Facility: Process(es) Covered: HHS(s): Date Part A Score Part B Score Completion Score History xx/xx/xxxx xx% xx% A. PROCEDURE/POLICY REVIEW Documents Reviewed Date Reviewed Title of Document Rev. # Date # Pgs. Resp. 1) CONDUCTING THE AUDIT NAC Ref. Code x / 2 = xx% Item #1 Completion Score Weighted 30% of Part A – i. Does the program procedure require that the audit be conducted and the evaluation 459.95427(1a) certified at least once every three years; and does the procedure define the responsible 459.95341 individual who certifies the evaluation? ii. Does the program procedure define the review criteria, acceptance criteria, and 459.95427(1a) responsible individual(s) who conduct the review of each of the following elements: 459.95341 a. Process Safety Information 459.95341 b. Process Hazard Analysis 459.95341 459.95427(1a) c. Standard Operating Procedures 459.95341 459.95427(1a) d. Training 459.95341 459.95427(1a) e. Mechanical Integrity 459.95341 459.95427(1a) f. Management of Change 459.95341 459.95427(1a) g. Pre-Startup Safety Review
Facility: Process(es) Covered: HHS(s): Completion Score History Date Part A Score Part B Score xx/xx/xxxx xx% xx% A. PROCEDURE/POLICY REVIEW Documents Reviewed Date Reviewed Title of Document Rev. # Date # Pgs. 1) CONDUCTING THE AUDIT NAC Ref. Resp. Code Item #1 Completion Score – Weighted 30% of Part A x / 2 = xx% i. Does the program procedure require that the audit be conducted and the evaluation certified at least once every three years; and does the procedure define the responsible individual who certifies the evaluation? 459.95427(1a) 459.95341 ii. Does the program procedure define the review criteria, acceptance criteria, and responsible individual(s) who conduct the review of each of the following elements: 459.95427(1a) 459.95341 a. Process Safety Information 459.95341 b. Process Hazard Analysis 459.95341 c. Standard Operating Procedures 459.95427(1a) 459.95341 d. Training 459.95427(1a) 459.95341 e. Mechanical Integrity 459.95427(1a) 459.95341 f. Management of Change 459.95427(1a) 459.95341 g. Pre-Startup Safety Review 459.95427(1a)
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