UNIT PRE STARTUP SAFETY REVIEW

Project#: Date:
MOC#:
MOC or PHA Title:
Work Order #:
Unit:
NOTE: THIS FORM IS TO BE USED IN ADDITION TO THE "CHECKLIST" TAB IN CHANGE MANAGER. THIS PSSR FORM IS INCOMPLETE BY
*macros should be ITSELF
enabled for this sheet to function
properly
1 IDENTIFICATION
TARGET DATE
Y N N/A B A DATE COMPLETED COMMENTS
A. Is Equipment Numbered
B. Are HAZCOM Labels in Place*
C. Are Electrical Panels Labeled*
D. Are Terminal Strips Labeled*
E. Are Wires Tagged*
F. Is Piping Color Coded
G. Are Hazard Signs in Place*
H. Are Radiation Sources Labeled*

2 OCCUPATIONAL SAFETY / INDUSTRIAL HYGIENE

TARGET DATE
Y N N/A B A DATE COMPLETED COMMENTS
A. Are There Any Tripping Hazards
B. Are There Any Headknockers/Obstacles
C. Are There Any Pinch Points/Sharp Edges
D. Are There Any Burn Hazards
E. Is There Access to Valves/Equip.
F. Handrails, Kickplates in place where required*
G. High Noise Areas Labeled
H. Is Area Lighting Adequate*
I. Ventilation Adequate
J. Bumpers around equipment in high traffic areas
K. PPE in Place*

3 SAFETY EQUIPMENT
TARGET DATE
Y N N/A B A DATE COMPLETED COMMENTS

Y = Yes, N = No, N/A = Not Applicable, B = Before, A = After, * = Item must be completed prior to start-up. 1 of 4
 UNIT PRE STARTUP SAFETY REVIEW
A. Are Safety Showers Adequate*
B. Are Eyewash Stations Adequate*
C. Are Fire Extinguishers Adequate*
D. Are Sprinkler Systems Adequate*
E. Are Fire Monitors tested, Hoses Adequate*
F. Alarm system operational/tested*

4 ENVIRONMENTAL
TARGET DATE
Y N N/A B A DATE COMPLETED COMMENTS
A. Is Ventilation Adequate*
B. Are Air Monitoring Systems Adequate*
C. Is Lighting Adequate
D. Are Fugitive Emissions Documented
E. Are Sampling Systems in Place
F. Operating Permits Updated

5 CIVIL/STRUCTURAL: Section Applicable?: Section Applies

TARGET DATE
Y N N/A B A DATE COMPLETED
A. Is Grating Secure*
B. Any Structural Connections Not Complete
C. Floor Openings Covered*

6 MECHANICAL EQUIPMENT Section Applicable: Section Applies

TARGET DATE
Y N N/A B A DATE COMPLETED
A. Have Vessels Been Pressure Checked*
B. Are Safety Valve Locations Accessible
C. Are Safety Discharge Lines Routed Properly*
D. Are There Block Valves in PSV Discharge
E. Are Coupling Guards in Place*
F. Are Belt Guards in Place*
G. Has Rotation Been Checked*
H. Equipment files updated

Y = Yes, N = No, N/A = Not Applicable, B = Before, A = After, * = Item must be completed prior to start-up. 2 of 4
 UNIT PRE STARTUP SAFETY REVIEW

7 PIPING Section Applicable: Section Applies

TARGET DATE
Y N N/A B A DATE COMPLETED
A. Are Spring Hangers Needed
B. Is Piping Braced*
C. Is Piping the right Spec*
D. Has Piping Been Tested For Leaks/Pressure*
E. Is Insulation Complete
F. Painting Complete
G. Check Valves Installed Properly*
H. Valves car-sealed correctly and added to checklist
I. Safety valve tailpipes routed to a safe location

8 ELECTRICAL EQUIPMENT Section Applicable: Section Applies

TARGET DATE
Y N N/A B A DATE COMPLETED
A. Is Equipment Grounded*
B. Are Cable Trays Secure*
C. Are Conduits Sealed and Secured*
D. Has Primary Distribution Been Checked*
E. Have Transformers Been Checked*
F. Have Motor Control Centers Been Checked*
G. Has Switchgear Been Checked*
H. Have Starters/Switches Been Checked*
I. Have Control Stations Been Checked*
J. Have Motor Rotations Been Checked*
K. Have Generators Been Checked*
L. Have Lighting/Receptacles Been Checked*
M. Has UPS System Been Checked*
N. Has Heat Tracing Been Checked

9 INSTRUMENTATION Section Applicable: Section Applies

TARGET DATE
Y N N/A B A DATE COMPLETED

Y = Yes, N = No, N/A = Not Applicable, B = Before, A = After, * = Item must be completed prior to start-up. 3 of 4
 UNIT PRE STARTUP SAFETY REVIEW
A.Was the Instrument Loop Checked*
B.Have the Instruments Been Pressure Checked*
C.Have the DCS configurations been checked
D.Calibration Complete*
E.Safety Instrumented Systems (SIS) functionally
Tested*
F Instrument files updated with spec sheets
G Software backup performed

10 GENERAL
TARGET DATE
Y N N/A B A DATE COMPLETED COMMENTS
A. Is the Equipment Built to Design/Spec*
B. Is Training Complete (Operations and
Maintenance)*
C. Is HAZOP Complete, if Required*
D. Have HAZOP Items Been Resolved*
E. New equipment added to PM program
F. ICP Updated

Y = Yes, N = No, N/A = Not Applicable, B = Before, A = After, * = Item must be completed prior to start-up. 4 of 4