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CONTACT INFORMATION Campbell Institute NATIONAL SAFETY COUNCIL CALL (630) 775-2063 WEB thecampbellinstitute.org EMAIL [email protected] 1012 900001825 ©2012 NATIONAL SAFETY COUNCIL A transformative force in EHS THIS LEADING-EDGE KNOWLEDGE IS BROUGHT TO YOU BY THE CAMPBELL INSTITUTE

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CONTACT INFORMATION

Campbell Institutenational safety council

call (630) 775-2063

web thecampbellinstitute.org

email [email protected] 900001825 ©2012 national safety council

A transformative force in EHS

this leading-edge knowledge is brought to you by the campbell institute

IBM - APPENDICES

Robert W. Campbell Award – 2007

The Bahrain Petroleum Company B.S.C. (Closed)

Attachment 31

PSM Process Hazard Analysis (PHA)

SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 1 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

1. PURPOSE The purpose of this standard is to outline the basic requirements for carrying out

Process Hazard Analysis (PHA) studies as applied to Company's existing facilities in accordance with the Company's PSM (Process Safety Management) System. PHA is a systematic review of processes to identify hazards, evaluate consequences and existing safeguards, and recommend additional corrective and/or control measures -- PHA is more commonly known as "HAZOP" (Hazard and Operability study) in BAPCO.

Note 1: For HAZOPs of projects, refer to Engineering Division Guide EDG-A1. 2. SCOPE The procedure contained herein shall be applied to all existing facilities within the

Company that are related to Company's core business process (production or process units, offsites, utilities, loading terminals etc.).

Note 2: The procedure for revalidation of PHA studies of existing process units, offsites

and utilities is given in SS/370/PSM/421/SH. Note 3: In case of any conflict between this document and any other codes and standards,

BAPCO's advice must be sought for clarification and resolution. The general hierarchy of applicability shall prevail; namely:

(a) Legislation and standards of the Government of the Kingdom of Bahrain (b) Company policy, standards, design guides and design practices (c) Caltex Engineering Specifications (GPS, NYS) (d) ChevronTexaco Gray Manuals and Texaco GEMS (e) Industry standards (such as API, ANSI, ASME, NFPA, NEC, IEE). In case of conflict within a hierarchy, the more stringent of the requirements shall prevail. 3. DEFINITIONS 3.1 Abbreviations and Acronyms ANSI American National Standards Institute API American Petroleum Institute ASME American Society of Mechanical Engineers BP8000 BAPCO form for recording data on Relief Valves CHAZOP Computer HAZOP EDG Engineering Design Guide EDMS Engineering Document Management System EIA Environmental Impact Assessment EMPAC Enterprise MPAC (Maintenance Planning and Control) FMEA Failure Modes and Effects Analysis GEMS General Engineering & Materials Specifications (Texaco) GPS General Project Specifications (Caltex Engineering Specifications) HAZAN Hazard Analysis (quantitative)

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 2 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

HAZOP Hazard and Operability study IEE Institution of Electrical Engineers ISC Industrial Safety Committee JIT Job Instruction Training MOC Management of Change NEC National Electric Code NFPA National Fire Protection Association (U.S.) NYS New York Specifications (Caltex Material Specifications) OTM Operator Training Manual P&ID Piping and Instrument Diagram PFD Process Flow Diagram PHA Process Hazard Analysis (2nd Element of PSM) PHAWORKS A computer package for recording of HAZOP Worksheets PI system Process Information system PSI Process Safety Information (1st Element of PSM) PSM Process Safety Management QAS Quality Assurance System QRA Quantitative Risk Assessment RV Relief Valve 4. RESPONSIBILITIES 4.1 Applicability The information contained herein will be useful to all those employees who may be

asked to participate in Company PHA studies. In general, participants for PHA are expected to be drawn from the three Technical Divisions, viz., Engineering, Refining, and Maintenance.

4.2 Facility Owner GM and GM Engineering shall Review and approve the PHA plan proposed by Adviser Risk Management. 4.3 Managers in Technical Divisions shall Provide personnel to participate in PHA studies. 4.4 Adviser Risk Management shall Be responsible for leading all PHA studies of existing facilities, planning and scheduling

of such studies and for drafting all future revisions of this standard. All questions or concerns related to this standard should be referred to him

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 3 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

5. REFERENCES i) SS/370/PSM/400/SH, Process Safety Management. ii) SS/370/PSM/401/SH, Process Safety Information. iii) SS/370/PSM/409/SH, Management of Change Procedure. iv) Caltex FS&OH, Guidelines for Conducting Hazard & Operability Studies. v) SS/370/PSM/421/SH, Revalidation of Process Hazard Analysis (PHA) Studies. 6. PROCEDURE 6.1 Requirements At least one PHA shall be carried out of all existing units, offsites and utilities

(sometimes also known as the "initial" PHA). Revalidations shall be carried out in accordance with SS/370/PSM/421/SH.

6.2 Methodology 6.2.1 Per Company PSM Standard, it is permissible to use one or more of the following

methods, as appropriate, to conduct PHA of existing facilities. a) What-if, b) Checklist, c) What-if/checklist, d) Hazard and operability study (HAZOP), e) Failure mode and effects analysis (FMEA), f) An appropriate equivalent methodology.

