PSSR Checklist

• Location
  Address

• Prepared by

• Conducted on

  Date

Information

• Equipment/Facility

  Select New equipment Modified equipment New facility

  • New equipment
  • Modified equipment
  • New facility

• Equipment name

• Location of Equipment

• Facility name

• PSSR Team Members

• Has process been inactive for 120 days?

  Yes

  No

• When was the process last active?

  Date

Lockout/Tagout

• Is the machine capable of being locked out?

  Yes

  No

  N/A

• Has the equipment specific lockout/tag out procedure been developed?

  Yes

  No

  N/A

• Are there any special lockout devices needed?

  Yes

  No

  N/A

• Have they been ordered and distributed to the appropriate personnel?

  Yes

  No

  N/A

• Have production, and maintenance employees been properly trained on the lockout procedures?

  Yes

  No

  N/A

Mechanical Hazards

• Are equipment disconnects and operating controls labeled?

  Yes

  No

  N/A

• Are the start and stop controls within easy reach of the operator?

  Yes

  No

  N/A

• Is there plant maintenance for the equipment?

  Yes

  No

  N/A

• Are maintenance personnel trained to perform the plant maintenance?

  Yes

  No

  N/A

• Can the machine be oiled without removing the safeguards?

  Yes

  No

  N/A

• Is there more than one operator?

  Yes

  No

  N/A

• Are separate controls provided?

  Yes

  No

  N/A

• Are Emergency Stops working and accessible to the operator?

  Yes

  No

  N/A

Machine Guarding

• Have all pinch points and points of operation been properly guarded?

  Yes

  No

  N/A

• Have all chains and sprockets been properly guarded?

  Yes

  No

  N/A

• Are there any exposed set screws, key ways, collars, etc?

  Yes

  No

  N/A

• Have all pulleys and belts been properly guarded?

  Yes

  No

  N/A

• Are all machine guards securely attached?

  Yes

  No

  N/A

• Are interlocks prohibited from being bypassed if applicable?

  Yes

  No

  N/A

• Test all interlocks to ensure functioning properly if applicable?

  Yes

  No

  N/A

Electrical

• Is the machine wired according to code? (National Electric Code, National Fire Protection Association)

  Yes

  No

  N/A

• Is the machine grounded?

  Yes

  No

  N/A

• Is the power supply correctly fused and protected?

  Yes

  No

  N/A

• Will additions or modifications require an Arc Flash analysis?

  Yes

  No

  N/A

• Are all electrical connections secured, cords only the length necessary, conduit only used where required (no cords running through walls, under doors, etc)?

  Yes

  No

  N/A

• Is there any temporary equipment S/O cord (allowed for only 90 days) if any follow up required?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Has PPE Hazard Analysis been conducted for new jobs?

  Yes

  No

  N/A

• Is required PPE available and issued to operators?

  Yes

  No

  N/A

• Have operators been properly trained in the use and care of required PPE?

  Yes

  No

  N/A

Noise

• Have appropriate measures been taken to safeguard workers against noise hazards?

  Yes

  No

  N/A

• Has an area survey been conducted?

  Yes

  No

  N/A

• If noise is above 85 dB, has noise reduction measures been considered?

  Yes

  No

  N/A

Evacuation/Egress

• Have existing means of egress been obstructed or changed (at least 28")?

  Yes

  No

  N/A

• Have exit routes been rerouted if necessary?

  Yes

  No

  N/A

• Have employees been trained in new exit routes?

  Yes

  No

  N/A

• Has the emergency evacuation drawing been updated?

  Yes

  No

  N/A

• Is head room at least 7 feet high with no overhead obstructions below 6'8"?

  Yes

  No

  N/A

• Have all emergency exits been designated by appropriate signage/lighting?

  Yes

  No

  N/A

• Are new sprinkler systems operational and tested?

  Yes

  No

  N/A

• Fire Extinguisher accessible and adequately marked?

  Yes

  No

  N/A

Ventilation

• Does the new equipment generate hazardous vapors/gasses/fumes which will require additional ventilation?

  Yes

  No

• Has ventilation been installed?

  Yes

  No

  N/A

• If ventilation has not been installed, have employees been instructed in temporary hazard abatement procedures?

  Yes

  No

  N/A

Ergonomics

• Has an ergonomic audit (ergonomic job measurement system, ergonomic assessment) been conducted of the new/modified equipment?

