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* 1. Please list your contact information.

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

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

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Date

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* 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?

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* 5. Does the aerial map provided on the schools safety web page accurately reflect your campus?

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

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

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* 8. Do you know how to identify a pipeline marker?     Identify Pipeline Markers

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

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

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

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

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* 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

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* 14. After reviewing the information provided today, do you feel BETTER prepared to identify and respond to a potential pipeline emergency near your school?

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