Field Checklist Template

Pipeline Leak Survey Form That Works Offline

Most leak surveys happen where the phone has no bars. This form saves on the phone anyway, records which segment you walked and with what instrument, and keeps every leak you find tied to its repair.

  • Segment: line ID, start and end points, class location
  • Instrument: detector type, serial number, calibration date
  • Survey: method, conditions, areas you could not reach
Works offline in the field Audit-ready records

Pipeline Leak Survey

Pipeline Leak Survey

Synced
Segment, class location and surveyor recordedPass
Leak detector checked and serial number loggedPass
Valves, risers and above-ground pipingPass
Manholes, vaults and pavement cracks along the routePass
Road and creek crossingsPass
5 of 5 checks passedready to submit

Field status

Saved offline · syncs on reconnect

Interactive checklist

Work through the field-ready essentials

0 of 9 checked

Field workflow

How to use this form

01

Set it up per system

Add your segments and your leak grades to the template, so every surveyor records them the same way.

02

Survey the segment

Record the instrument before you start. The form saves on the phone without signal and syncs when you are back in coverage.

03

Log every leak on the spot

Mark each leak as a failed item with its reading, grade and photo. A hazardous leak still gets handled under your emergency procedures first.

04

Close each leak out

Every failed item becomes a corrective action with an owner and a due date. The repair, the recheck and the closeout stay with the survey.

Built for the job

What to include in a pipeline leak survey form

A leak survey record has to answer the same questions years later: which pipe, when, how it was checked, and what happened to each leak.

Segment and surveyor

Line or system ID, the start and end of the segment walked, class location or business district, surveyor name, and the date of the survey.

Instrument and method

Leak detector type and serial number, last calibration or bump test, and the method used, such as walking, mobile or a check at manholes and pavement cracks.

Conditions and coverage

Weather and ground conditions that affect readings, and any part of the segment you could not survey, with the reason.

Each leak found

Location or GPS point, reading, the leak grade your procedures use, a photo, and whether you made the area safe before leaving.

Repair record

Who owns the repair, the due date your procedures set for that grade, the date it was repaired, and any recheck after the repair.

Clean surveys too

A survey that found no leaks still gets a record with a date and a name. Without it, nothing shows the survey happened on time.

Compliance & proof

This form is a starting point

Federal rules for gas pipelines set minimum leak survey intervals in 49 CFR Part 192. Transmission lines are surveyed at intervals not exceeding 15 months, at least once each calendar year, with shorter intervals in Class 3 and 4 locations for lines carrying unodorized gas (192.706). Distribution systems are surveyed with leak detector equipment at least once each calendar year in business districts and at least once every 5 calendar years outside them (192.723). Hazardous leaks must be repaired promptly (192.703). State programs and your own procedures can require more.

It does not replace your operations and maintenance procedures or the rule text. Survey intervals, leak grading and repair deadlines depend on your system, your state and your procedures.

  • One record per segment surveyed, with date, surveyor and instrument
  • Each leak located, graded and photographed, with repair dates through to closeout
  • Surveys with no findings kept alongside the ones with leaks

Questions from the field

Pipeline leak survey form FAQ

When binders stop scaling

Run this survey on a phone

BasinCheck saves each leak survey with the surveyor, time and location, works without signal, and turns every leak into a corrective action with an owner and a due date.

In BasinCheck

Inspection and JSA connected

Failed item assigned and tracked

Evidence retained for review