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Inspection Checklists/Forms

Washington UTC pipeline safety inspectors use forms and checklists when conducting their inspections. These forms ensure that inspectors cover all the requirements under state and federal law. State requirements apply only to intrastate pipelines. The forms listed below are used when conducting inspections of intrastate facilities. Interstate forms can be found on the PHMSA website.

Forms below are in Microsoft Word Format


Random Crew Inspection - Gas Distribution

Random Crew Inspection - Gas Transmission

Random Crew Inspection - Liquids

Gas Pipeline Construction Evaluation

Gas Distribution Records Review and Field Inspection

Gas Transmission Records Review and Field Inspection

Standard Intrastate Gas Inspection - Procedures and Plan Review

Propane/Air Peak Shaving System Inspection Guide & Report

Standard Inspection Report for Small LPG Systems-Records Review & Field Inspection

Standard Liquid Inspection - Procedures and Plan Review

Standard Liquid Inspection - Records Review & Field Inspection

Headquarter Alcohol Mis-use

Headerquarter Anti-Drug

Haz. Liquid Pipeline Operator Jurisdictional Evaluation Report

Uprate Checklist

Operator Qualification Field Verification Form

Optional Field Data Collection Form





Posted/updated: 07/13/2010