Summit Pipeline Inspector Daily Inspection & Safety Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Contractor

Location

• Add location
  Address

Date - Time

• Select date

  Date

Weather

Temperature

Specific task being performed

• Maine line

  Yes

  No

  N/A

• Service

  Yes

  No

  N/A

• HDD

  Yes

  No

  N/A

• Leak repair

  Yes

  No

  N/A

• Sewer repair

  Yes

  No

  N/A

• Purge

  Yes

  No

  N/A

• Emergency repair

  Yes

  No

  N/A

Other task not listed above

• Yes

  No

  N/A

Operator Qualifications

• Does the contractor have proper OQ documentation

  Yes

  No

  N/A

• Are there at least 2 OQ operators present

  Yes

  No

  N/A

Safety items

• Has the contractor completed the mandatory JSA

  Yes

  No

  N/A

• Has the inspector identified any employees not wearing the required PPE

  Yes

  No

  N/A

• List the name / names of any employee who is not wearing the correct PPE below

• Has the inspector visually confirmed that the fire extinguisher is fully charged

  Yes

  No

  N/A

• Does the task require the use of a flash suit

  Yes

  No

  N/A

• Has the employee worn the suit during the necessary time

  Yes

  No

  N/A

Excavations

• Has the Dig Safe ticked been verified

  Yes

  No

  N/A

• Has the proposed excavation been properly pre-marked

  Yes

  No

  N/A

• Depth of excavation

• Is there a trench box being used

  Yes

  No

  N/A

• Are there egress ladders in use every 25' for excavations over 4' deep

  Yes

  No

  N/A

• Are the spoil piles set back to the required minimum of 2'

  Yes

  No

  N/A

• Are there any unprotected holes that require immediate attention

  Yes

  No

  N/A

Listed below are any comments that the inspector feels necessary related specifically to safety items

Job-Site Set Up

• Has proper site set up been completed including proper signage per MUTCD

  Yes

  No

  N/A

• Are there flaggers in use

  Yes

  No

  N/A

• Are the flaggers posted at the beginning of the taper

  Yes

  No

  N/A

• Do the flaggers hold a valid certification

  Yes

  No

  N/A

• Do the flaggers have an escape route

  Yes

  No

  N/A

• Have provisions been made for safe pedestrian access including proper signs

  Yes

  No

  N/A

• Has the site set up properly barricaded the public from entering the work zone

  Yes

  No

  N/A

• Has the inspector had to make any corrections to the job site

  Yes

  No

  N/A

Electro-Fusion Inspection Checklist

General:

• Fusion Technicians Name:

• Company:

• Did the operator complete an inspection of equipment for cleanliness and proper operation

  Yes

  No

  N/A

• Did the operator clean pipe ends with a clean, dry, lint-free, non-synthetic cloth, such as cotton

  Yes

  No

  N/A

Couplings

• Were the pipe ends cut square and even

  Yes

  No

  N/A

• Was the stab depth marked on the pipe with an approved marking tool

  Yes

  No

  N/A

• Was the pipe scraped properly and the stab depth re-marked on the pipe

  Yes

  No

  N/A

• Was the OD of the pipe and the ID of the coupling cleaned with 96% solution isopropyl alcohol and allowed to dry

  Yes

  No

  N/A

• Was an approved scraper used and if so list the type

  Yes

  No

  N/A

• Was the pipe inserted into the coupling to the stab depth marks

  Yes

  No

  N/A

• Was the barcode on the fitting scanned using the reader wand on the processor

  Yes

  No

  N/A

• Was a check made to ensure the fitting was read correctly

  Yes

  No

  N/A

• Was the cooling time recorded on the pipe wall

  Yes

  No

  N/A

Sidewall Fittings ( Including patches and tapping tees ):

