Add location
Select date
Identify type of infringement?

Infringement notes:

Is the infringement over the pipeline?

If no, distance to nearest point on the pipeline?

Additional comments regarding proximity?

Pipeline information?

Site contact details?

Actions taken?

Advice given?

Site sketch (if applicable):
Name & Signature:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.