The selection of method is left at the discretion of the PHA team leader. Note 1: For process units, the standard, line-by-line guideword driven HAZOP is the

preferred method. All process units must undergo at least one full HAZOP. Note 2: Since HAZOP is the main PHA technique to be used, all subsequent clauses herein

refer to HAZOP instead of PHA. 6.2.2 Whichever method is used, a PHA should be aimed to address the following: a) The hazards of the process. b) Review and take into considerations any previous incident that had a potential for

catastrophic consequences in the workplace. c) Engineering and administrative controls applicable to the hazards and their

interrelationships, such as appropriate application of detection methodologies to provide early warning of releases. Acceptable detection methods might include process monitoring and control instrumentation with alarms, and detection hardware such as hydrocarbon sensors.

d) Consequences of failure of engineering and administrative controls. e) Facility siting for new projects. f) Human factors (most of these are integral to the engineering and administrative controls. g) A qualitative evaluation of a range of the possible safety and health effects on

employees in the workplace if there is a failure of controls.

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 4 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

6. PROCEDURES (CONT..)

6.3 Planning and Preparation 6.3.1 The order of priority for conducting HAZOP studies for the existing plants/units in the

Company shall be determined by the facility operating division, in discussions with Engineering.

6.3.2 After establishing the order of priorities, a schedule for PHA/HAZOP studies can be

prepared by the Adviser Risk Management and agreed upon by the operating departments, principally OPD, OS&E, and P&U. Availability of participants from other departments such as TSD, PC&I, RED, Fire & Safety, Plant Engineering, and Plant Maintenance can then be established.

6.3.3 Prior to deciding upon a date for the HAZOP meetings, Adviser Risk Management

requests, obtains and reviews all information and documents needed for the study, as tabulated in Appendix 1.

6.3.4 When all data has been collected and reviewed by Adviser Risk Management, a date is

scheduled for the actual HAZOP study meetings and the nominated team members are informed.

6.4 Composition of the Team 6.4.1 Mandatory, full-time members shall be: Team Leader: Adviser Risk Management. Dedicated Scribe (supplied by Engineering Services). Plant Engineering Department: Senior Engineer or Area Engineer. Operating Department: Superintendent or Specialist. Technical Services Department: Process Specialist or Process Engineer. PC&I Department: Instrument Engineer.

6.4.2 Other, strongly-recommended full-time members shall be: Plant Maintenance: Representative (will represent all of Maintenance Division). RED: Department Representative. Fire & Safety: Department Representative.

Note: A dedicated Scribe, trained in the use of PHAWORKS for on-line scribing, is recommended. The Team Leader should not act as the Leader as well as the Scribe.

6.4.3 Other members, for part time attendance, can also be called from other departments; for example:

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 5 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

6. PROCEDURES (CONT..)

Industrial Hygiene ROP Environmental Affairs. 6.5 Review Meetings 6.5.1 Kick-off Meeting/s a) Prior to holding the HAZOP meetings, the Team Leader will call for a kick-off meeting

to distribute and discuss information such as PFDs, process description, P&ID's, plot plans and hazardous area classification drawings. Other matters discussed in the kick-off meeting could be process data extracts from the PI system, RV data from BP8000 and EMPAC sources, and operating procedures extracted from the QA System or JIT/OTM manuals. It is permissible to hold more than one kick-off meeting, if situation demands.

b) On the basis of the kick-off meeting, visits are made to the unit under study by various

members of the team for purposes such as: checking the drawings against the unit, reviewing the display of process operating and alarm information on the plant, checking the practicability of certain manual operations such as closing isolation valves in the event of a leak, and so on.

6.5.2 HAZOP Meetings a) The bulk of the HAZOP team's discussions are conducted in these meetings. The team

works logically through the P&ID's, examining them critically for areas where deviations from normal operations can lead to undesired outcomes. For this purpose, the unit/plant is divided into conveniently sized sections called "Nodes."

b) In theory, the team should apply all HAZOP guide word and parameter combinations to

each process line and vessel. In practice, it would be enormously time consuming and the Team Leader uses his experience to judge the correct detail of questioning for each area. As each line and vessel is studied, a running record of the deviations, causes, consequences, safeguards, and recommendations (if any) is entered in the HAZOP worksheets.

c) In addition to the line-by-line analysis, the team must carry out a 'global' review of those

issues which are applicable to the unit as a whole. Some examples of these are: Plant start-up, shutdown and normal operating procedures Emergency shutdown systems and procedures Utility failure scenarios Civil, structural, and fireproofing considerations.

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 6 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

6. PROCEDURES (CONT..)

d) A complete list of such global issues can be obtained from Adviser Risk Management. e) Further details on the HAZOP procedure are given in the Caltex Fire Protection, Safety

and Occupational Health Department's publication entitled "Guidelines for Conducting Hazard & Operability Studies," copies of which are available in the Engineering Division Library or from the Adviser Risk Management.

6.5.3 Follow-up Meeting/s Follow-up meetings will generally be required to review comments on draft worksheet,

resolve any outstanding issues, and to finalize the recommendations made by the Team. 6.6 The HAZOP Report a) All items raised during the HAZOP study meeting should be recorded on HAZOP Study

Worksheets, either manually or preferably using a computer software package such as “PHAWORKS.” HAZOP Worksheets must contain a record of all parameter deviations discussed and all issues considered. It is not sufficient to record items by exception, i.e. only those items which required follow-up. As a minimum, the Worksheets must contain the following:

Node, and Node Intention if applicable. Parameter, and Parameter Intention if applicable. Deviation. Cause. Consequences. Safeguards, if any. Recommendations, if any. Recommendation Assigned To. b) At the end of the study, the Team Leader prepares the completed HAZOP worksheets.

