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NGD Leakage QA/QC
NGD Leakage QA/QC
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NGD Leakage QA/QC

Technical Support Audit V 1.5

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Free NGD Leakage QA/QC Checklist

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Information

  • Employee Name / Crew Leader

  • Audit Type

  • Location

  • TCC Location

    • COH-Springfield (0651)
    • COH-Wintersville (0731)
    • COH-Bellaire (0732)
    • COH-East Liverpool (0733)
    • COH-Columbus SE (0822)
    • COH-Columbus NE (0823)
    • COH-Columbus NW (1324)
    • COH-Columbus Central & SW (1325)
    • COH-Alliance (0971)
    • COH-Findlay (1031)
    • COH-Fremont (1053)
    • COH-Firelands (1054)
    • COH-Toledo (1121)
    • COH-Lorain (1222)
    • COH-Middleburg HTS (1261)
    • COH-New Lexington (1424)
    • COH-Zanesville (1441)
    • COH-Cambridge (1442)
    • COH-Coshocton (1443)
    • COH-Newark (1451)
    • COH-Athens (1521)
    • COH-Chillicothe (1531)
    • COH-Jackson (1533)
    • COH-Portsmouth (1541)
    • COH-Mansfield (1721)
    • COH-Marion (1732)
    • COH-Mt. Vernon (1743)
    • COH-Ironton (1943)
    • CMD-Hagerstown (2141)
    • CMD-Cumberland (2151)
    • CMD-Greencastle (2171)
    • CPA-Mt. Lebanon (2221)
    • CPA-Rochester (2231)
    • CPA-Emleton (2232)
    • CPA-New Bethlehem (2234)
    • CPA-Warren (2239)
    • CPA-Smithfield (2321)
    • CPA-Washington (2391)
    • CPA-York (2421)
    • CPA-State College (2451)
    • CPA-Bradford (2238)
    • CKY-Lexington (2621)
    • CKY-Frankfort (2623)
    • CKY-Winchester (2629)
    • CKY-Ashland (2631)
    • CKY-Maysville (2632)
    • CKY-Lancer (2633)
    • CGV-Fredricksburg (3730)
    • CGV-Lynchburg (3760)
    • CGV-Chester (3770)
    • CGV-Staunton (3810)
    • CGV-Vint Hill (3815)
    • CGV-Lexington (3830)
    • CGV-Suffolk (3910)
    • CMA-Westboro (0855)
    • CMA-Brockton (0856)
    • CMA-Springfield (0857)
    • CMA-Ludlow (0911)
    • CMA-Taunton (0952)
    • CMA-Brockton-Meadow Ln. (0953)
    • CMA-Easton (0954)
    • CMA-Hanover (0955)
    • CMA-Wrentham (0956)
    • CMA-Northampton (0957)
    • CMA-Lawrence (0961)

  • PSID

  • RT Number

  • Site ID

  • Job Order Number

  • Route Number

  • Prepared by

  • Company Employee(s) (CREW)

  • Vehicle Number

  • Contractor Involved?

  • Contractor Company Name

    • Alex E. Paris Contracting Company,Inc.
    • Allegheny Contracting, LLC
    • Area Wide Protective
    • Atmospheric Corrosion Specialist
    • Banks Gas Services,Inc.
    • Buckeye Utility Services, LLC
    • C.J. Hughes Construction Company,Inc.
    • Casper Colosimo & Son,Inc.
    • Corrpro
    • Crofton Diving System
    • Dekatherm,Inc.
    • Feeney Brothers Excavation, LLC
    • InfraSource Construction Services, LLC
    • InfraSource Construction, LLC
    • Kinsley Construction, LLC
    • KS Energy Services, LLC
    • Lineal Industries, Inc.
    • M. O'Herron Company
    • Matcor
    • Matvest,Inc. DBA Bermex
    • Michels Corporation
    • Mid-Ohio Pipeline Company, Inc.
    • Miller Pipeline Corporation
    • Minnesota Limited
    • New England Utility Constructors,Inc.
    • NPL Construction Company
    • Premier Utility Services
    • R&R Construction Company
    • R.L. Coolsaet Construction Co.
    • RH White Construction Company,Inc.
    • Riley Brother, Inc.
    • RLA Investments, Inc.
    • Robert J. Devereaux Corporation
    • Rummel,Klepper & Kahl
    • Southeast Connections, LLC
    • Stanley Pipeline, Inc.
    • Tank Services Co.
    • The Fishel Company
    • Trace Services,Inc.
    • Utility Line Services, Inc.
    • W.E. Curling, Inc.

