1. (a) Each utility shall file department "Form E-5G, Utility Accident Report," dated October 2023 with the department and the commission within 10 working days of when a utility accident, as described in En 508.03(b), occurs, and as required in En 508.03(c).

2. (b) Each utility shall include the following on Form E-5G:

   1. (1) The current, date and name and address of utility;
   2. (2) Date, time of discovery, and location of accident;

   3. (3) Description of any person injured including:

      1. a. Name;
      2. b. Age;
      3. c. Residence;
      4. d. Employer; and
      5. e. Status of any injured person, whether employee, person under contract, invitee, licensee, trespasser or other;
   4. (4) Description of injury, current condition, duration of disability and, if applicable, anticipated return to work date;
   5. (5) Description of cause and manner of accident;
   6. (6) If applicable, cause of death and previous related accident report number;
   7. (7) Designation of federal or state statute violated, if applicable;
   8. (8) Estimated amount of property damage and breakdown of property damage amounts;
   9. (9) Method of discovery of the accident;
   10. (10) Estimated amount of gas released measured in terms of 1,000 cubic feet (mcf) and value of gas released, including calculations;
   11. (11) Time operator or contractor acting on behalf of operator arrived on scene;
   12. (12) Time operator made pipeline safe;
   13. (13) Date and time final restoration and return to gas service was completed;
   14. (14) Quantity of people evacuated and quantity of meters shut off or service interrupted;
   15. (15) Description of the pipeline facility involved, such as: age, material type, diameter, location, classification, above ground, below ground, depth, pressure at time of accident, map of pipeline;
   16. (16) Date and time of notification to the National Response Center, if required;
   17. (17) Recommendation for and steps taken to guard against repetition of accident; and
   18. (18) The signature, full name and title of the utility employee who supervised the preparation of the report, and date of signature.

Source. #13796, eff 10-25-23