A first draft of the HAZOP study report (consisting of primarily the completed worksheets) is then prepared, and distributed to the HAZOP team members for review, action and comment.

c) Further meetings are then called to discuss and revise the first draft report. Then

Adviser Risk Management prepares the complete HAZOP Report which contains individual recommendation sheets as well. This report is issued to all parties at interest for review, comment and action.

d) The team might also identify the need for other specialist studies such as: HAZAN Hazard Analysis QRA Quantitative Risk Assessment FTA Fault Tree Analysis FMEA Failure Modes and Effects Analysis RAM Reliability, Availability, & Maintainability analysis

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 7 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

6. PROCEDURES (CONT..)

CHAZOPs “Computer HAZOPs” carried out to evaluate process control and ESD

software. CHAZOPs are normally handled by PC&I. e) The final report is then printed and distributed upon approval by Manager Engineering

Services. The report is distributed to: (i) Executive Summary to: General Managers - Engineering, Refining, Maintenance. (ii) Complete Report to: Managers - Eng Servcs, Plt Eng, PC&I, RED, Operating Dept., TSD, F&S, Plt.Mtce. All managers of the HAZOP team members, if not included above. PSM Coordinator. All HAZOP team members. Engineering Division Library. 6.7 Administration and Follow-up a) Following issuance of the HAZOP report, its recommendations are included in the

HAZOP Status Report. This Status Report is prepared by Adviser Risk Management and issued biannually. It records the implementation status of open HAZOP recommendations.

b) The biannual HAZOP Status Report typically contains: i) A listing and description of the HAZOP recommendation. ii) Actioning department. iii) Identification of Job Owner or responsible Project Engineer. iv) Whether an MOC Number or Shop Order Number has been issued. v) The current status of the recommendation. c) Information required to update the biannual report is initially supplied by the

Engineering Division Superintendents. Copies are then distributed to other departments seeking their input to this follow-up activity.

d) This process of verification of status on the required activity is an essential element of

the continuing “focus” which is required to ensure that these specific items of critical importance continue to get the priority of action which is warranted.

6.8 Auditing of HAZOP Quality a) The quality of HAZOPs carried out on existing process units can be audited

independently as and when required. Requests for such an audit must be initiated by the CE / DCE or any one of the Technical Division General Managers (Engineering, Refining, Maintenance).

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 8 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

6. PROCEDURES (CONT..)

b) The audit can be carried out either by an individual or a team appointed by General

Manager Engineering. The audit team members can be Company personnel or external consultants or a combination of both. The F&S PSM Coordinator can be called upon to organize and/or carry out any audits requested by the Industrial Safety Committee.

7. APPENDICES APPENDIX 1: Responsibilities for Supplying Data for HAZOP Studies 8. SUPERSEDED DOCUMENTS This revision supersedes parts of EDG-A1 issue of July 1998.

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 9 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

APPENDIX 1: Responsibilities for Supplying Data for HAZOP Studies PSI Item for HAZOP

(if applicable) Responsibility for supplying PSI Item to HAZOP Team Leader

Comment (Note: All data used should be the most up to date

available at that time.) Plot Plans (including major equipment listing).

Civil & Structural Group, Plant Engineering Department.

Ensure that drawing is suitable for carrying out a compliance review with CES equipment spacing criteria.

Hazardous Area Classification Drawings.

Senior Designer - Engineering Design Office, after checking / confirming with the Supt. P&U Engineering - Plant Engineering Department.

For initial review, the HAZOP Scribe can obtain copies either from EDMS or hard copies from the Electrical Drafting Office.

Process Description. Technical Services Department representative in the HAZOP Team.

HAZOP Scribe can assist by generating a rough draft extracted from operating procedures, JITs and OTMs. Ensure that information related to operating controls and conditions is included in the process description, if available.

Process Flow Diagrams including stream data.

Senior Designer - Engineering Design Office, after checking / confirming with the Technical Services Department representative in the HAZOP Team.

Initial draft copies for HAZOP Worksheet preparatory work can be extracted from EDMS by HAZOP Scribe.

P & ID's. Senior Designer - Engineering Design Office.

Senior Designer - Engineering Design Office must carry out a minimum 5% field check to ensure P&IDs are "as-built" before issuing for HAZOP study.

ESD Cause & Effect Diagrams.

PC&I Department representative in the HAZOP Team.

PC&I Department representative to ensure that the C&E Diagrams are matching with the latest P&IDs.

Operating procedures (including start-up, shutdown and emergency procedures).

Operating department representative in the HAZOP Team.

The HAZOP Scribe can extract some of these from Company's QA system. Additionally, information can be obtained from the JITs and the OTMs (if available).

Typical readings of operating parameters extracted from the PI System.

PC&I Department representative in the HAZOP Team.

For initial review, the HAZOP Scribe can extract this information directly from the PI System.

Alarm settings. PC&I Department representative For initial review, the HAZOP Scribe

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SS/370/PSM/402/SH Issue Status 01 10 February 2003 FIRE AND SAFETY DEPARTMENT Page 10 of 9 PROCESS HAZARD ANALYSIS (PHA) OF EXISTING FACILITIES

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in the HAZOP Team. can extract this information from the JIT/OTM, if available.