  • Contract Foreman

  • Crew Members

  • Conducted on

Safety and PPE

  • Work Zone Safety Checklists

  • Leakage

  • Proper Cone Placement (HSE 4100.020)

  • Tools Properly Staged and Stored (HSE 4100.050)

  • Placement of Vehicle and Ignition Sources Away and Upwind From Work Area (GS 1770.010)

  • Personal Protective Equipment

  • Hard Hat (HSE 4200.050)

  • Gloves (HSE 4200.040)

  • Eye Protection (HSE 4200.030)

  • Proper Footwear (Foot Protection) (HSE 4200.020)

  • Traffic Vest (MUTCD)

  • Hearing Protection (HSE 4000.030)

  • All PPE in Clean and Serviceable Condition

  • Equipment and Tools

  • Availability and Conditions of Tools (HSE 4100.050)

  • Hand Tools in Good Condition (HSE 4100.050)

  • Vehicles

  • Valid Drivers License

  • Engine Off When Parked (HSE 4100.050)

  • Low Gear or Reverse When Parked (Manual) (HSE 4100.050)

  • Ignition Keys Removed When Unattended (HSE 4100.050)

  • Parking Brake Set (HSE 4100.050)

  • Vehicle Free of Clutter and In Cab Distractions (HSE 4100.050)

  • MDT Properly Secured (HSE 4100.050)

  • Vehicle Backed Into Parking Space Where Practical (HSE 4100.050)

  • Strobes and/or Warning Lights in Use At Night

  • Insurance and Crash Packet Available (HSE 4300.020)

  • Vehicle Warning Lights Operating

  • Ergonomics

  • Proper Lifting Techniques Used

  • Proper Body Mechanics (Pull/Push)

  • HAZMAT/Chemicals (HSE 4000.040)

  • Chemical Information Available (HSE 4000.040)

  • Employees Know Chemical Hazards (HSE 4000.040)

  • Containers in Good Condition

  • Containers and Secondary Containers Are Properly Labeled (HSE 4000.040)

  • Containers Closed and Sealed (HSE 4410.010)

  • Aerosol Cans Managed Properly

  • Flammables in Safety/Approved Cans (HSE 4410.010)

  • Recognition of Hazards

  • Tripping/Slipping Hazards or Holes

  • Traffic/ Pedestrian Hazards

  • Structural (Floor,Steps,Porch)

  • Low Clearances/ Overhead

  • Exposed, Low Hanging Electrical Hazards

  • Poison (Ivy, Oak, Etc.) Plant Life Hazards

  • Ticks or Insects - Spray?

  • Stray Animals/ Dogs

  • Brush, Limbs, etc.

