Facility: Process(es) Covered: HHS(s): Date Part A Score Part B Completion Score History xx/xx/xxxx xx% xx% A. PROCEDURE/POLICY REVIEW Documents Reviewed Date Reviewed Title of Document Rev. # Date # Pgs. Resp. 1) INFORMATION PERTAINING TO PHA TIMING NAC Ref. Code x / 3 = xx% Item #1 Completion Score Weighted 10% of Part A – i. Was the PHA completed before introducing HHS or explosives into the process? 459.95414(1) ii. Was this PHA completed within 5 years of the previous PHA? 459.95414(9) iii. Was the relevant Process Safety Information compiled and verified prior to conducting the 459.95412(1) PHA? Refer to PSI Compilation Checklist on Data Form Notes/Comments Pertaining to Responses to Questions under Issue 1): Resp. 2) INFORMATION PERTAINING TO PHA METHODOLOGY NAC Ref. Code x / 2 = xx% Item #2 Completion Weighted 5% of Part A – i. Was the PHA methodology approved by CAPP staff prior to proceeding, and was that 459.95414(3) methodology used by the facility? ii. Was the PHA methodology selected from the options provided in regulation? 459.95414(4) Notes/Comments Pertaining to Responses to Questions under Issue 2):
Facility: Process(es) Covered: HHS(s): Completion Score History Date Part A Score Part B xx/xx/xxxx xx% xx% A. PROCEDURE/POLICY REVIEW Documents Reviewed Date Reviewed Title of Document Rev. # Date # Pgs. 1) INFORMATION PERTAINING TO PHA TIMING NAC Ref. Resp. Code Item #1 Completion Score – Weighted 10% of Part A x / 3 = xx% i. Was the PHA completed before introducing HHS or explosives into the process? 459.95414(1) ii. Was this PHA completed within 5 years of the previous PHA? 459.95414(9) iii. Was the relevant Process Safety Information compiled and verified prior to conducting the PHA? Refer to PSI Compilation Checklist on Data Form 459.95412(1) Notes/Comments Pertaining to Responses to Questions under Issue 1): 2) INFORMATION PERTAINING TO PHA METHODOLOGY NAC Ref. Resp. Code Item #2 Completion – Weighted 5% of Part A x / 2 = xx% i. Was the PHA methodology approved by CAPP staff prior to proceeding, and was that methodology used by the facility? 459.95414(3) ii. Was the PHA methodology selected from the options provided in regulation? 459.95414(4) Notes/Comments Pertaining to Responses to Questions under Issue 2):