Relief Valves data (BP8000).

RED representative in the HAZOP Team.

Only hard copies are available.

Relief Valves data from EMPAC.

RED representative in the HAZOP Team.

For initial review, the HAZOP Scribe can extract this information from a report requested from Computer Services Department.

Past incidents and status of recommendations from investigation reports.

RED representative in the HAZOP Team.

In addition, the operating department can provide information on past incidents.

Maintainability review completed checklists.

Plant Maintenance representative in the HAZOP Team to coordinate input from all maintenance functions.

A copy of the blank checklist must be provided by the HAZOP Scribe in the kick-off meeting or prior to it to the Plant Maintenance team member.

Ventilation and pressurization systems for buildings & control rooms.

Supt. P&U Engineering - Plant Engineering Department.

For initial review, the HAZOP Scribe can extract some of this information from pertinent drawings in EDMS or hard copy drawings in the Engineering Division Vault.

MSDS F&S representative in the HAZOP Team to obtain these from the Industrial Medical Officer.

For initial review, the HAZOP Scribe can obtain these from: BAPCO Intranet - Occupational Health Page, and Hard copies in Occ Health Offices.

MOC records and data analysis.

F&S representative in the HAZOP Team to obtain these from the MOC Administrator.

For initial review, the HAZOP Scribe can obtain these from the ORAMOC System.

IBM - APPENDICES

Robert W. Campbell Award – 2007

The Bahrain Petroleum Company B.S.C. (Closed)

Attachment 32

PSM Hazards & Operability Study (HAZOP) for Engineered Projects

SS/370/PSM/422/SH Issue Status 01 18 January 2004 ENGINEERING DIVISION Page 1 of 19

HAZARD AND OPERABILITY STUDIES (HAZOPs) OF ENGINEEREDPROJECTS: ENGINEERING DESIGN GUIDE EDG-A1

INDEX PAGE 1. PURPOSE 2 2. SCOPE 2 3. DEFINITIONS 3 4. RESPONSIBILITIES 4 4.1 Applicability 4 4.2 Compliance 4 4.3 Decision on Scheduling of HAZOPs 5 4.4 Future updates 5 5. REFERENCES 6 6. PROCEDURE 6 6.1 Project Not Related to Process 6 6.2 Other Small Projects or Projects with Limited Scope 7 6.3 Team Composition for Checklist/What-if/..... 7 6.4 Approval of Project Turnovers and BP2062s 7 6.5 HAZOP Studies on Major Projects 8 6.6 General Guidelines for the HAZOP Procedure 9 6.7 HAZOP Team Composition 9 6.8 HAZOP3 Technique 11 6.9 HAZOP3 Report and Follow-up 12 7. APPENDICES 13 8. SUPERSEDED DOCUMENTS 13 APPENDIX 1: Guide to timing of HAZOP studies 14 APPENDIX 2: Sequence of HAZOP Studies on a Major Project 15 APPENDIX 3: HAZOP Parameters 18 APPENDIX 4: Severity, Likelihood, and Risk Ranking 19

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SS/370/PSM/422/SH Issue Status 01 18 January 2004 ENGINEERING DIVISION Page 2 of 19

HAZARD AND OPERABILITY STUDIES (HAZOPs) OF ENGINEEREDPROJECTS: ENGINEERING DESIGN GUIDE EDG-A1

1. PURPOSE The purpose of this PSM standard is to outline the basic requirements for HAZOP

studies as applied to engineered projects. It relates to all such studies to be carried out for projects aimed at installation of new facilities or projects aimed at modifications / upgrades of existing plant and equipment. It also specifies the minimum level of technical review, which must be carried out in lieu of the HAZOPs, in accordance with the Company's Management of Change (MOC) Procedure.

2. SCOPE The procedure contained herein shall be applied to all new projects within Company

facilities (new plant, unit, or equipment) as well as extensions, modifications or changes to existing plant, unit or equipment as defined under MOC.

Note 1: This standard does not cover first-time HAZOPs of existing process units,

offsites and utilities. For HAZOPs of existing facilities, refer to SS/370/PSM/402/SH.

Note 2: The procedure for revalidation of HAZOPs of existing process units, offsites and

utilities is given in SS/370/PSM/421/SH. Note 3: Engineering work carried out under the Company's Major Incident Procedure

(MIP) or Disaster Recovery Plans is outside the scope of this standard. Note 4: In case of any conflict between this document and any other codes and

standards, BAPCO's advice must be sought for clarification and resolution. The general hierarchy of applicability shall prevail; namely:

(a) Legislation and standards of the Government of the Kingdom of Bahrain (b) Company policy, standards, design guides and design practices (c) Caltex Engineering Specifications (GPS, NYS) (d) ChevronTexaco Gray Manuals and Texaco GEMS (e) Industry standards (such as API, ANSI, ASME, NFPA, NEC, IEE). In case of conflict within a hierarchy, the more stringent of the requirements shall

prevail.

