Hazard Review Worksheet

• Conducted on

  Date

• Prepared by

• Location
  Address

Section A: General Facility Considerations

• Have all operators been trained on the written operating procedures required for this facility?

  Yes

  No

• Have written operating procedures been prepared specifically for this facility?

  Yes

  No

Have potential consequences of this facility being located in close proximity to the following been considered?

• School, college or university

  Yes

  No

  N/A

• Daycare or pre-school

  Yes

  No

  N/A

• Hospital, clinic or medical facility

  Yes

  No

  N/A

• Industrial park

  Yes

  No

  N/A

• Residential area

  Yes

  No

  N/A

• Is this ammonia installation equipped with a remote-activated emergency shut-down system?

  Yes

  No

Can the entire ammonia installation be shut down from:

• the bulkhead or receiving area?

  Yes

  No

  N/A

• the riser(s) used for nurse tanks?

  Yes

  No

  N/A

• the riser(s) used for railcars?

  Yes

  No

  N/A

• a strategically placed remote location such as an office, etc?

  Yes

  No

  N/A

Has the possibility and consequences of each of the following been considered for this facility?

• Flooding (Flash or Flood Plain)

  Yes

  No

  N/A

• Tornado

  Yes

  No

  N/A

• Earthquake

  Yes

  No

  N/A

• Is the appropriate personal protective equipment available onsite and ready for use by operators performing handling, inspection, repair and maintenance duties?

  Yes

  No

• Is this installation protected from vandalism, sabotage or otherwise secured by a fenced perimeter?

  Yes

  No

• Is this ammonia installation protected from vandalism, sabotage or otherwise secured by security devices such as locks, etc?

  Yes

  No

• Is a 150 gallon "emergency jump tank" of clean water or an emergency safety shower always available to workers during transfer operations?

  Yes

  No

• Has this facility provided an emergency contact notification sign at the entrance to the facility?

  Yes

  No

• At any time or point is air introduced into equipment used for anhydrous ammonia?

  Yes

  No

Section B: Storage Tank Considerations

Are any storage tanks located in close proximity to the following activities?

• Roadway, street or path with substantial traffic

  Yes

  No

  N/A

• Movement of railcars of grain, fertilizer, etc

  Yes

  No

  N/A

• Airport or air strip with planes landing/taking off

  Yes

  No

  N/A

• Movement of a forklift, end loader or heavy equipment

  Yes

  No

  N/A

• Storage of nitrate (Ammonium, Potassium or Sodium)

  Yes

  No

  N/A

• Storage of flammable materials (Gasoline, Diesel or Propane)

  Yes

  No

  N/A

• Storage of combustible materials (Brush, Pallets, Tires, etc)

  Yes

  No

  N/A

• Storage of shop materials such as oxygen or acetylene gas

  Yes

  No

  N/A

• Are all tanks protected from vehicular impact by barriers of sufficient design and construction?

  Yes

  No

• Are all tanks protected from being overfilled beyond the 85% safe level?

  Yes

  No

• Has the possibility and consequences been considered that the contents of a storage tank filled to 85% during cold weather will increase in pressure resulting in the tank being overfilled?

  Yes

  No

• Do all tanks have a legible ASME dataplate?

  Yes

  No

• Are all components utilized on tanks constructed of materials compatible with anhydrous ammonia?

  Yes

  No

• Are all tanks equipped with properly sized excess flow valves?

  Yes

  No

• Are all tanks equipped with positive shutoff globe valves?

  Yes

  No

• Are all tanks equipped with emergency shutoff valves?

  Yes

  No

• Are all tanks equipped with current pressure relief valves and weatherproof rain caps?

  Yes

  No

• Are all tanks protected from vibration/movement by use of flexible connectors, swing joint or other means?

  Yes

  No

• Are all flexible connectors stainless steel and double-braided?

  Yes

  No

  N/A

• Is a fire extinguisher mounted and ready for use in the storage tank area?

  Yes

  No

  N/A

• Are all tanks painted, labeled and maintained in good condition?

  Yes

  No

  N/A

• Are all tanks inspected periodically to ensure the safe mechanical operating condition?

  Yes

  No

  N/A

• Is the appropriate personal protective equipment available onsite and ready for use in the storage tank area?

  Yes

  No

  N/A

• Have all operators involved with the storage tank process received training?

  Yes

  No

  N/A

• Has the person with responsibility for the maintenance and repair of the storage tank process received training?

  Yes

  No

  N/A

• Are all storage tanks shut down with valves closed and locked when not attended or in use?

  Yes

  No

  N/A

• Are all tanks installed with at least 18 inches of clearance from the bottom of the tank to ground level?

  Yes

  No

  N/A

• Are all tanks mounted on saddles of sufficient design and construction?

  Yes

  No

  N/A

• Are all tanks free of unacceptable dents or gouges?

  Yes

  No

  N/A

Section C: Compressor Considerations

• Section N/A ?

