Information
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MNOPS Case #
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MNOPS Inspector
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Inspection Start Date
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Brief Site Description
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Operator / Contractor
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Site Location
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Personnel Interviewed
Construction Questions
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Daily/Site Inspection Report
Date/Site
Basic Site Information
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Date for this inspection
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Project Synopsis
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Location
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(if different from basic site location)
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Existing Pipe Description [size, type, pressure, etc]
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New Pipe Description [size, type, pressure, etc]
General Construction Considerations
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General Construction Considerations?
GSOC Info
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GSOC Ticket Number
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Notes
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Photo
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Construction Plan Reviewed?
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Construction Specifications Reviewed?
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Condition of Pipe Materials?
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Elimination of Rocks & Debris in Pipe Contact Area?
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Back-fill Free of Materials That Could Damage Pipe or Coating?
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Caps on Stockpiled Pipe / Temporary End Caps on Pipe in Ditch and Stored Pipe?
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Proper Cover?
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Meter Set / Above Ground Facilities Protected From Damage?
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Carrier Protected in Casing?
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Fire Extinguisher Available and Date Checked?
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Shear Sleeve Installed at Service Tee Outlet?
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Excess Flow Valve Installed Where Required?
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Is any directional drilling/boring involved in the project?
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Does operator's directional drilling/boring procedures include actions to protect their facilities from the dangers posed by drilling and other trench less technologies (i.e. cross bores)?
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Do records / observations indicate that directional drilling/boring procedures were followed to protect their facilities from the dangers posed by drilling and other trench less technologies (i.e. cross bores)?
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Following excavation tolerance zone and maintaining clearance?
Steel Pipelines
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Steel Pipeline?
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Welder Qualification/Card Checked and Not Expired?
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Welding Procedures Checked?
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Weld Inspections and NDT Requirements?
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Buried pipe examined for external corrosion when exposed?
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Pipe removed from pipeline examined for internal corrosion?
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Cathodic Protection Voltage Checked?
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External Coating; Fittings and Welds Coated or Wrapped?
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Anode(s) Installed?
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Test Leads?
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Pressure Testing?
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Check duration, pressure, and use of calibrated equipment.
Plastic Pipelines
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Is there plastic pipe?
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Frequency of Heating Iron Temperature Checks by Fuser?
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Reviewed Fuser’s Documentation of Heating Iron Temperature Checks?
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Pressure Testing / Pretesting?
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Check duration, pressure, and use of calibrated equipment.
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Is the date of manufacture on the pipe less than permissible UV exposure for outdoor storage, or does the operator have records for indoor storage?<br>-Medium Density PE (Yellow PE2406/PE2708) shall not be exposed to UV rays, direct or indirect, for longer than 3 years.<br>-High Density PE (Black PE3408/PE4710) shall not be exposed to UV rays, direct or indirect, for longer than 10 years.<br>(provided operator manual has been updated and allows for storage longer than historical two years)
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Pipe Marking ASTM 2513 or 2517?
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Joining Qualification/Card Checked and Not Expired?
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Fusion Procedures Checked?
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Fuser knows Cooling Time Between Final Fusion & Leak Test/Rough Handling/Handling?
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Cooling Time Matches Fusion Procedures?
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Locate Wire Splices Coated/Protected?
Site Sketch or Photo
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Include Site Sketch?
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Drawing
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Include Site Photo(s)?
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Photo
Notes
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Record any pertinent notes
Notes
Operator Qualifications / Drug & Alcohol
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Check OQ? [maintenance/rehab/O&M covered?]
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Random Check of OQ For Which Person(s) [PHMSA Form 15 – Protocol 9]. Record employee name and covered task,
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Span of control utilized?
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Direct Supervision of Any Unqualified Person(s) [192.805(c)]?
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Employee(s) recognize Abnormal Operating Conditions (AOCs)?
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Supervisor understands Drug and Alcohol – Reasonable suspicion, accident, training [199] requirements?
Summary / Violations
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Synopsis
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Any probable violations observed?
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Description of Any Probable Violation Found
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Exit Interview Completed?
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Photos
