMSA Form-2 (Standard Inspection Report of Gas Distribution Operator)
[back to top]
Microsoft Word (1.6M)
| Acrobat (291K) Updated 07MAR08 |
PHMSA Form-3 (Standard Inspection of a Liquid Pipeline Carrier)"
[back to top]
Microsoft Word (1318K) |
Acrobat (178K, PDF)
Updated 07MAR08 |
PHMSA Form-4 (Standard Inspection Report of an LNG Facility)
[back to top]
Microsoft Word (1100K) |
Acrobat (252K, PDF) Updated 07MAR08 |
PHMSA Form-5 (Evaluation Report of Gas Pipeline & Compressor Station Construction)
[back to top]
Microsoft Word (522K) |
Acrobat (63K) Updated 07MAR08 |
PHMSA Form-7 (Evaluation Report of Liquid Pipeline Construction)
[back to top]
Microsoft Word (469K) |
Acrobat (69K, PDF) Updated 07MAR08 |
PHMSA Form-10 (Breakout Tank Inspection Form)
[back to top]
Microsoft Word (1.09M) |
Acrobat (145K, PDF) Updated 07MAR08 |
PHMSA Form-11 (Pipeline Failure Investigation Report)
[back to top]
Microsoft Word (905K) |
Acrobat (96K) Updated 07MAR08 |
PHMSA Form-12 (Gas Storage Field Review)
[back to top]
Microsoft Word (901K) |
Acrobat (127K) Updated 07MAR08 |
PHMSA Form-13 PHMSA
2008 Drug and Alcohol Program Check
(To be used in conjunction with other inspections)
[back to top]
Microsoft Word (88K) |
Acrobat (35K) Updated 07MAR08 |
PHMSA Form-14 (Operator Qualification Inspection Form)
[back to top]
Microsoft Word (297K) |
Acrobat (207K, PDF) Updated 07MAR08 |
PHMSA Form-15 (Operator Qualification Field Inspection Form)
[back to top]
Microsoft Word (111K) |
Acrobat (56K, PDF) Updated 07MAR08 |
PHMSA Form-17 (Supplemental SCC Questionnaire Gas Transmission or Liquid Pipeline)
[back to top]
Microsoft Word (33K) |
Acrobat (14K) Updated 24MAR06 |
PHMSA Form-18 (Evaluation of LNG Facility Siting, Design, Construction and Equipment)
[back to top]
Microsoft Word (1157K) |
Acrobat (912K) Updated 09MAR07 |
PHMSA Form-19 (Hazardous Liquid IMP Field Verification Inspection)
[back to top]
Microsoft Word (225K) |
Acrobat (100K) Updated 07MAR08 |
Last Update
11-sep-08 10:45 AM
|
