School Pipeline Safety Assessment

Please complete the checklist below to ensure that you have the critical information needed to identify, respond, and help prevent a potential pipeline emergency.

Names and Titles of the Participants: *

Participating School Staff know (select all that apply): *

how to identify a pipeline marker,
the location of the pipeline(s) near the school,
the product that is in the pipeline(s)
the purpose and requirements for using 811,
the physical indications of a pipeline leak,
the hazards associated with a pipeline leak,
the actions to take in the event of a pipeline leak,
the minimum recommended evacuation distance that is provided,
the pipeline company's name and emergency phone number.

Additional Comments or Questions:

Email (to receive a copy):