(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).
(b) Each utility shall include the following on Form E-5G:
(1) The current, date and name and address of utility;
(2) Date, time of discovery, and location of accident;
(3) Description of any person injured including:
a. Name;
b. Age;
c. Residence;
d. Employer; and
e. Status of any injured person, whether employee, person under contract, invitee, licensee, trespasser or other;
(4) Description of injury, current condition, duration of disability and, if applicable, anticipated return to work date;
(5) Description of cause and manner of accident;
(6) If applicable, cause of death and previous related accident report number;
(7) Designation of federal or state statute violated, if applicable;
(8) Estimated amount of property damage and breakdown of property damage amounts;
(9) Method of discovery of the accident;
(10) Estimated amount of gas released measured in terms of 1,000 cubic feet (mcf) and value of gas released, including calculations;
(11) Time operator or contractor acting on behalf of operator arrived on scene;
(12) Time operator made pipeline safe;
(13) Date and time final restoration and return to gas service was completed;
(14) Quantity of people evacuated and quantity of meters shut off or service interrupted;
(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) Date and time of notification to the National Response Center, if required;
(17) Recommendation for and steps taken to guard against repetition of accident; and
(18) The signature, full name and title of the utility employee who supervised the preparation of the report, and date of signature.
*ViaData Note: The link to this form on the New Hampshire Public Utilities Commission website is provided by ViaData as a convenience.