• Was the area to be fused marked with a non petroleum based marker

  Yes

  No

  N/A

• Was the area to be fused upon scraped with an approved pipe penetration tool

  Yes

  No

  N/A

• Was an approved scraper used and if so list the type

  Yes

  No

  N/A

• Was the area to be fused re-marked with a non petroleum based marker

  Yes

  No

  N/A

• Was the area to be fused cleaned with 96% solution isopropyl alcohol

  Yes

  No

  N/A

• Was the fitting to be fused cleaned with 96% solution isopropyl alcohol

  Yes

  No

  N/A

• Was the barcode on the fitting scanned using the reader wand on the processor

  Yes

  No

  N/A

• Was a check made to ensure the fitting was read correctly

  Yes

  No

  N/A

• Was the cooling time recorded on the pipe wall

  Yes

  No

  N/A

• Pass

• Fail

• Quantity of Fusions Inspected

• Quantity of Fusions Found Unsatisfactory

• Actions Taken

Additional Comments

Photos

• Add media

  Media

Butt Fusion Inspection Checklist

• Fusion Technician

• Company

• Did the operator complete an inspection of equipment for cleanliness and proper operation

  Yes

  No

  N/A

• Did the operator clean the pipe ends with a clean, dry, lint-free, non-synthetic cloth, such as cotton

  Yes

  No

  N/A

• Were the pipe ends faced to the facer stops

  Yes

  No

  N/A

• Were shavings and chips removed after facing pipe

  Yes

  No

  N/A

• Had the facer stopped rotating before the jaws were opened

  Yes

  No

  N/A

• When the pipe ends were brought together under pressure were any visual gaps observed

  Yes

  No

  N/A

• Did the operator check the alignment of the pipe ends

  Yes

  No

  N/A

• What is the measured amount of misalignment ( inches or MM)

• Was the operation checked for pipe slippage at fusion pressure

  Yes

  No

  N/A

• Was drag pressure properly calculated

  Yes

  No

  N/A

• Drag pressure observed

  Yes

  No

  N/A

• How was Theoretical Fusion Pressure calculated ( not required for manual machines)

• Data logger

• Fusion Pressure Calculator

• McCalc

• Formula

• What was the observed gauge pressure ( Theoretical Fusion Pressure + Drag) that was used to fuse the pipe

• Was the heater cleaned and the surface temperature checked with a pyrometer

  Yes

  No

  N/A

• What was the observed pyrometer temperature reading

• Was the recommended shift sequence followed ( hydraulic machines)

  Yes

  No

  N/A

• Was pressure applied during heat soak ( manual machines)

  Yes

  No

  N/A

• Did the bead size against the heater before the heater removal

  Yes

  No

  N/A

• Inspected pipe interfacial area after heater removal

  Yes

  No

  N/A

• Was the condition acceptable

  Yes

  No

  N/A

• Was the locking cam engaged during the cooling cycle ( manual machines)

  Yes

  No

  N/A

• Is the finished bead size uniform and acceptable

  Yes

  No

  N/A

• Completed cooling cycle time (under fusion pressure)

• Hours

• Minutes

• Seconds

• Is the operator proficient with the Data logger set up and operation

  Yes

  No

  N/A

• Was the joint Data logged

  Yes

  No

  N/A

• Pass

• Fail

• Quantity of Fusions Inspected

• Quantity of Fusions Found Unsatisfactory

Additional Comments

Photos

• Add media

  Media

Pipeline Pressure Test Report

• This form must be completed for each section of newly installed section of pipe or service line that is disconnected from the main for any reason

Pipeline Data

• Line Location

• Pipeline Installed By:

• Completion Date:

Test Data

• Type of Pipe

• Size of Pipe (Inches)

• Length of Line (Linear Foot)

Test Medium

• Nitrogen

• Air

• Natural Gas

• Water

• Other (please describe)

• Time Started

• Am

• Pm

• Time Ended

• Am

• Pm

• Test Pressure Start (PSIG)

• Test Pressure Stop (PSIG)

• Line Loss

  Yes

  No

  N/A

• Corrective Measures Taken

Pressure Test Approval

• Pass

• Fail

• Remarks

• Contractor Representative:

  Sign

• Select date

  Date

• Summit Natural Gas Inspector:

  Sign

• Select date

  Date

Photos

• Add media

  Media

Daily Inspection Report - Mains/ Headers

• Is this a main

• Is this a header

• CYBD Number

• Service a Order Number

• Tailgate Meeting Held

  Yes

  No

  N/A

• Increased Inspection Frequency

  Yes

  No

  N/A

• Nunber of Days

Crew Member Name and Title - Include OQ Approved ( List Task Numbers)

Inspection Checklist - Task

• Are at least two OQ'd fusion operators present

  Yes

  No

  N/A

• Were pressure test reports reviewed

  Yes

  No

  N/A

• Were exposed main reports reviewed

  Yes

  No

  N/A

• Are photographs of all crossings within 14' attached

  Yes

  No

  N/A

• Was site material inspected for correctness and quality

  Yes

  No

  N/A

• Was backfill inspected for depth and quality

  Yes

  No

  N/A

• Are as-built drawings current and accurate

  Yes

  No

  N/A

• Quantity of fusions inspected

• Quantity of fusions found unsatisfactory

• Crew member performing functions

• Action taken

Inspector

• Add signature

  Sign

• Select date

  Date

Daily Inspection Report - Services

Crew Members Name and Title - Include OQ Approved (List Task Numbers

Service #1

• Location - Street

• Closest Intersection

• Were pressure test reports reviewed

  Yes

  No

  N/A

• Were exposed main reports reviewed

  Yes

  No

  N/A

• Are photographs of all crossings within 14' attached

  Yes

  No

  N/A

• Was pipe protection required

  Yes

  No

  N/A

• Was the site material inspected for correctness and quality

  Yes

  No

  N/A

• Was backfill inspected for depth and quality

  Yes

  No

  N/A

Service #2

• Location - Street

• Closest Intersection

• Were pressure test reports reviewed

  Yes

  No

  N/A

• Were exposed main reports reviewed today

  Yes

  No

  N/A

• Are photographs of all crossings within 14' attached

  Yes

  No

  N/A

• Was pipe protection required

  Yes

  No

  N/A

• Was site material inspected for correctness and quality

  Yes

  No

  N/A

• Was backfill inspected for depth and quality

  Yes

  No

  N/A

Service #3

• Location - Street

• Closest Intersection

• Were pressure test reports reviewed

  Yes

  No

  N/A

• Were exposed main reports reviewed

  Yes

  No

  N/A

• Are photographs of all crossings within 14' attached

  Yes

  No

  N/A

• Was pipe protection needed

  Yes

  No

  N/A

• Was the site material inspected for correctness and quality

  Yes

  No

  N/A

• Was backfill inspected for depth and quality

  Yes

  No

  N/A

Inspection Checklist - Task

• Do all new crew members have OQ documentation approved by SNG-ME Forman prior to work

  Yes

  No

  N/A

• Are at least two OQ'd fusion operators present

  Yes

  No

  N/A

• Was fusion plates checked for temperature today

  Yes

  No

  N/A

• Are as-built drawings current and accurate

  Yes

  No

  N/A

• As-built should align with Commercial Report

• Were pipe fusions inspected

  Yes

  No

  N/A

• Quantity of fusions inspected

• Quantity of fusions found unsatisfactory

  Yes

  No

  N/A

• Crew member performing fusions

• Action taken

• Inspector

• Add signature

  Sign

• Select date

  Date

Inspection of Exposed Pipe

• Location - Street

• Select date

  Date

By house number

By pole number

Other

Service

Main

Size

Depth of Pipe

Types of Pipe

• Plastic

• Steel

Condition of Pipe

• Poor

• Fair

• Good

• If Pitting, Depth if Pits

Coating

• Yes

  No

  N/A

• Condition

Coating Material

• Epoxy (Green)

• Plastic (Yellow)

• Pritec ( Black)

Interior Condition

• Checked

• Not checked

If checked:

• Tap Coupon

• Pipe Segment

Condition

• Poor

• Fair

• Good

• Wall thick

Comments

• Signature of Person Reporting:

• Add signature

  Sign

• Signature of Secondary Qualified Reporter:

• Add signature

  Sign

Conclusion - Final thoughts and or Comments

Photos

• Add media

  Media