PSSR Checklist

A PSSR inspection allows you to thoroughly review the status of employee training, construction, equipment, and other components involved in a company change. This PSSR checklist will help ensure that your employees are kept safe during Management of Change (MOC). Edit this pre-startup safety review (PSSR) checklist to fit your needs.

Date

Hour MinutesAM/PM Option

Person Conducting PPSR*

First NameLast Name

Equipment Name*

Functionality (Provide brief description)

Location *

Assigned Department*

Take Photo

Equipment Manual

Has the machinery/equipment been installed so that it will be stable and secure during operation?*

YesNoN/A

Have all overhead fixtures, for example, pipe-hangers, pipe sleeves, pipe sleeve covers, valve handles, floor opening covers, etc., which could fall or be dislodged, been properly secured?*

YesNoN/A

Has all access to dangerous moving parts, or danger zones created by the equipment, been prevented by the provision of the correct guards, interlocks (both safety & non-safety) and/or barriers?*

YesNoN/A

Have the correct safety measures been taken to prevent any risk from hot/cold surfaces, ejection of material, failure of parts and their ejection, overheating/fire?*

YesNoN/A

Have bump/trip hazards been properly identified and adequately marked?*

YesNoN/A

Have all sharp edges been removed?*

YesNoN/A

Have all trip and fall hazards been protected with guard rails and gates?*

YesNoN/A

Has safe access been provided to the equipment that requires operator and calibration and maintenance personnel access for normal operations, adjustments, service, calibration, maintenance, or repair?*

YesNoN/A

Has safe access been provided to the equipment that requires operator and calibration and maintenance personnel access for normal operations, adjustments, service, calibration, maintenance, or repair?*

YesNoN/A

Is the equipment provided with the properly identified START/STOP and EMERGENCY controls that are positioned for safe operation without hesitation, or loss of time, and without ambiguity?*

YesNoN/A

Comments*

Have the workstations, workplace, or equipment been constructed so that the need for stooping, bending stretching, over-reaching and working over-head during operation has been eliminated or minimized?*

YesNoN/A

Has the need to lift, carry, push or pull heavy loads, or parts, been eliminated to the extent possible?*

YesNoN/A

Are all display screens, dials and START/STOP/ EMERGENCY buttons positioned so that they are readily visible and accessible by the operating personnel?*

YesNoN/A

Have workstations been designed and equipped so that the operator can adopt a comfortable position? (That is, able to stand, or change position and sit upright, angle at elbows and knees 90, feet on floor.)*

YesNoN/A

Does the operation of this equipment increase the risk of Upper Limb Disorder; for example, repetitive tasks, handling operations, machine paced work and prolonged operation?*

YesNoN/A

Comments*

Has adequate and appropriate PPE (Personal Protective Equipment) been specified in the Standard Operating Procedures?*

YesNoN/A

Has appropriate PPE been provided?*

YesNoN/A

Have the PPE users been trained in the use of the PPE?*

YesNoN/A

Is the training documented?*

YesNoN/A

Have all health risks arising from the gases, liquids, dusts, mists, biological hazards or vapors used by, contained in or emitted by this equipment been assessed?*

YesNoN/A

Have the health risks been eliminated or are adequate engineering controls utilized to minimize the risks?*

YesNoN/A

PSSR

Machinery & Equipment

Ergonomics

Occupational Health

Process Safety & Technology

Review & Documentation

Mechanical Safety

Standard Operating Procedures (SOPS) Safety

Does the operating procedures cover:

Task Training

Interlocks and Alarms

Environmental

Emergency Response

Electrical And Lockout/Tagout

Field Verification

Signs Off