Appendix B Pre-Startup Safety Review (PSSR)

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Appendix B

Pre-Startup Safety Review (PSSR)

Description of equipment or space:____________________________________

Location (if applicable) ____________________________________

Date of PSSR: __________________________________________

Attendees:

Establish a team to conduct the PSSR. At least 1 other individual associated with the
change should be involved. Answer each question below by checking Yes, No or N/A.
Actions to correct the deficiency must be developed for all questions answered with a
“No”. Document the actions and note which items must be completed prior to the
release of the equipment or space to the end user.

# Item Yes No N/A


1. Has the construction of the project been in accordance with
the design specifications?
2. Are the Materials of Construction for all piping, valves,
equipment and instruments suitable for the chemical service?
3. Has grounding protection been installed?
4. Have all new alarms and interlocks been tested as functional?
5. Have all Pre-Startup Best Management Practices been
followed including, but not limited to:
• Checking motor rotation.
• Drying of equipment and piping systems prior to
introducing process chemicals.
• Integrity and/or leak testing of equipment and piping.
6. Was appropriate access to and around the equipment
considered?
7. Was appropriate room for maintenance & operations work
considered?
8. Are proper escape routes available?
9. Are vessels and pipelines labeled i.e., flow direction for piping,
HazCom and equipment number for vessels?
10. Are Start/Stop buttons, disconnect switches, etc., labeled?

Approval Date: July 2020 Management of Change Program SAFE020


Review Date: February 2021 Page 1 of 2 Owner: RMS Director
# Item Yes No N/A
11. Are emergency shut-off switches/valves properly marked and
located so as to be accessible in foreseeable emergencies?
12. Are valves, circuit breakers labeled and capable of being
locked out?
13. Are energy control procedures developed and available?
14. Is machine guarding appropriate and installed?
15. Appropriate provisions provided for material handling?
16. Adequate lighting/emergency lighting?
17. Safety Showers available, identified and operational? Is
drainage installed?
18. Is the installation free of head-knockers and trip hazards?
19. Have any necessary safety signs been installed?
20. Were Human Factors considerations properly addressed
(direction of operation of valves and switches,
location/orientation of controls and switches, etc.)?
21. Have any identified Industrial Hygiene concerns (exposure to
chemicals or noise) been communicated to RMS and
addressed?
22. Has area been cleared of debris?
23. Have remotely operated valves been checked for proper
operation (open/close)?
24. Are hoists, ladders (fixed), and lifting devices properly
designed and installed?
25. Has safety equipment been installed as necessary, i.e.,
ventilation, emergency stop buttons, fire suppression, fire
extinguishers, etc.?
26. Have personnel received training on new equipment and / or
procedures?
27. Other

Actions to Address Deficiencies


Action Description Responsible Target Does Action Need
Person Date Completing Prior to
Releasing? Yes or No

Approval Date: July 2020 Management of Change Program SAFE020


Review Date: February 2021 Page 2 of 2 Owner: RMS Director

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