Doc No: PSM/FR/7.3
Ref Doc : PSM/PR/7
Rev. : 1
PROCESS SAFETY MANAGEMENT Date of this Rev : Dec 2019
SYSTEM
Date of Rev 0 : Jan 2019
Page 1 of 2
SAFETY AUDIT COMPLIANCE REPORT
HPCL - VISAKH REFINERY
From :
Head- Executing Department
To
Head- F&S
:
This has Reference to the Safety Audit Report No __________________ Dated _______on the following project.
Plant No. Plant Name
Safety Audit Request Category
(Strike out the one not applicable)
Cat-I : MOC
Related
Cat-III : New
Project
Scheme or Project Title
Section of the Project for which
Safety Audit was Requested
(Applicable only for category-III)
I
STATUS OF THE SAFETY AUDIT RECOMMENDATIONS IS AS BELOW:
(This table should exactly match the table of corresponding Safety Audit report)
S No.
II
Recommendation
Completed Yes / No
STATUS OF THE INCOMPLETE ITEMS AND PLAN FOR THEIR
COMPLETION
S No. from the
above table
Recommendation
Status of
Completion
Planned date of
completion
Sign
Name
Approved By
Designation
Procedure: PSM/PR/7- Pre-Startup Safety Review.
Head- Executing Department
Doc No: PSM/FR/7.3
Ref Doc : PSM/PR/7
Rev. : 1
PROCESS SAFETY MANAGEMENT Date of this Rev : Dec 2019
SYSTEM
Date of Rev 0 : Jan 2019
Page 2 of 2
SAFETY AUDIT COMPLIANCE REPORT
HPCL - VISAKH REFINERY
III
VERIFICATION OF SAFETY AUDIT RECOMMENDATIONS
COMPLETION
Following recommendations are verified to be completed:
Sl No from the
Table of I
IV
Completed Yes/ No
ANALYSIS OF INCOMPLETE RECOMMENDATIONS FOR PROCEEDING
WITH PSSR
S No from the
Table of I
V
Recommendation
Incomplete Recommendation
Planned date of completion as
advised by Executing
Department
Can conduct PSSR
without this ?
Yes/ No
RECOMMENDATION BASED ON SAFETY AUDIT
(Strike out whichever not applicable)
All Recommendations are satisfactorily implemented. PSSR can be conducted when offered.
OR
Following Recommendations are pending for implementation. To re-submit this compliance
report after completion of the following Recommendations:
Sign
Name
Approved By
Designation
cc:
CGM-Oprns.
Head-Refinery
Procedure: PSM/PR/7- Pre-Startup Safety Review.
Head- F&S