Activity 5.

1 Preliminary Hazard List

Preliminary Hazard List (PHL)
Equipment-Related Hazards
Project/System:________________________________________ Date: _________________
Prepared by:_____________________________________________________

Hazardous Event Hazard Category Causes Consequences Recommendations

Condition or state Identify the hazard Identify the potential The failure effect Suggested actions to
that has the potential based on the energy causes for each hazard on people, property, be taken to reduce haz-
to cause an injury or type, such as business, production, ards, such as conduct
property damage electrical, mechanical, environment, etc. a job safety analysis
chemical, etc. (JSA), provide required
PPE, training, etc.

Preliminary Hazard List (PHL)

Operator-Related Hazards
Project/System:________________________________________ Date: _________________
Prepared by:_____________________________________________________

Hazardous Event Hazard Category Causes Consequences Recommendations

Condition or state Identify the hazard Identify the potential The failure effect Suggested actions to
that has the potential based on the energy causes for each hazard on people, property, be taken to reduce haz-
to cause an injury or type, such as business, production, ards, such as conduct
property damage electrical, mechanical, environment, etc. a job safety analysis
chemical, etc. (JSA), provide required
PPE, training, etc.
 Activity 5.2  What If/Checklist Analysis Worksheet

Preliminary Hazard List (PHL)

Project/System:________________________________________ Date: _________________
Prepared by:_____________________________________________________

Equipment-Related Hazards
What If Statement Hazard Category Cause Consequence Recommendations
Formulate “what Identify the Identify the The failure effect Suggested actions to
if” questions about hazard based on potential causes for on people, property, be taken to improve
possible failure the energy type, each hazard business, production, the performance and
scenarios such as electrical, environment, etc. reduce the hazards,
mechanical, such as conduct a job
chemical, etc. safety analysis (JSA),
provide required PPE,
training, etc.

Operator-Related Hazards
Formulate “what Identify the Identify the The failure effect Suggested actions to
if” questions about hazard based on potential causes for on people, property, be taken to improve
possible failure the energy type, each hazard business, production, the performance and
scenarios such as electrical, environment, etc. reduce the hazards,
mechanical, such as conduct a job
chemical, etc. safety analysis (JSA),
provide required PPE,
training, etc.
 Activity 5.3 FMECA Worksheet
Potential Failure Mode, Effects, and Criticality Analysis (FMECA)
System Name: Air Nibbler Severity Ranking Table Occurance Rating Table Detection Ranking Table
5 Catastrophic: A failure results in 5 A high probability of occurrence 1 Very high probability that the
death and/or major losses and cost 4 A moderate probability of failure will be detected
Date: 4 Critical: A failure results in a occurrence 2 High probability that the failure
serious injury or property damage 3 An occasional probability of will be detected
Prepared By: 3 Major: A failure results in minor occurrence 3 Moderate probability that the
injury to personnel and/or 2 A remote probability of occurrence failure will be detected
property damage 1 Minor: A failure results in minor 4 Low probability that the failure
Start Date: 2 Minor: A failure results in minor system failure but does not cause will be detected
system damage but does not cause injury to property damage 5 Very low probability that the
injury failure will be detected
1 Negligible: Near miss without
injury, property damage, or delay

S O D
Responsible
S O D R E C E R
Part Name Part Failure Recommended Individual/
Consequences E Potential Causes C E P V C T P
& Number Function Mode Actions Party & Due
V C T N Action N
Date
Results
1-

2-

3-
 Activity 5.4  ETBA Worksheet
Energy Hazard Initial
Cause Target Barrier Recommendations Final Risk Index
Source Category Risk Index
The Identify Identify Such as: Known as the Multiply Suggested actions Multiply the
subsystem the hazard the operator, current controls the to be taken to frequency by
responsible based on potential property, the in place. frequency improve the severity; expected
for the the energy causes environment, by severity performance and to be lower than
energy type, for each etc. Examples: reduce the hazards, the initial one
such as hazard Physical: such as conduct a based on the
electrical, PPE, guard, job safety analysis implemented
mechanical, insulation, etc. (JSA), provide recommendations
chemical, Administrative: required PPE, etc.
etc. training, SOPs,
procedures, etc.
 Activity 5.5  HAZOP Worksheet
Actions
Node/ Possible Recommended
Parameter Guide Word Deviation Consequences Safeguards Assigned
Subsystem Causes Actions
To/Date

Insert Provide a Guide word, Use a guide Provide Provide the Current Provide Who is
node/ parameter, such as word and a possible effects here, controls solutions to responsible
subsystem such as high, low, parameter, causes such as injury, eliminate or for
temperature, more, less, such as property reduce the completing
pressure, no, etc. more damage, risk this task?
volume, pressure downtime, etc.
time, etc. Make
sure to
There could investigate
be more all possible
than one guide words
parameter for each
for each parameter.
subsystem.