Process Hazard Analysis Template

• Organization Name

• Creator

• Date of Analysis

  Date

• Process Name

• Process Description

Hazard Identification

• Potential Hazards (Check all that apply)

  Select Chemical Exposure Fire/Explosion Toxic Release Mechanical Failure Overpressure High/Low Temperature Electrical Shock Corrosion/Erosion

  • Chemical Exposure
  • Fire/Explosion
  • Toxic Release
  • Mechanical Failure
  • Overpressure
  • High/Low Temperature
  • Electrical Shock
  • Corrosion/Erosion

• Other Potential Hazards Not Mentioned Above

• Severity Rating (1: Low, 5: High)

• Description of Identified Hazards

• Existing Controls

Safety Systems

• Safety Devices Present

  Select Alarms Pressure Relief Valves Emergency Shutdown Systems Fire Suppression Systems Gas Detectors Ventilation Systems

  • Alarms
  • Pressure Relief Valves
  • Emergency Shutdown Systems
  • Fire Suppression Systems
  • Gas Detectors
  • Ventilation Systems

• Other Safety Devices Needed

• Effectiveness of Safety Systems

• Maintenance Frequency of Safety Systems

  Daily

  Weekly

  Monthly

  Quarterly

  Annually

• Recent Safety System Inspection

  Date

• Recent Safety System Findings and Recommendations

Standard Operating Procedures (SOPs)

• Reviewed SOPs

• Are procedures adequate?

  Yes

  No

  N/A

• If No, describe the issues.

Human Factors

Operator Training

• Last Training Date

  Date

• Certification Validity Date

  Date

Workload and Fatigue Considerations

• Operator Shift Duration (Hours)

• Break Schedules

  Yes

  No

  N/A

• Fatigue Management in Place?

  Yes

  No

  N/A

Human Error Potential

• Describe potential errors

• Impact of Errors

Maintenance Schedule

• Last Maintenance Date

  Date

• Next Maintenance Due

  Date

• Inspection Frequency

  Daily

  Weekly

  Monthly

  Quarterly

  Annually

• Inspection Results (Issues Found)

  Yes

  No

  N/A

• What are the issues?

Emergency Response

• Emergency Plan Availability

  Yes

  No

  N/A

• Location of the Plan

• Emergency Equipment Availability

  Select Fire Extinguishers First Aid Kits Emergency Showers Spill Kits

  • Fire Extinguishers
  • First Aid Kits
  • Emergency Showers
  • Spill Kits

• Other Emergency Equipment Required

• Last Emergency Drill Conducted

  Date

• Drill Type

• Drill Observation

Environmental Impact

• Potential Environmental Hazards

  Select Air Emissions Water Pollution Soil Contamination Waste Disposal

  • Air Emissions
  • Water Pollution
  • Soil Contamination
  • Waste Disposal

• Other Potential Environmental Hazards Not Mentioned Above

• Mitigation Measures in Place

• Environmental Compliance Status

  In Compliance

  Non-Compliance

• Describe.

Change Management (If Applicable)

• Process Changes Reviewed

  Yes

  No

  N/A

• Impact of Change Assessed

  Yes

  No

  N/A

• Potential Hazards Introduced

• Documentation of Changes

  Updated SOPs

  Updated Flow Diagrams

  Communication to Staff

Documentation and Reporting

• Records Maintained

  Incident Reports

  Near-Miss Reports

  Maintenance Logs

  Inspection Reports

  Training Records

• Assigned Reporting Person

• Continuous Improvement Measures

• Process Hazard Analysis Approval and Sign-off

  Sign

• Designation