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PSSR Form

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Fachri Fadillah
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28 views

PSSR Form

Uploaded by

Fachri Fadillah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Pre Start Up Safety Review (PSSR)

Pre-Start-up Safety Review (PSSR) Form

1.0 EQUIPMENT / INSTALLATION PER DESIGN


Item Item Description New Document Assigned to: Disposition Completion/NA Completed/Applicability
or Revision
# Date Determination By
Required?
1.01 Certification documentation is
complete (certificate for:
equipment, piping,
instrumentation/Electrical Data
Sheet, calibration sheet, meger √Yes □N/A Project team √Completed 10/15/2023
test, continuity test, electrical
drawings, P&ID, and also piping
hydro test document) (Attach
Form)
1.02
Mechanical/Piping/Process
Equipment Installation Checklist □Yes √N/A Project team √Completed 10/15/2023
items complete (attach form).

1.03 LOTO Checklist form is completed


(attach form)
□Yes √N/A Project team √Completed 10/15/2023

1.04 Electrical/Instrumentation
Installation Checklist items, loop
test and functional test document □Yes √N/A Project team √Completed 10/15/2023
are complete (attach form).
1.05
Fire & Gas Installation Checklist
items and functional test document □Yes √N/A Project team √Completed 10/15/2023
are completed (attached form).
1.06 Incomplete Work List "Required for
Start-up" Items is Complete
□Yes √N/A Project team √Completed 10/15/2023

2.0 PROCEDURES
Item Item Description New Document Assigned to: Disposition Completion/NA Completed/Applicability
or Revision
# Date Determination By
Required?
2.01 Operation personnel have been
trained in Start-up procedures
and Standard Operating
Procedures. All this procedures □Yes √N/A Project team √Completed 10/15/2023
had been updated, reviewed,
and available at Control Room.
2.02 Emergency Procedures are
updated and available.
□Yes √N/A PHSS √Completed 10/15/2023

2.03 Safety procedures (e.g. alarm


management and response,
checking HPLP interfaces, □Yes √N/A PHSS √Completed 10/15/2023
PSV/ESD setting etc)
2.04 Maintenance/Preventive
Project team
Maintenance
procedures/program are □Yes √N/A √Completed 10/15/2023
PHSS
updated and available.

B.01 NOT CONTROLLED WHEN PRINTED OR DOWNLOADED Page 1 of 3


Pre Start Up Safety Review (PSSR)

3.0 ASSESS IMPACT ON SAFETY & HEALTH


Item Item Description New Document Assigned Disposition Completion/NA Completed/Applicability
or Revision
# to: Date Determination By
Required?
Confirm that Process Safety
Analysis (HAZOP) has been
conducted such that the following
Project
3.01 items are complete/attached: □Yes √N/A team √Completed 10/15/2023
- All HAZOP action items required
for start-up are complete and
approved by Process TA
- All process changes during design
(tracked by P&ID/Process Change
Logs) have been ensured that any
change does not
result in a dilution in safety, and
that the review of such changes in
fully documented.
- All process changes and variation
in safe operating limits occurred as
results of the modification/project
do not result in a dilution in safety,
and that the review of such Project
3.02
changes in fully documented in □Yes √N/A team √Completed 10/15/2023
PHSER3.
Note - If there is any changes (from
original design) during design and
construction , E&C to provide list of
design changes (as required in
PHSER 3) completed with
Justification of changes, and this
changes must have been
reviewed/recalculated.

4.0 TRAINING
Item Item Description New Document Assigned to: Disposition Completion/NA Completed/Applicability
or Revision
# Date Determination By
Required?
4.01 Operators assigned to operate
the affected process at start-
up and continuous operations □Yes √N/A Project team √Completed 10/15/2023
have been trained.

5.0 PROCESS SAFETY INFORMATION


Item New Document Assigned Disposition Completion/NA Completed/Applicability
or Revision
# Item Description to: Date Determination By
Required?
5.01 "Required for start-up" Engineering
Process Safety Information e.g P&ID,
PFD, Equipment Specs Sheet, E&I Project
Specs Sheet etc. are updated and √Yes □N/A team √Completed 10/15/2023
available in the control room

B.01 NOT CONTROLLED WHEN PRINTED OR DOWNLOADED Page 2 of 3


Pre Start Up Safety Review (PSSR)

6.0 PSSR Documentation & Approval


PSSR Form completed and required supplemental documentation attached.

Sr. Supervisor Mutiara & Pamaguan Date

Section Head Southern Area Date

Field Manager PHSS Date

Sr. Manager Production & Project Zona 9 Date

B.01 NOT CONTROLLED WHEN PRINTED OR DOWNLOADED Page 3 of 3

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