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SS/370/PSM/422/SH Issue Status 01 18 January 2004 ENGINEERING DIVISION Page 3 of 19

HAZARD AND OPERABILITY STUDIES (HAZOPs) OF ENGINEEREDPROJECTS: ENGINEERING DESIGN GUIDE EDG-A1

3. DEFINITIONS 3.1 Abbreviations and Acronyms ANSI American National Standards Institute API American Petroleum Institute ASME American Society of Mechanical Engineers BP8000 BAPCO form for recording data on Relief Valves CHAZOP Computer HAZOP EDG Engineering Design Guide EDMS Engineering Document Management System EIA Environmental Impact Assessment EMPAC Enterprise MPAC (Maintenance Planning and Control) FMEA Failure Modes and Effects Analysis GEMS General Engineering & Materials Specifications (Texaco) GPS General Project Specifications (Caltex Engineering Specifications) HAZAN Hazard Analysis (quantitative) HAZOP Hazard and Operability study HAZOP1 Study done during a project's initial development phase HAZOP2 Study done during process/project specification phase HAZOP3 Conventional, guideword HAZOP done at project design stage IEE Institution of Electrical Engineers ISC Industrial Safety Committee JIT Job Instruction Training MOC Management of Change (PSM Element #9) NEC National Electric Code NFPA National Fire Protection Association (U.S.) NYS New York Specifications (Caltex Material Specifications) OTM Operator Training Manual P&ID Piping and Instrument Diagram PFD Process Flow Diagram PHA Process Hazard Analysis (2nd Element of PSM) PHAWORKS A computer package for recording of HAZOP Worksheets PI system Process Information system PSI Process Safety Information (1st Element of PSM) PSM Process Safety Management PSSR Pre-Startup Safety Review (PSM Element #6) QAS Quality Assurance System QRA Quantitative Risk Assessment RV Relief Valve 3.2 HAZOP1 The first study establishes the criteria to be adopted and the information and data

requirements for subsequent studies.

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SS/370/PSM/422/SH Issue Status 01 18 January 2004 ENGINEERING DIVISION Page 4 of 19

HAZARD AND OPERABILITY STUDIES (HAZOPs) OF ENGINEEREDPROJECTS: ENGINEERING DESIGN GUIDE EDG-A1

3. DEFINITIONS (Cont'd..) 3.3 HAZOP2 The second study is designed to reveal any significant hazards which, if not identified

at an early stage, could endanger the validity of the project. 3.4 HAZOP3 The third study is the conventional guideword HAZOP study designed to reveal any

remaining hazards before commencement of equipment design work. Final approved design P&IDs must be available for this study. Control schemes and process conditions need to be defined prior to the study. Detailed equipment design can come later, but the detailed process, control and emergency shutdown (ESD) arrangements must be in the “final design” state.

3.5 Major Project Major Modification / Major Project is defined in SS/370/PSM/406/SH (PSSR

Standard) as follows: "Any revision designed to update, upgrade, de-bottleneck, revise or reconfigure a

plant / process or major equipment hardware. Major modifications / projects usually involve large capital investment and require significant plant or equipment "downtime" in order to execute the work. Installation of a new plant or column or the complete re-traying of an existing column, would be examples of a "Major Modification".

4. RESPONSIBILITIES 4.1 Applicability This standard applies mainly to engineers in Plant Engineering and Process Control

& Instrumentation (PC&I), including Engineering Division personnel assigned to major projects. The information contained herein will also be useful to all those employees who may be asked to participate in Company HAZOP studies. In general, participants for HAZOPs are expected to be drawn from the three Technical Divisions, viz., Engineering, Refining, and Maintenance.

4.2 Compliance 4.2.1 Plant Engineering, PC&I, and Project Managers / Engineers assigned to major

projects are responsible for ensuring compliance with the intent of this standard.

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SS/370/PSM/422/SH Issue Status 01 18 January 2004 ENGINEERING DIVISION Page 5 of 19

HAZARD AND OPERABILITY STUDIES (HAZOPs) OF ENGINEEREDPROJECTS: ENGINEERING DESIGN GUIDE EDG-A1

4. RESPONSIBILITIES (Cont'd..) 4.2.2 If HAZOPs are a part of the work contracted out on a project, then it shall be the

responsibility of the assigned Project Manager or Engineer to ensure that the Contractor is fully aware of the requirements contained herein and that all HAZOPs are carried out in compliance with this standard. Under special circumstances, a Contractor-proposed schedule and HAZOP methodology can be used instead of this standard, upon prior approval of the engineering manager at interest (Manager Plant Engineering, Manager PC&I or the Manager responsible for a Major Project). A Contractor-proposed HAZOP methodology must undergo a review by Adviser Risk Management prior to its approval.

4.3 Decision on Scheduling of HAZOPs

4.3.1 For all in-house engineered projects the Engineering Superintendent at interest shall decide if any of HAZOP1-3 are required or not. On a project where none of HAZOP1-3 are deemed necessary by the Engineering Superintendent, an MOC Technical Review per BP4059 shall be carried out. In this respect, the MOC Technical Review (BP4059) represents the minimum level of review which must be carried out. The MOC review need not be carried out on a project for which one or more of HAZOP1-3 have been completed or are planned.

Note: On all engineered projects which fall within the purview of the MOC system (i.e.

which are not just replacements-in-kind), either an MOC Technical Review or at least one HAZOP must be performed, irrespective of the type and size of the project. There are no exceptions to this rule.

4.3.2 An MOC Technical Review Team may recommend that one or more of HAZOP1-3

be performed on the project, as part of their recommendations arising from the review meeting(s).

4.3.3 For major projects, the Project Manager / Engineer shall determine the HAZOP

schedule (in consultation with Adviser Risk Management, if needed). A copy of the schedule will be sent to Adviser Risk Management for record.

4.4 Future updates Adviser Risk Management shall be responsible for updating this standard.

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SS/370/PSM/422/SH Issue Status 01 18 January 2004 ENGINEERING DIVISION Page 6 of 19

HAZARD AND OPERABILITY STUDIES (HAZOPs) OF ENGINEEREDPROJECTS: ENGINEERING DESIGN GUIDE EDG-A1

5. REFERENCES i) SS/370/PSM/400/SH Process Safety Management Standard ii) SS/370/PSM/401/SH Process Safety Information iii) SS/370/PSM/402/SH Process Hazard Analysis (PHA) of Existing Facilities iv) SS/370/PSM/409/SH Management of Change Procedure v) SS/370/PSM/421/SH Revalidation of Process Hazard Analysis vi) Form BP2062 Request for Engineering Service vii) Form BP5000 Request for Change (MOC) viii) Form BP1864 Project Turnover ix) Form BP4059 MOC Review Meeting Minutes x) Caltex FS&OH Guidelines for Conducting HAZOP Studies 6. PROCEDURES 6.1 Projects Not Related to Process a) For projects which are not directly related to process, such as electrical, civil,

structural, Awali Town and Hospital projects, and hence, for which the line-by-line, guideword HAZOP3 methods are not considered suitable, the requirements of this standard shall be met by carrying out a study using any one or more of the techniques listed in Clauses 6.1.1 to 6.1.4. The Project Engineer shall prepare a written report of the study and distribute the report to all concerned parties, including a copy to Adviser Risk Management.

b) When an MOC Technical Review has been carried out in lieu of a HAZOP (per

Clause 4.3.1), a copy of the completed and approved BP4059 shall be submitted to the MOC Administrator in accordance with the Company's MOC Procedure.

6.1.1 Specific Checklist(s) Specific checklists can be developed by the Project Engineer (in discussion with

Adviser Risk Management, if need be) in accordance with the PSM Element #2 (PHA).

6.1.2 What-if Method A list of What-if questions can be developed by the Project Engineer (in discussion

with Adviser Risk Management, if need be) in accordance with the PSM Element #2 (PHA).

6.1.3 MOC Checklist

The MOC Review Checklist (reverse side of BP4059) can be directly used, or amended by the Project Engineer (in discussion with Adviser Risk Management, if need be).

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6. PROCEDURES (Cont'd..) 6.1.4 Failure Modes and Effects Analysis (FMEA) A list of failure modes and effects can be developed by the Project Engineer in

discussion with Adviser Risk Management, if need be, in accordance with the PSM Element #2 (PHA).

6.2 Other Small Projects or Projects with Limited Scope For other projects where the application of the full range of HAZOP1 through 3 is not

deemed necessary by the Engineering Superintendent at interest, one or more of the techniques listed in Clause 6.1 may be utilized to meet the intent of this standard. The Project Engineer shall prepare a written report of the study and distribute the report to all concerned parties, including a copy to Adviser Risk Management. In case of an MOC Review, a copy of the approved BP4059 shall be submitted to the MOC Administrator in accordance with the Company's MOC Procedure.

6.3 Team Composition for Checklist/What-if/MOC Review/FMEA The general guidelines for teams carrying out the reviews of projects listed in Clauses

6.1 and 6.2 are similar to those for major HAZOP teams; namely: i) The Team Leader should preferably be a Senior Engineer / Specialist or higher. ii) The Project Engineer cannot be the Team Leader for his own project. iii) The Team must consist of at least two people familiar with the plant or the project. 6.4 Approval of Project Turnovers and BP2062s 6.4.1 Project Turnovers To ensure compliance with the MOC requirement the Project Turnover, Form

BP1864, has been modified to include three boxes to indicate the type of MOC review(s) carried out, as follows:

i) MOC BP4059 ii) HAZOP iii) None (MOC is not applicable) Note: No Project Turnover shall be signed by the Project Engineer, approved by his

Section Head or issued from Engineering unless at least one of the three boxes is checked.

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6. PROCEDURES (Cont'd..) 6.4.2 BP2062s Similarly, Section B of the Engineering Service Request, BP2062, has been modified

to include three boxes to indicate the type of MOC review(s) carried out, as follows: i) Technical Review per BP4059 ii) HAZOP per EDG-A1 (i.e. this PSM standard) iii) Not needed at this stage. 6.5 HAZOP Studies on Major Projects Note: It should be noted that the term “HAZOP” is used in BAPCO to cover the whole

process of project safety review, whereas the industry, in general, uses this term to refer only to HAZOP3. It is emphasized that a HAZOP study is not a substitute for a design review, and vice versa. HAZOP studies are aimed at assessing the validity or integrity of a selected option or a finished design from the point of view of system operability and safety under various deviations or “what-if” scenarios that may apply.

