* 1. Please list your contact information.

* 2. Please select the method of school pipeline safety training you have engaged in through this program. (select all that apply)

* 3. Please indicate the date the communication you selected above occurred.

Date VIDEO was viewed
Date of VISIT

* 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?

* 5. Do you know how to identify a pipeline marker?

* 6. Are you aware of the one-call notification system (811) and requirements for safe digging/excavation?

* 7. Are you aware of what product (Natural Gas, Crude Oil, etc.) is in the pipeline near your school?

* 8. Are you aware of the physical indications of a pipeline leak?

* 9. Are you aware of the hazards associated with an unintended release from a pipeline?

* 10. Do you know what actions to take in the event of a pipeline leak?

* 11. Are you aware of the minimum evacuation distance that is recommended if your school experiences a pipeline emergency that results in an evacuation?

* 12. Do you know the company name and emergency phone number for the pipeline near your school?