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Name:
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Date:
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Do you have natural gas pipelines running through your community?
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Do you know the name of your local natural gas company?
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If yes, who?
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Have you heard or seen a message regarding natural gas safety in the last 12 months?
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If yes, about how many?
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Before today, about when was your last contact with someone from the natural gas
Industry related to pipeline safety?
(If known, fill in approximate date or number of weeks, months, or years ago.)
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Do you have the number to call the natural gas company if there is an incident or
you need more information?
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Do you know who regulates the natural gas company in this community?
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Do you know what precautions an excavator should take prior to digging to avoid
accidentally hitting a natural gas pipeline?
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If yes, what are they?
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Are you familiar with the one-call line?
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How would you rate the adequacy of information you have about natural gas safety
(e.g., how to recognize a leak, what to do when there is a leak, what first responders
should do, etc.)?
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Does your community have an emergency response plan to deal with a natural gas leak
(regardless of whether intentional or accidental.)?
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Are you aware of any pipeline leaks that occurred in your community in the last
2 years?
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If yes, how many?
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What were they?
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Have any of your local citizens or businesses expressed concern in the last 12 months
about any issue regarding natural gas safety?
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If yes, what was it?
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Overall, do you feel the natural gas industry has an adequate public safety awareness
program?
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