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Pipeline Safety Program Sample Inspection Forms

Following are examples of forms used by Pipeline Safety Program inspectors.

• Distribution Integrity Management Program (DIMP) Inspection Form for Operators of Gas Distribution Systems for Requirements of 192.1005-192.1011 (265 KB)
• Gas Integrity Management Inspection Manual and Inspection Protocols with Results Forms (631 KB)
• PHMSA Public Awareness Program Effectiveness Inspection Specific Information, Form 21 (120 KB)
• SDPUC 2012 Inspection Plan (52 KB)
• SDPUC 2012 Records Inspection Checklist (115 KB)
• Substance Abuse Program: Comprehensive Audit and Inspection Protocol Form Specimen Collection Sites, Form No.: 3.1.7 (62 KB)
• Substance Abuse Program: Comprehensive Audit and Inspection Protocol Form Alcohol Testing Sites, Form No.: 3.1.8 (64 KB)
• Substance Abuse Program: Comprehensive Audit and Inspection Protocol Form Combined Anti-Drug and Alcohol Misuse Programs, Form No.: 3.1.11 (279 KB)

• Gas Integrity Management Inspection Manual and Inspection Protocols with Results Forms (755 KB)
• Gas Integrity Management Protocols with Form (193 KB)
• Gas IMP Field Verification Inspection (182 KB)
• Operator Qualification Field Inspection Protocol Form (157 KB)
• Operator Inspection-Specific Information (299 KB)

• SDPUC 2010 Records Inspection Checklist and Apendices A and B (264 KB)
• SDPUC 2010 Public Awareness Inspection Checklist for Distribution Facilities (38 KB)
• SDPUC 2010 Public Awareness Inspection Checklist for Transmission Facilities (38 KB)
• PHMSA Substance Abuse Program: Comprehensive Audit and Inspection Protocol Form Combined Anti-Drug and Alcohol Misuse Programs, 2010 (221 KB)