PSMS Metrics Collection Form

PSMS Metrics Collection Form - 2026
Organization Name
Quarter
Stakeholder Engagement

# Damages (1st Party) per 1000 Tickets
DATA
COMMENTS
# Damages (2nd Party) per 1000 Tickets
DATA
COMMENTS
# Damages (3rd Party) per 1000 Tickets
DATA
COMMENTS
# Damages due to No Call / 811
DATA
COMMENTS
Risk Management

# Aging Infrastructure Replacement Plan vs Actual
DATA
COMMENTS
# Leak Backlog vs Plan by Grade (Class 2)
DATA
COMMENTS
# Leak Backlog vs Plan by Grade (Class 3)
DATA
COMMENTS
# Damages per 1000 Tickets
DATA
COMMENTS
# Cast Iron Breaks per Mile of Cast Iron
DATA
COMMENTS
# Customer Unplanned Outages per 1000 Customers
DATA
COMMENTS
Incident Investigation & Lessons Learned

# Lessons Learned Shared Internally
DATA
COMMENTS
Safety Assurance

% Internal Company Audits / Assessments Findings vs Planned Audits / Assessments
DATA
COMMENTS
Management Review & Continuous Improvement

% Corrective Actions Late *
DATA
COMMENTS
* % Corrective Actions Late is defined as: # Corrective Actions Open / Total # Corrective Actions Due.
Emergency Preparedness & Response

% Drills / Simulations vs Plan
DATA
COMMENTS
% Emergency Response within 60 min
DATA
COMMENTS
% Emergency Response within 45 min
DATA
COMMENTS
% Emergency Response within 30 min
DATA
COMMENTS
Competence, Awareness, & Training

% Operator Qualification Completion / Plan
DATA
COMMENTS
Documentation & Record Keeping

# Damages due to Incorrect Maps / Records
DATA
COMMENTS
Should be Empty:

PSMS Metrics Collection Form - 2026