Form Center

2. Madison Natural Gas Pipeline Safety Survey
4. 1. In the last year, have you seen or heard any information from the City of Madison relating to pipeline safety?*

   1. Yes

   1. No
5. 1.a. What was the source of the information?*

   Check all that apply

   1. Written material (brochure, flyer, handout)
   2. Radio
   3. TV
   4. Newspaper ad or article
   5. Face-to-face meeting
   6. Posted information (e.g. on or near City of Madison's pipeline)
   7. Other
7. 1.b. About how many times did you see the information on pipeline safety in the last year?*
9. 2. Have your or has anyone in your household ever tried to obtain information about pipeline safety in the last 12 months?*

   1. Yes
   2. No

   1. Don't know
10. 2.a. Where did you try?*

    Check all that apply

    1. Call
    2. Letter
    3. Visit to gas company office
    4. Other
12. 3. Do you live close to a petroleum or gas pipeline?*

    1. Yes
    2. No
13. 3.a. Where is the pipeline or how close are you to it?*
15. 4. What would you do in the event you were first to see damage to a pipeline?*

    Check all that apply

    1. Call 911
    2. Call the pipeline operator
    3. Flee the area
    4. Nothing (it is not my responsibility)
    5. Other
17. 5. What would you do if you saw someone intentionally trying to damage a pipeline?*

    Check all that apply

    1. Call 911
    2. Call the pipeline operator
    3. Flee the area
    4. Nothing (it is not my responsibility)
    5. Other
19. 6. Have you ever called a pipeline operator, 911, or anyone else to report a suspicious or worrisome activity near a pipeline?*

    1. Yes

    1. No
20. 6.a. What did you report?*

    Click all that apply

    1. A pipeline break
    2. A pipeline leak
    3. Digging near the pipeline
    4. Other
22. 7. Have you or anyone in your household or company ever encountered a damaged pipeline or product released from a pipeline?*

    1. Yes

    1. No
23. 7.a. What did you do?*
25. 8. Have you ever passed information about pipeline safety to someone else?*

    1. Yes

    1. No
26. 8.a. What information and to whom?*
28. 9. Who would you contact if you needed to know the location of a gas line or other utility on your property?*

    1. City of Madison
    2. The Utilities Protection Center (811)
    3. I do not need to contact anyone
    4. The phone, power, and water companies
30. 10. Do you agree or disagree that the City of Madison has been doing a good job of informing people about pipeline safety?*

    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
31. If you disagree, why?*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field