PHMSA - Feedback

(Required fields are identified by an *)

Contact Information

Name: *

Affiliation *

Organization:

Company:

Street Address:

City:

State:

Country (International Only):

Zip Code:

E-mail Address: *

Telephone Number: *

Fax Number:

Registration Number:

Message Summary

Type: *

Guide Number:

Question Category: *

What type of message would you like to send? *

Topic *

Date of Desired Workshop or Seminar: *

Location of Desired Workshop or Seminar: *

Please Enter Your Question/Comment: *

Please Upload File (Only upload PDF files):

Complaint Information

Any person with knowledge of excavation damage to a hazardous liquid or natural gas pipeline subject to Title 49 Code of Federal Regulations (CFR), Part 192 & Part 195 may complete this form. PHMSA will use this form as the first step to determine if there was a potential violation of Title 49 CFR Part 196 - Protection of Underground Pipelines from Excavation Activity. PHMSA is not obligated to act on any information that is submitted. PHMSA will only contact you in the event that we decide to investigate the damage.

In what state did the alleged excavation damage occur?
[PHMSA does not have jurisdiction over excavators in States that are not listed here. If the excavation damage occurred in a State that is not listed here, you may wish to contact the excavation damage prevention law enforcement organization in that State.] *

Did the damage occur to a natural gas or hazardous liquid pipeline subject to Title 49 CFR, Part 192 or Part 195? * Yes No

Was there excavation damage to the pipeline (see definitions below)? * Yes No

Was the damage caused by a pipeline operator or their contractor? Yes No

Contact Information

Your Name: *

Your Company/Affiliation: *

Street Address: *

City: *

State: *

Zip Code: *

E-mail Address: *

Telephone Number: *

Mobile Telephone:

Do you want your identity to remain anonymous? * Yes No

Message Summary

Please provide as much information about the pipeline excavation damage as possible:

Location of the excavation damage (physical address, coordinates, or intersection). Please be as precise as possible: *

Date of excavation damage: *

Time of excavation damage: * :

Time zone: *

Description of pipeline damage: *

Parties involved (who damaged the pipeline?): *

Injuries/emergency response required/evacuation required/etc.? *

Was there a release of natural gas or hazardous liquids? *

Are you aware of a valid one-call (811) dig ticket for the excavation activity? *

Any other relevant information:

Attachments:

Guidance: Upload any documentation that may be relevant to the excavation damage. Documentation may include photographs, written statements, sketches, copies of one-call tickets, etc.

Verification

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions *