Information
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PM Number:
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MOC Short Description:
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Location:
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Date:
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This form shall be completed for new facilites or modified facilities when the modification is significant enough to require a change in the process safety information (PSI) before any hydrocarbons or other highly hazordous chemicals are introduced into the process. Attach additional information (checklists, training documentation, etc.) if appropriate. (This information may also be kept in MOC application)
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New Process?
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Modified Process?
Team Members:
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Operations:
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Engineering:
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Construction:
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Safety:
Pre- Startup Safety Review Requirements:
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The following are specific requirements for new facilities and for modified facilities which were shutdown for turnaround or modification, plus common requirements for both. Check all that apply. Indicate the responsible person(s) or group(s). Sign and date when complete. Space is provided to list details if appropriate.
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For all facilities, the construction and equipment is in accordance with design specifications.
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Responsibility (Facility Engineer, Construction Specialist, etc.):
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Add signature
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For all facliites, the safety, operating, maintenance, and emergency procedures are in place and adequate prior to startup.
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Responsibility (Process Specialist, Process Supervisor, Safety):
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Add signature
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List the procedures prepared or revisited:
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For new facilities, a Process Hazard Analysis (PHA) has been performed and the critical PHA recommendations have been resolved or implemented prior to startup.
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Responsibility (Engineering, Process Specialist, Safety):
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Add signature
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For modified facilities, the Management of Change (MOC) has been authorized for the change identified on MOC and this PSSR.
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Responsibility (Engineering,Process Specialist, Process Supervisor, Safety):
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Add signature
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At the time of startup, each employee (staff or contractor) involved in operating the process has been trained.
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Responsibility (Process Specialist, Process Supervisor):
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Add signature
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List the employees that have been trained prior to startup:
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A walk-through checklist has been performed, and the showstoppers have been addressed prior to startup.
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Responsibility (Engineering, Process Specialist, Process Supervisor, Safety):
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Add signature
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Note: Followup training for employees or contractors involved in the process but not involved in the startup, will be captured on the Pre-Startup training checklist.
