Document #: Corp-EHS-EXP-PSSR-100 Effective Date: 08/01/2016 Revision Date: 03/04/2021
Pre-StartUp Safety Review (PSSR) Form MOC#:2021-MOC-01604 Date: 12/15/2021
Section 1: Pre-startup Safety Review (Completed by the Initiator) NA
1. Equipment design and installation has been examined and meets applicable standards? NA
2. Have all required Engineering Reviews been completed? NA
3. Have all affected Process Safety Management Standard elements been addressed? NA
4. Have all affected employees and contractors been informed and trained on changes? NA
5. Have all of the pre-implementation tasks been completed? NA
Process Conditions Facility Concerns
No 1-1 High pressure No 4-1 Loads on structure
Yes 1-2 High /temperature
low flow No 4-2 Steam use / condensate
No 1-3 No 4-3 Nitrogen use
No 1-4 Tank levels No 4-4 Water use
No 1-5 Reactivity No 4-5 Vacuum use
No 1-6 pH No 4-6 Compressed air use
1-7 No 4-7 Other compressed gas use
1-8 No 4-8 Electrical supply
Chemical Hazards No 4-9 Effluent to sewer
No 2-1 New hazardous chemical No 4-10 Air / Water permit issues
No 2-2 Flammables No 4-11 Waste Generation
No 2-3 Corrosives No 4-12 Exit signs, emergency lighting
No 2-4 Toxicity Operating / Ergonomics / Logistics
No 2-5 Chronic effects Yes 5-1 Working at elevation
No 2-6 PPE No 5-2 Lifting / reaching issues
No 2-7 New chemical added to inventory No 5-3 Operator and mechanic access
Engineering Aspects No 5-4 JSA requirement
No 3-1 Electrical ratings /classifications No 5-5 Hose / cord hazards
No 3-2 Pressure ratings / relief systems No 5-6 Hand hazards / pinch points
No 3-3 Process temperature / insulation No 5-7 Area lighting
No 3-4 Process control hardware/software Procedures and Documentation
No 3-5 Alarm systems No 6-1 Safety, Operating, Maintenance SOPs
No 3-6 Safety interlocks/machine guarding No 6-2 Emergency planning/response procedures
No 3-7 Emergency stops No 6-3 Any preventive maintenance required
No 3-8 Materials of construction /corrosion No 6-4 Valve/Equipment labeling
No 3-9 Ventilation No 6-5 Add to critical equipment list
No 3-10 Grounding and bonding No 6-6 Confined space procedure required
No 3-11 Noise concerns No 6-7 LOTO procedure required
No 3-12 Confined Space No 6-8 Single/Multiple energy source list
No 3-13 Arc flash potential No 6-9 P & IDs updated
6-10 SAP BOM / Asset register updated
Process Safety Management
7-1 Employee Participation
7-2 Process Safety Information (See 6)
7-3 Process Hazard Analysis
7-4 Operating Procedures (See 6-1)
7-5 Training (See Section 1)
7-6 Contractors (See Section 1)
7-7 Mechanical Integrity Inspection/Testi
7-8 Hot Work
Verified by Initiator: MMU Date: 12/15/2021
Verified by Area/Department Manager: MMU Date: 12/15/2021
Verified by Quality Manager (for all HAACP MOCs): Date:
Section 2: Start-Up Authorization and Project Closeout
1. Are all safety concerns and action items from MOC complete?
Accepted By Initiator: MMU Date: 12/15/2021
Note: Upload this form into the MOC module within EXP. The upload is located in the attachments
section at the bottom of the general tab. This must be done in order for the MOC to be closed.
nse procedures
YES
NO
NA
