Professional Documents
Culture Documents
Project No:
Project Title:
PSSR ____ of ____
General
1. Have all assigned MOC steps
prior to PSSR on MOC/ Project
been addressed?
2. Has construction and equipment
been checked to ensure that it is
consistent with the P&IDs and all
design specifications?
3. Was a Risk Review been
performed for new or significantly
modified facilities, using
appropriate methodology?
4. Has the Safety Case been
referenced versus the proposed
change to determine if the change
would inadvertently disable/d
defeat any existing safeguards?
5. Have all action items from the
Safety and Health Review, PHA
etc., been resolved?
6. Are utility systems isolated from
process systems? Are flanges or
blinds inserted, check valves
closed, circuit breakers open?
7. All mechanical tools/equipment
not required by the design or for
operations has been removed (i.e.
tarps, hoses, tools, welding
machines, etc.)
8. All combustible material
removed (i.e. scaffold boards,
tarps, plastic, trash, etc.)
9. QA/QC documentation reviewed
and complete.
Ye
s
No
N/A
Responsibilit
y*
Completed
(Sign/Initial)
Commen
ts
No
N/A
Responsibilit
y*
Completed
(Sign/Initial)
Commen
ts
been checked?
4. Are environmental control
devices in good order ?
5. Have construction
wastes/materials been disposed in
an acceptable manner ?
6. Has there been a review of
hazardous energy isolation?
7. Firewater system installed per
design and commissioned?
8. Are there any inherent dangers
in the immediate vicinity of the
equipment isolation devices (hot
piping, sharp points, etc.)?
Ye
s
9. Are there adequate isolation
devices to complete hazardous
energy isolation of equipment?
10. Are there adequate safety
protection devices in place on the
equipment e.g.blow-out
preventors, ball cock valves?
11. Safety related painting
complete, (Cross walk railings,
curbs, guardrails, etc.)
12. Eye wash stations and safety
showers installed and tested.
13. Fire extinguishers located as
per layout drawings.
14. Required noise reduction
systems in place.
15 Hearing protection warnings
installed
Mechanical
1. Has rotating equipment been
checked for rotation, alignment,
and lubrication?
2. Pre-service required by vendors
has been performed.
3. Are all required guards in place?
4. Has internal inspection been
performed after installation?
No
N/A
Responsibilit
y*
Completed
(Sign/Initial)
Commen
ts
No
N/A
Responsibilit
y*
Completed
(Sign/Initial)
Commen
ts
vibration checked.
7. Have all starters and control
stations been properly labeled?
8. Have all conduit seals been
poured?
9. Is conduit and cable tray
properly supported?
10. All connections sealed and
water tight?
Operational
1. Has all equipment such as
valves, louvers, dampers, etc.,
been operated?
2. Are all screens, orifices, filter
elements, etc., in place for
operation?
3. Is there sufficient devices (drain
bleeders, vent bleeders, etc.) to
properly prepare equipment for
maintenance?
4. Are all required valve car seals
and locks in place and logged
Ergonomics, Access and
Lighting
1. Is access to equipment and
valves adequate for operation,
maintenance, and emergencies?
2. Is there adequate overhead
lighting in the work area?
3. Is there adequate lighting on
the equipment (such as sight
glasses, etc.)?
Ye
s
4 Are the access/work platforms
adequate for normal operation
and/or shut down / start up of
equipment?
5. Is there adequate access to the
equipment isolation devices?
6. Are the equipment isolation
devices ergonomically acceptable?
7. Are the equipment isolation
No
N/A
Responsibilit
y*
Completed
(Sign/Initial
)
Commen
ts
Address
Prior to
Startup
Follow-up
Responsibilit
y
Date
Completed
Resolution/Comm
ents
Have all action items identified as NO been resolved? (Start-up cannot proceed
until all action items checked NO are resolved unless classified for after
commissioning) Yes / No.
See PSSR Summary sheet - Appendix 7(a) for signatures of all participants in
the PSSR.