Exit 2023 Online School Pipeline Safety Assessment Question Title * 1. Please list your contact information. School Name: Your Name: Your Title: School Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Phone Number: Email Address: Question Title * 2. Please select the method of school pipeline safety training you have engaged in through this program. (select all that apply) School Pipeline Safety on Demand VIDEO School Pipeline Safety personal VISIT School Pipeline Safety WEB-MEETING School Pipeline Safety annual MAILER with poster (received and reviewed) Other (please specify) Question Title * 3. Please indicate the date the communication you selected above occurred. Date VIDEO was viewed Date Date of VISIT Date Date of WEB-MEETING Date Date of OTHER Date Question Title * 4. Prior to this program, were you aware that there are underground pipeline(s) located near your school that carry natural gas or other petroleum products? Yes No Question Title * 5. Does the aerial map provided on the schools safety web page accurately reflect your campus? Yes, the map is accurate No, the map needs to be updated Describe changes to be made on the aerial map. Question Title * 6. Are you aware of what product (Natural Gas, Crude Oil, etc.) is in the pipeline near your school? Yes No Question Title * 7. Do you know the company name and emergency phone number for the pipeline near your school? Yes No Question Title * 8. Do you know how to identify a pipeline marker? Identify Pipeline Markers Yes No Question Title * 9. Are you aware of the one-call notification system (811) and requirements for safe digging/excavation? 811 Yes No Question Title * 10. Are you aware of the physical indications of a pipeline leak? Identify a pipeline leak Yes No Question Title * 11. Are you aware of the hazards associated with an unintended release from a pipeline? Hazard Information Yes No Question Title * 12. Are you aware of the minimum evacuation distance that is recommended if your school experiences a pipeline emergency that results in an evacuation? Yes No Question Title * 13. In the event of a pipeline leak, does your school currently have an emergency plan that evacuates safely away from the pipeline to the recommended evacuation distance? Advanced Planning Yes No Unsure Other Please Explain Question Title * 14. After reviewing the information provided today, do you feel BETTER prepared to identify and respond to a potential pipeline emergency near your school? Yes No Unsure If No or Unsure, please explain Next