  • Loose Meter Sets/Doors

  • Loose/Falling Objects

  • Sanitation

  • Handrails (Non-existent/Damaged)

  • Fire Protection/First Aid

  • Fire Extinguisher Inspected Monthly (HSE 4000.082)

  • Fire Extinguisher Tag Current (Annual) (HSE 4000.082)

  • Fire Extinguisher Positioned Properly (HSE 4100.010)

  • First Aid Kit Complete and Sanitary (HSE 4000.020)

  • First Aid Kit Consumables Replaced (HSE 4000.020)

  • Appearance

  • ID Badge

  • Uniform

  • Overall Appearance

Leakage

  • OQ Valid

  • Leakage

  • Equipment Calibrated (GS 1708.040)

  • Equipment Operated in Accordance with the Manufacturer's Instructions (GS 1708.040, .030)

  • Proper Understanding/Operation of the Equipment (GS 1708.030)

  • Survey-CSL

  • Understands/Follows Survey Sheets (GS 1708.100)

  • Correct Pattern Used (GS 1708.020)

  • Bar Test Underground Leaks (GS 1708.055)

  • Soap/CGI Aboveground Leaks (GS 1708.030)

  • Marked Leak Location

  • Proper Leak Grade (GS 1714.010)

  • Survey Technique (GS 1708.030)

  • Documentation/DPI Properly Completed (GS 1708.100)

  • Proper Notification and Action Taken When Grade 1 is Found (GS 1714.010)

  • Leaks/AOC's Not Documented During Initial Survey

  • Survey-Main (Walking)

  • Business Inspection (GS 1708.020)

  • Both Sides of the Street

  • Available Openings

  • Surveyed at the Building Walls/ Adjacent Walls (GS 1708.020)

  • Sufficient Number Bar of Holes

  • Proper Leak Grade (GS 1714.010)

  • Documentation/DPI Properly Completed (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Intermediate

  • Both Sides of the Street

  • Available Openings

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Completed (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Outside Business District (Residential) (GS 1708.020)

  • Both Sides of the Street

  • Available Openings

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Completed (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Supplemental (GS 1708.020)

  • Both Sides of the Street

  • Available Openings

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Completed (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Survey-Main (Moblie)

  • Business Inspection (GS 1708.020)

  • Both Sides of the Street

  • Proper Vehicle Speed (1708.030)

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Intermediate

  • Both Sides of the Street

  • Proper Vehicle Speed (1708.030)

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Supplemental (GS 1708.020)

  • Both Sides of the Street

  • Proper Vehicle Speed (1708.030)

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Outside Business District (Residential) (GS 1708.020)

  • Both Sides of the Street

  • Proper Vehicle Speed (1708.030)

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Designated Buildings (GS 1708.020)

  • Inspected Curb Box

  • Inspected CSL to Service Entrance

  • Inspected Meter Set

  • Inspected Inside of Wall Entry

  • Inspected Floor Drains

  • Inspected Outside Adjacent Facilities

  • Used Proper Equipment Based On Survey Location

  • Survey Technique (GS 1708.030)

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Reinspect (GS 1714.010)

  • Both Sides of the Street

  • Available Openings

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Reclassification

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Patrolling (GS 1702.010 Distribution) (GS 1704.010 Transmission)

  • Encroachment

  • Atmospheric Corrosion

  • Supports and Hangers

  • Expansion Joints

  • Casings

  • Coatings

  • Marker Placement and Correct Information Displayed (GS 1720.010)

  • Survey Technique (GS 1708.030)

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Follow Up (GS 1714.060)

  • Both Sides of the Street

  • Available Openings

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Positive Readings Found

  • Reclassification

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

  • Leaks/AOC's Not Documented During Initial Survey

  • Odor Investigation (GS 1708.070)

  • Established Scope of Area to Survey

  • Available Openings

  • Sufficient Number Bar of Holes

  • Proper Leak Grade

  • Documentation/DPI Properly Documented (GS 1708.100)

  • Marked Leak Location

  • Survey Technique (GS 1708.030)

  • Proper Action Taken When Grade 1 Is Found

Final Page

  • Reviewed Gas Standard on the Task Being Performed

  • Employee Demonstrated ability on how to Access the Gas Standards

  • Further Action Required

  • General comments

  • Years of Service

NGD Leakage QA/QC
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NGD Leakage QA/QC

Technical Support Audit V 1.5

Use this Template
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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