Process Safety Information Checklist
Use this checklist to document process details, hazards, operating limits, safety systems, inspection status, documentation gaps, and corrective actions for a process safety review.
Process and Site Information
Process/Unit Name or ID
*
Facility/Site Name
*
Department/Area
Please Select
Operations
Maintenance
Engineering
Production
Warehouse
Utilities
Other
Process Description or Purpose
*
Location / Building / Line / Equipment Tag
Date of Checklist Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Chemical and Hazard Information
Process Chemicals or Materials Handled
*
Physical State or Form
*
Liquid
Gas
Solid
Slurry
Powder
Other
Key Hazardous Properties
*
Flammable
Toxic
Corrosive
Reactive
Oxidizer
Pressure Hazard
Thermal Hazard
Other
Special Handling Requirements
Operating Conditions and Limits
Normal Operating Parameters
Operating Limits Table
*
Rows
Normal Range
Safe Limit
Units
Temperature
1
2
Pressure
3
4
Flow Rate / Volume
5
6
Concentration / Composition
7
8
Critical Alarms / Interlocks / Shutdown Limits
9
10
Temperature Range
*
Pressure Range
*
Are current operating limits documented and available?
*
Yes
Partially
No
Safety Systems and Emergency Controls
Safety and emergency controls present
*
Inspection status
*
Rows
Present
Inspected
Operational
Needs Attention
Relief devices
11
12
13
14
Ventilation systems
15
16
17
18
Containment measures
19
20
21
22
Gas detection
23
24
25
26
Fire protection
27
28
29
30
Emergency shutdown
31
32
33
34
Isolation valves
35
36
37
38
Spill control
39
40
41
42
PPE requirements
43
44
45
46
Emergency response actions
47
48
49
50
Emergency shutdown and isolation features verified
Emergency shutdown system
Manual isolation valves
Automatic isolation valves
Interlocks
Alarms
Other
Spill and release control measures available
Secondary containment
Drain isolation
Absorbent materials
Neutralization materials
Drain covers
Other
Missing, deficient, or out-of-service controls
Emergency response actions required
Inspection, Maintenance, and Training Status
Last inspection date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Maintenance status
*
Please Select
Current
Due soon
Overdue
Not applicable
Outstanding issues
Responsible maintenance owner
First Name
Middle Name
Last Name
Training/communication status
Completed
Scheduled
Not started
Not applicable
Reviewer comments
Documentation, Deficiencies, and Follow-Up
Attached documents or source records
Deficiency notes or gaps identified
Corrective actions required
Priority or severity of each deficiency
Low
Moderate
High
Critical
Responsible person / reviewer name
Submission confirmation / final comments
Submit Checklist
Should be Empty: