Format No. EPCL-HSEF-4.

323, Rev 00, Date:15/07/2011

PRE START UP SAFETY REVIEW (PSUSR) REPORT/CHECKLIST.

(Purpose: This is an inspection made prior to operational start up of new or modified facility / process equipment to assure that the modification/changes are in accordance with the intended design and process safety ) Date of issue __________ Description of the facility/change: Reference MOC No./ Plant: Names of team members: Date of PSUSR : Detailed P&ID / Isometric drawings completed and approved (approved P&ID must be available with clouded lines and other documents for reference). Sr. Completion Observation / Category Action Signature after Check points No. Status Pending Actions (if, (A or B) by/Target completion any) date 1. Does the equipment construction, A installation is as per the approved MOC/ P&ID / Isometric drawings and meets design / specifications? 2. Applicable PHA/HAZOP A recommendations incorporated? 3. SOP and RA modified / updated. A 4. Addition of new chemical MSDS A and/or process safety information is available? 5. Employees whose job tasks affected by A change informed and trained? 6. Maintenancestandards/methods B updated?(consider information from I&C) 7. Mechanical integrity1

Format No. EPCL-HSEF-4.323, Rev 00, Date:15/07/2011

8. 9. 10. 11. 12. 13.

14. 15. 16.

17.

18. 19.

20.

Structure / Supports/ Clamping / Grouting/flange joints Load test requirement? Inspection / Testing Documents available Insulation requirement for hot/cold and personal protection. Machine Guards. Access/work platforms: Stairs / ladders,Railings / toe guards,etc. Electrical System: Earthing / Cable dressing Selection of Electrical/ instrument equipment as per hazardous area classification. Control of static electricity Hazards. Drainage system:Floor gradient/ trenches Fire protection system: MCP/Hydrants/Fire extinguishers Sprinkler / Deluge/ detectors/foam system Statutory Compliance Status (if applicable)Factories act, DPR environment regulations). Third Party Certification? Safety Signs/Boards: Safety signs ? Safety Instruction Boards? Colour coding of pipe lines ? Equipment tag No./name Painted? Others (specify)

A A A A A A A A

A B A

A B B B B B

Format No. EPCL-HSEF-4.323, Rev 00, Date:15/07/2011

COMMENTS OF PSUSR TEAM:

Comments

Signature Name Dept/Discipline Date.

APPROVAL FOR START UP

FINAL Clearance for commissioning granted Yes No Put in appropriate box.

1-HOF-HSE&F

Name_____________ Signature _____________Date ___________

2-HOF( Owning Plant/Department) Name_____________ Signature _____________Date ___________

Note: Categories A / B A Critical points which need to be resolved /completed before start up of the facility.

B Points having low risk and where alternate temporary measures are acceptable for a limited period (2 weeks)