  No

  Yes, N/A

• Has the person with responsibility for the maintenance and repair of compressors received training?

  Yes

  No

  N/A

• Are all compressors inspected periodically to ensure the safe mechanical operating condition?

  Yes

  No

  N/A

Section D: Liquid Pump Considerations

• Section N/A ?

  No

  Yes, N/A

• Has the person with responsibility for the maintenance and repair of liquid pumps received training?

  Yes

  No

  N/A

• Are all liquid pumps inspected periodically to ensure the safe mechanical operating condition?

  Yes

  No

  N/A

• Are all liquid pumps used for ammonia equipped with a pressure-activated bypass?

  Yes

  No

  N/A

• Are all pressure-activated bypass devices tested periodically?

  Yes

  No

  N/A

Section E: Piping, Hose & Fitting Considerations

Is there any piping located in close proximity to the following activities?

• Roadway, street or path with substantial traffic

  Yes

  No

  N/A

• Movement of railcars of grain, fertilizer, etc

  Yes

  No

  N/A

• Airport or air strip with planes landing/taking off

  Yes

  No

  N/A

• Movement of a forklift, end loader or heavy equipment

  Yes

  No

  N/A

• Storage of nitrate (Ammonium, Potassium or Sodium)

  Yes

  No

  N/A

• Storage of flammable materials (Gas, Diesel or Propane)

  Yes

  No

  N/A

• Storage of combustible materials (Brush, Pallets, Tires, etc)

  Yes

  No

  N/A

• Storage of shop materials such as oxygen or acetylene gas

  Yes

  No

  N/A

• Is all piping protected from vehicular impact by barriers of sufficient design and construction?

  Yes

  No

  N/A

• Is underground piping utilized at this facility?

  Yes

  No

  N/A

• Are all underground runs of piping tested at least every 5 years for leaks?

  Yes

  No

  N/A

• Are all valves and fittings free of leaks?

  Yes

  No

  N/A

• Are all threaded/welded connections free of leaks?

  Yes

  No

  N/A

• Are all fittings, piping and hose constructed of materials compatible with anhydrous ammonia?

  Yes

  No

  N/A

• Is all piping painted and maintained in good condition?

  Yes

  No

  N/A

• Are all liquid and vapor lines properly labeled or color-coded?

  Yes

  No

  N/A

• Have the colors used to identify liquid and vapor lines been recorded in the written operating procedures?

  Yes

  No

  N/A

• Is all piping utilized in the system of seamless construction?

  Yes

  No

  N/A

• Are all pipe supports of sufficient design and construction?

  Yes

  No

  N/A

• If Schedule 40 piping is utilized in the system are all connections welded?

  Yes

  No

  N/A

• Are all hydrostatic relief valves rated 350-400 Psig so as not to exceed the installation's engineered design pressure?

  Yes

  No

  N/A

• Are all flexible connectors stainless steel and double-braided?

  Yes

  No

  N/A

• Are all flexible connectors installed per the manufacturer's instructions and limited to a length no longer than required for proper installation?

  Yes

  No

  N/A

• Are all fittings, piping and hose inspected annually to ensure safe mechanical operating condition?

  Yes

  No

  N/A

• Has the person with responsibility for the selection, repair and maintenance of piping, hose and fittings received training?

  Yes

  No

  N/A

• Are any hoses utilized for ammonia service made onsite?

  Yes

  No

  N/A

• Are all hoses made onsite for ammonia service tested annually to ensure satisfactory working pressure?

  Yes

  No

  N/A

• Has the practice of making hoses onsite and the consequences of failure been reviewed?

  Yes

  No

  N/A

• Are all hoses with expiration dates within the current operating timeframe?

  Yes

  No

  N/A

Section F: Bulkhead Considerations

• Are all bulkheads designed and constructed to withstand the force exerted in the event of a pull-away?

  Yes

  No

  N/A

• Are all bulkheads equipped with devices designed to "shear" and protect the plumbing?

  Yes

  No

  N/A

• Are all bulkheads equipped with positive shutoff globe valves?

  Yes

  No

  N/A

• Are all bulkheads equipped with emergency shutoff valves?

  Yes

  No

  N/A

• Are all bulkheads equipped with back-check valves?

  Yes

  No

  N/A

• Are all bulkheads inspected periodically to ensure the safe mechanical operating condition?

  Yes

  No

  N/A

• Has the person with responsibility for the maintenance and repair of bulkheads received training?

  Yes

  No

  N/A

• Are chock blocks available and ready for use in the bulkhead/receiving area?

  Yes

  No

  N/A

• Are all incoming trucks checked to confirm the transfer hose provided is constructed of materials that are compatible and approved for use with anhydrous ammonia?

  Yes

  No

  N/A

• Are "STOP-Tank Car Connected" sign(s) available and ready for use in the railcar bulkhead/receiving area?

  Yes

  No

  N/A

• Is the appropriate personal protective equipment available onsite and ready for use in the bulkhead/receiving area?