6.5.1 Sequence of HAZOP Studies a) To achieve the objectives of hazard control, a series of studies shall be carried out at

various phases of a project. These have been designated as HAZOP1 through HAZOP3, as defined in Clause 3. Appendix 1 is a guide showing how HAZOP studies are integrated into the various phases of a project. It should be interpreted flexibly as timing, resources and available information vary widely from project to project.

b) Appendix 2 describes the objectives and key activities of each study (HAZOP1

through HAZOP3), together with examples of the documentation required. 6.5.2 Need for Other Specialist Studies Any of the studies listed above may result in recommendations to carry out other

specialist studies such as: HAZAN Hazard Analysis QRA Quantitative Risk Assessment FTA Fault Tree Analysis FMEA Failure Modes and Effects Analysis RAM Reliability, Availability, & Maintainability analysis CHAZOPs“Computer HAZOPs” carried out to evaluate process

control and ESD systems. CHAZOPs are normally handled by PC&I.

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6. PROCEDURES (Cont'd..) 6.6 General Guidelines for the HAZOP Procedure a) Each study is carried out by a multidisciplinary team led by a nominated individual.

For new projects the HAZOP review team must involve at least two people who have some prior experience or knowledge of the project or the plant and / or who will be directly concerned with the operation of the plant after implementation of the project.

b) All items raised during the HAZOP study meeting should be recorded on HAZOP

Study Worksheets, either manually or using a computer software package such as “PHAWORKS”.

c) Although each of the three HAZOP studies has its own methodology which is

repeatable for different projects, the timing of the studies is very much dependent upon the specific requirements of a particular project.

d) Separate studies can be performed for different sections of a project and it is likely

that an area of particular concern, and to which the project is sensitive, could be singled out for very early HAZOP studies 1 and 2. However, it is important to ensure that the influence of any hazard which affects the entire project / plant site is carefully considered.

6.7 HAZOP Team Composition Usually, the HAZOP team for a major project or a project installing new facilities

will be as follows: 6.7.1 Project Engineer Usually a mechanical / chemical engineer (but can be an instrument engineer, a civil

engineer or an electrical engineer) and is the person who is responsible for preparing the initial project scope and cost estimate, and implementing the final agreed scope within the approved funds.

6.7.2 Process Specialist or Engineer Usually a chemical engineer who draws up the flowsheet and is responsible for

providing process data, normally from Technical Services Department. 6.7.3 Operations Representative Usually an Operating Department Superintendent or Specialist who participates in

start-ups and shutdowns or who is / will be closely involved in the day to day operation of the plant.

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6. PROCEDURES (Cont'd..) 6.7.4 Instrument Engineer His presence is essential as modern plants contain sophisticated control and ESD

systems and HAZOP studies often result in the addition of yet more instrumentation to the plant.

6.7.5 Independent Chairman (Team Leader) This person needs to be familiar with the HAZOP technique, but not necessarily the

plant or the project. His job is to ensure that the HAZOP team follows the procedure. He needs to be skilled in the leading of a team of people who are normally not responsible to him and he should be the sort of person who pays meticulous attention to detail.

For major projects installing new facilities, the team leader should preferably be the

Engineering Superintendent-at-interest. In some cases, the Superintendent-at-interest may designate a Senior Engineer or request Adviser Risk Management to lead the team and prepare the study reports. The Project/Job Engineer is not permitted to be the Team Leader for a HAZOP of his project.

6.7.6 Other members Subject matter experts can be called in to participate in HAZOP studies on a full time

or on a part time basis, as the need arises. Some likely participants are personnel from Plant Maintenance, Fire, Health & Safety, and Reliability Engineering.

6.7.7 Contractor personnel If the plant has been designed by an engineering contractor, the HAZOP team should

contain people from the Contractor, the Process Licensor (if applicable) and the client organizations. Adviser Risk Management may be called in to participate in these studies, especially those in which the team leader is a Contractor or Process Licensor employee.

If HAZOPs are a part of the work contracted out on a major project, then it shall be

the responsibility of the Project Manager / Project Engineer to ensure that the Contractor is fully aware of the requirements contained herein and that all HAZOPs are carried out in compliance with this Standard. Under special circumstances, a Contractor-proposed schedule and HAZOP methodology can be used instead of this standard, upon prior approval as per Clause 4.2.2.

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6. PROCEDURES (Cont'd..) 6.7.8 Scribe A dedicated Scribe, trained in the use of PHAWORKS for on-line scribing, is

recommended. The Team Leader shall not act as the Leader as well as the Scribe. In case a dedicated Scribe is not available, it is permissible for team members to act as scribes, in rotation, for various sessions of the HAZOP (provided these members have been appropriately trained).

6.8 HAZOP3 Technique a) For a HAZOP3 study, the principal sources of information are the approved P&IDs,

along with other relevant drawings. As necessary, reference is made to operating instructions and to equipment specifications. Process operating and alarm information, along with any ESD Cause and Effects Diagrams, should also be available for review during HAZOP3 meetings.

b) The team works logically through the P&IDs, examining them critically for areas

where deviations from normal operations can lead to undesired outcomes. Typically the team considers such deviations as:

High flow, low flow, reverse flow. High pressure, low pressure. High temperature, low temperature. High level, low level. Contaminants in process materials, etc. c) For each deviation, the team asks: “Can it happen?” If the answer is positive, the next

question is, “Can it cause a hazard?” Note that these consequences of deviations should be developed with the assumption that engineering and administrative controls have failed. Therefore, in the "Consequences" column of the Phaworks Worksheet, the scenario should be described without taking credit for any existing Safeguards. Where a deviation can cause a hazard, the team considers what mitigating features might exist, for example relief valves, shutdown systems, alarm, etc. In theory, the team should apply each guideword to each process line and vessel. In practice, it would be enormously time consuming and the team leader uses his experience to judge the correct detail of questioning for each area. As each line and vessel is studied, it is marked on the P&IDs to ensure no items are missed and a running record of the deviations, causes and consequences maintained on HAZOP3 worksheets.

