PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building

Checklist: ___________________________________________________________

PC OGD PASR FORM

Note: 1) PASR No. is to be obtained from Unit PASR Coordinator

2) PASR Coordinator to ensure the PASR is to be registered and tracked in PASR Tracking Database

PASR No:

Title:

Description:

Date:

Other Related PASR:

A. Category of Start Up Required Checklist

1. Event
New Facility / Modified (EMOC) Supporting Document/s
Refurbishment / Renovation Others:__________________
Others

Note: Prepare required documents (refer to PSI procedure 03.01 L3 Process Technology Documentation and Drawings and Updates)

B. Conduct PASR
B.1 Assign PASR Leader

Name Department Signature

Leader

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

C. Approval to proceed with activity

All Category A recommendations are closed.
Category B action items have been assigned and tracked by respective person in charge.

Approved by PASR Area

Owner/Area Owner Engineer:
(HOD):
Signature: Signature:

Date: Date:

Note 1: Any disagreement in PASR findings need to be discussed with PASR Team prior to approval
Note 2 : Area Engineer to submit all PASR documents to Unit PASR Coordinator/ Unit PS.
Note 3: PASR activity already updated in PASR Database

D. PASR Action Item Category A Deviation

Category A recommendations can’t be closed.
PASR Owner/Area Owner to monitor the category A recommendations until closed.

Approved by PASR
Escalated PASR Owner/Area
Owner (HOP): Owner
(HOD):
Signature: Signature:

Date: Date:

Note 1: Any disagreement in PASR findings need to be discussed with PASR Team prior to approval
Note 2 : Area Engineer to submit all PASR documents to Unit PASR Coordinator/ Unit PS.
Note 3: PASR activity already updated in PASR Database

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

E. Closure of PASR
All remaining action items closed.

Approved by PASR Area

Owner/Area Owner Engineer:
(HOD):
Signature: Signature:

Date: Date:

PASR Completed Documents Handover to:

Unit PASR
Coordinator (Name):

Signature:

Date:

F. Attachments:

1. Reference of document used

2. Checklist used
3. Action plans with assign action parties
4. ________________________________
5. ________________________________

Risk Rank
No Check Point Y N N/A Remarks
(H/M/L)
SUPPLEMENTAL PASR FOR BUILDING CHECKLIST
General
Have the concerns from the Design Safety Review
1
been resolved satisfactorily? Action Item Closed?

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

Risk Rank
No Check Point Y N N/A Remarks
(H/M/L)
Is construction and/or equipment in accordance with
2
design specifications and requirements?
3 Has a area/job site inspection been performed?
4 Has the area/job site been properly cleaned?

5 Others:
Law and Requirement
Is the building arrangement complying to Uniform
1
Building By-Law (UBBL) requirement?
2 Others
Safety
1 Is material above occupied areas properly placed?
Have all exterior windows been assessed for potential
2
injury to occupants?
3 Is the air intake properly located?
For shelter-in-place (SIP) facilities, can the ventilation
4 system be shut down to prevent air ingress or air
movement within the building?
Do SIP facilities have fully stocked Shelter in Place
5
kits?
If a pressurization system is required for electrical
6
classification or SIP, is pressure adequate? (positive
Is there sufficient bottled air or fresh air supplied for
7 personnel that must remain on site or must shut down
equipment during a toxic release?
Are all sewers connected to the building properly
8
sealed to prevent ingress of vapors?
Are large pieces of office equipment or stacks of
9
materials within the building adequately secured?
Are the lighting fixtures, ceilings, or wall-mounted
10
equipment well supported?
11 Are design load limits posted and observed?

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

Risk Rank
No Check Point Y N N/A Remarks
(H/M/L)
12 Others:
Emergency Response
Is the building included in an emergency response plan
1
for fire and toxic release?
Are the occupants trained on emergency response
2
procedures?
3 Are evacuation instructions posted?
Has the emergency response plan taken into account
4 the location of fire, explosion, and toxic hazards in
relation to the building location?
Is the building included in an emergency response plan
5
for fire and toxic release?
Is there a building or facility alarm or communication
6
system to warn building occupants of an emergency?
7 Are exit signs and emergency lighting adequate?
8 Is emergency lighting functional?
9 Are exits adequate for emergency evacuation?
Are wind sock, vanes, or other indication visible from
10
each exit?
Are there exterior and interior fire suppression
11
equipment available to the building?
12 Others:
Instrumentations
Is there a detection system within the building or in the
1 fresh air intake to detect hydrocarbons, smoke, or toxic
materials?
Are smoke detectors provided in remote areas and in
2 ignition source areas such as kitchens or for equipment
that is normally hot?
Are there hydrocarbon or toxic detectors that alarm or
3
shutdown the air intake
4 Others:
Electrical
Are electrical equipment’s or cables are properly
1
connected and grounded?

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

Risk Rank
No Check Point Y N N/A Remarks
(H/M/L)
2 Others:
Information Technology (IT)
Are LAN cable properly connected for IT access and
1
connection?
2 Others:
Others
1 Others:
Note : SIP Kits (A Shelter in Place kit is a kit that allows you to seal off a building, room, or vehicle to make it as airtight as possible. This kit can greatly increase your survivability against
chemical, biological, and radiological exposure. The kit itself doesn’t have to be anything fancy and is very simple to put together).

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

Declaration:

We have inspected this Area/Unit on ___________________________ (date) and have filled in this checklist based on joint site visit and
relevant document check.

Name Position Department Signature

Leader -

Team Member 1 -

Team Member 2 -

Team Member 3 -

Team Member 4 -

Team Member 5 -

Team Member 6 -

Team Member 7-

Team Member 8 -

Team Member 9 -

Team Member 10 -

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

DISCIPLINE PUNCHLIST: CATEGORY A

NCR Category A: Corrective actions to be carried out & completed before start-up. Any deviation must escalate to Escalated PASR
Owner (HOP).

No Corrective Actions Action by Dateline Remarks/ Initials When Resolved

Declaration
The team have inspected this Area/Unit on __________________________________________ (date) and have filled in this checklist
based on site visit and relevant document check along with the engineer(s)/technician(s) concerned.

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 PRE-ACTIVITY SAFETY REVIEW CHECKLIST: Supplemental PASR For Building
Checklist: ___________________________________________________________

DISCIPLINE PUNCHLIST: CATEGORY B

NCR Category B: Corrective actions to be carried out & completed within a prescribed duration after start-up.

No Corrective Actions Action by Dateline Remarks/ Initials When Resolved

Declaration
The team have inspected this Area/Unit on __________________________________________ (date) and have filled in this checklist
based on site visit and relevant document check along with the engineer(s)/technician(s) concerned.

The information below captures at least the last 3 changes to this document (most current is first).

Date Activity by Activity

Updates PASR action item category A deviation escalation approval table and Punchlist
Category 1 (High) & 2 (Medium and Low) to Category A & B based on new PTS release.
Mohd Shukri Daud & Yusri Syam
09-Aug-2023
Yusoff
Added note for action item Category A & B
Standardized Supplemental PASR For Building Checklist with others PASR Checklist
11-Dec-2022 Mohd Shukri Daud

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