  Yes

  No

  N/A

• Are all bulkheads equipped with a "bleed-off" tank of water for use in capturing liquid ammonia?

  Yes

  No

  N/A

Section G: Riser Considerations

• Are all operators involved with using risers to load out ammonia properly trained on the process?

  Yes

  No

  N/A

• Are all risers equipped with pull-away protection designed and constructed to withstand a pull-away event?

  Yes

  No

  N/A

• Is all pull-away protection equipment properly installed so as to facilitate the shearing or breakaway in a pull-away event?

  Yes

  No

  N/A

• Are all risers equipped with properly sized excess flow valves?

  Yes

  No

  N/A

• Are all risers equipped with positive shutoff globe valves?

  Yes

  No

  N/A

• Are all risers equipped with emergency shutoff valves?

  Yes

  No

  N/A

• Are all valves properly labeled or color-coded?

  Yes

  No

  N/A

• Are all risers protected from vehicular impact by barriers of sufficient design and construction?

  Yes

  No

  N/A

• Are all risers inspected periodically to ensure the safe mechanical operating condition?

  Yes

  No

  N/A

• Has the person with responsibility for the maintenance and repair of the risers received training?

  Yes

  No

  N/A

• Are chock blocks available and ready for use in the riser/loading area?

  Yes

  No

  N/A

• Is the appropriate personal protective equipment available onsite and ready for use in the bulkhead/receiving area?

  Yes

  No

  N/A

• Is a fire extinguisher mounted and ready for use in the riser/loadout area?

  Yes

  No

  N/A

• Are all risers equipped with a means to secure hose end valves and other connections when unattended?

  Yes

  No

  N/A

Section H: Nurse Tank/Wagon Considerations

• Section N/A ?

  No

  Yes, N/A

Are any areas used to park nurse tanks located in close proximity to the following activities?

• Roadway, street or path with substantial traffic

  Yes

  No

  N/A

• Movement of railcars of grain, fertilizer, etc

  Yes

  No

  N/A

• Airport or air strip with planes landing/taking off

  Yes

  No

  N/A

• Movement of a forklift, end loader or heavy equipment

  Yes

  No

  N/A

• Storage of nitrate (Ammonium, Potassium or Sodium)

  Yes

  No

  N/A

• Storage of flammable materials (Gasoline, Diesel or Propane)

  Yes

  No

  N/A

• Storage of combustible materials (Brush, Pallets, Tires, etc)

  Yes

  No

  N/A

• Storage of shop materials such as oxygen or acetylene gas

  Yes

  No

  N/A

• Are all nurse tanks protected from being overfilled beyond the 85% safe level?

  Yes

  No

  N/A

• Has the possibility and consequences been considered that the contents of nurse tanks filled to 85% during cold weather will increase in pressure resulting in the tank being overfilled?

  Yes

  No

  N/A

• Do all nurse tanks have legible ASME dataplates?

  Yes

  No

  N/A

• Have all nurse tanks with missing or illegible ASME dataplates passed the visual inspection, tank thickness and pressure test required by DOT to remain in service?

  Yes

  No

  N/A

• Are all components utilized on nurse tanks constructed of materials compatible with anhydrous ammonia?

  Yes

  No

  N/A

• Are all nurse tanks equipped with properly sized excess flow valves?

  Yes

  No

  N/A

• Are all nurse tanks equipped with current liquid withdrawal valves?

  Yes

  No

  N/A

• Are all nurse tanks equipped with current liquid fill valves?

  Yes

  No

  N/A

• Are all nurse tanks equipped with current pressure relief valves and weatherproof rain caps?

  Yes

  No

  N/A

• Are all nurse tanks equipped with current vapor return valves?

  Yes

  No

  N/A

• Are all nurse tanks painted, marked and maintained in good condition?

  Yes

  No

  N/A

• Are all nurse tanks inspected periodically to ensure the safe mechanical operating condition?

  Yes

  No

  N/A

• Is the appropriate personal protective equipment available and ready for use with nurse tank operations?

  Yes

  No

  N/A

• Are all nurse tanks equipped with a supply of clean emergency water?

  Yes

  No

  N/A

• Have all operators involved with nurse tanks received training?

  Yes

  No

  N/A

• Has the person with responsibility for the maintenance and repair of nurse tanks received training?

  Yes

  No

  N/A

• Have all repairs involving welding on the pressure vessel been performed by a qualified "R-Stamp" welder?

  Yes

  No

  N/A

• Are all nurse tanks secured when not attended or in use?

  Yes

  No

  N/A

• Are all ACME valves hand tightened and inspected often to ensure a gasket is present and the assembly is free of leaks?

  Yes

  No

  N/A

• Has the plumbing used to connect "double" or "triple" nurse tank configurations been plumbed according to best management practice to include properly sized excess flow valves?

  Yes

  No

  N/A

• Are all nurse tanks free of unacceptable dents or gouges?

  Yes

  No

  N/A