  Yes

  No

  N/A

• Have identified ergonomic hazards been corrected?

  Yes

  No

  N/A

Confined Spaces & Hazardous Locations

• Has the new equipment created a hazardous location?

  Yes

  No

  N/A

• What is the nature of the hazard?

  Select Flammable Toxic Extreme temperature Confined space Other Explosive Electrical

  • Flammable
  • Toxic
  • Extreme temperature
  • Confined space
  • Other
  • Explosive
  • Electrical

• Identify hazard

• Permit required for confined spaces?

  Yes

  No

  N/A

• Are all hatches and other means of entry labeled as confined spaces?

  Yes

  No

  N/A

• Have space specific entry procedures been developed?

  Yes

  No

  N/A

• Have employees been trained on entry procedures?

  Yes

  No

  N/A

Fall Protection

• The new equipment will not create a situation in which employees must work more than 4' above the floor and outside of a standard guard rail?

  Yes

  No

  N/A

• Has appropriate fall protection equipment been provided to employees?

  Yes

  No

  N/A

• Have employees been trained in the use of required fall protection equipment?

  Yes

  No

  N/A

• No slip/trip/fall hazards created?

  Yes

  No

  N/A

Hazard Communication

• The new equipment has not introduced any new hazardous chemicals into the facility?

  Yes

  No

  N/A

• Have employees been trained in the hazards and protective measures for the new chemical?

  Yes

  No

  N/A

Training

• Does the new/modified equipment require additional process training?

  Yes

  No

  N/A

• Has the training been conducted?

  Yes

  No

  N/A

• Have new training requirements forwarded to the Training Department?

  Yes

  No

  N/A

Air Permits

• Has equipment received the necessary air permits?

  Yes

  No

  N/A

• Has the regulatory agency been notified of start up?

  Yes

  No

  N/A

• Has a standard operating procedure been modified or created to control the equipment per regulations?

  Yes

  No

  N/A

• Has an updated standard operating procedure been submitted to regulators for approval?

  Yes

  No

  N/A

• Does the facility have spare/redundant critical equipment to keep equipment running within compliance standards?

  Yes

  No

  N/A

Wastewater Compliance

• Has the equipment received the necessary wastewater permits and/or notifications?

  Yes

  No

  N/A

• Has a standard operating procedure been modified/created to control the equipment to not impact wastewater?

  Yes

  No

  N/A

• Is wastewater treatment operations prepared to handle the impact of this process change?

  Yes

  No

  N/A

SPCC/Storm water

• Are secondary containment and/or storm water controls in place?

  Yes

  No

  N/A

• Has the SPCC plan been updated, including site maps?

  Yes

  No

  N/A

• Has a "best management practice" been created for this potential pollution source?

  Yes

  No

  N/A

ISO 14001

• Are the necessary "Operational Controls" established and documented in the environmental management system?

  Yes

  No

  N/A

• Have any new reporting requirements been added to the environmental calendar?

  Yes

  No

  N/A

• Is the process change an Aspect or Significant Aspect?

  Yes

  No

  N/A

• Has the training schedule been updated to include the process change?

  Yes

  No

  N/A

Waste/Chemical Notification /Utilities

• Are the procedures in place to handle the waste (hazardous or non-hazardous) from the process change?

  Yes

  No

  N/A

• Has notification to regulators occurred to address legal requirements?

  Yes

  No

  N/A

• Are appropriate back flow connections installed to prevent contamination of potable water?

  Yes

  No

  N/A

• Are the appropriate mechanical and procedural systems installed to minimize energy/water usage?

  Yes

  No

  N/A

Completion

• Are safety, operating, maintenance, and emergency procedures are in place and are adequate?

  Yes

  No

• Is construction and equipment in accordance with design specifications?

  Yes

  No

• All PHAs have been performed and recommendations have been resolved or implemented for new facilities and mod facilities meet the requirements?

  Yes

  No

• Comments/Recommendations

• Safe and ready for commissioning/startup?

  Yes

  No

Tier I Approval

• Engineering

  Sign

• Safety

  Sign

• Quality

  Sign

• M & D Representative

  Sign

• Tier II Approval

  Yes

  No

• M & D Chief

  Sign

• CoMM Director

  Sign

• Command

  Sign