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6. PROCEDURES (Cont'd..) d) In addition to the line-by-line analysis, the team should carry out a 'global' review of

those issues which are applicable to the unit as a whole. Some examples of these are: ● Plant start-up and shutdown procedures ● Normal operating procedures ● Emergency shutdown systems and procedures ● Utility failure scenarios. e) A complete list of such global issues is given under the title "general" parameters in

Appendix 3. 6.9 HAZOP3 Report and Follow-up a) HAZOP3 Worksheets must contain a record of all parameter deviations discussed and

all issues considered. It is not sufficient to record items by exception, i.e. only those items which required follow-up. As a minimum, the Worksheets should contain the following:

Node, and Node Intention if applicable. Parameter, and Parameter Intention if applicable. Deviation. Cause. Consequences. Safeguards, if any. Recommendations, if any. Recommendation Assigned To. b) The inclusion of Severity, Likelihood, and Risk Ranking for individual hazard and/or

operability scenarios in the Worksheets is optional and is left at the discretion of the Team Leader. If it is decided to include these, then use of PHAWORKS default values is recommended, see Appendix 4.

c) Further details on the HAZOP3 procedure are given in the Caltex Fire Protection,

Safety and Occupational Health Department's publication entitled "Guidelines for Conducting Hazard & Operability Studies," copies of which are available in the Engineering Division Library or from Adviser Risk Management.

d) The Project Engineer / Manager is responsible to ensure that the HAZOP3 Report

draft versions are distributed for review and comment, all comments are resolved or addressed, and the finalized report is distributed to all concerned parties. A copy of the finalized report should also be sent to Adviser Risk Management for record. The original of the report is to be archived in the Project EX Files. In case of a project of wider interest, consideration be given to forwarding a copy of the report to the Engineering Division Library also.

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6. PROCEDURES (Cont'd..) 6.9.1 Administration and Follow-up Following issuance of the HAZOP3 report, its recommendations are to be followed

up and implemented by the Project Engineer / Manager. All recommendations need to be closed prior to the PSSR (Pre-Startup Safety Review) stage of the project.

6.9.2 Auditing of HAZOP3 Quality a) The quality of HAZOPs carried out on projects can be audited independently as and

when required. Requests for such an audit must be initiated by any one of the Technical Division General Managers (Engineering, Refining, Maintenance).

b) The audit can be carried out either by an individual or a team appointed by General

Manager Engineering. The audit team members can be Company personnel or external consultants or a combination of both. The F, H & S PSM Coordinator can be called upon to organize and/or carry out any audits requested by the Industrial Safety Committee.

c) In general, such audits will be carried out using specific checklists. An example

checklist can be obtained from the PSM Coordinator or Adviser Risk Management. 7. APPENDICES

The following appendices are included at the end of the document: APPENDIX 1: Guide to timing of HAZOP studies APPENDIX 2: Sequence of HAZOP Studies APPENDIX 3: HAZOP Parameters APPENDIX 4: Severity, Likelihood, and Risk Ranking 8. SUPERSEDED DOCUMENTS This revision supersedes EDG-A1 (NW/600/GN/EDG-A1/02) issue of July 12,

1998.

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APPENDIX 1

GUIDE TO TIMING OF HAZOP STUDIES Note: The schedule tabulated below is a guideline only. The decision on when a particular HAZOP is conducted depends upon many factors, and is left at the discretion of the Project Manager. PROJECT PHASE

PRE-ER PREPARATION AFTER ER PREPARATION

STAGE FEASIBILITY STUDY FEED

DESIGN

STUDY PHASE

HAZOP1

HAZOP2

HAZOP3

ACTION TO BE TAKEN IN STUDY

IDENTIFY HAZARDS ASSOCIATED WITH PROCESS STREAMS AND CHEMICALS. IDENTIFY MAJOR ENVIRONMENTAL PROBLEMS AND ASSESS SUITABILITY OF PROPOSED SITES. ESTABLISH QUANTITATIVE HAZARD CRITERIA WHERE APPROPRIATE.

EXAMINE PROCESS FLOW SHEETS. IDENTIFY SIGNIFICANT HAZARDS. ASSESS PROPOSED PLANT DESIGN AGAINST THE RELEVANT HAZARD CRITERIA. INDICATE AREAS WHERE REDESIGN IS APPROPRIATE.

CRITICAL EXAMINATION OF PLANT OPERATION WITH REFERENCE TO FIRM PIPING AND INSTRUMENT DIAGRAMS, DRAFT OPERATING INSTRUCTIONS, MAINTENANCE METHODS,. TRANSIENT OPERATING CONDITIONS & EMERGENCIES.

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APPENDIX 2

SEQUENCE OF HAZOP STUDIES ON A MAJOR PROJECT A2.1 HAZOP Study 1 A2.1.1 Introduction a) It shall be the responsibility of the Project Manager / Project Engineer to ensure that

HAZOP Study 1 is carried out if deemed necessary by the Project Manager or the Engineering Superintendent-at-interest.

b) The objective of the study is to initiate, in a formalized manner, the gathering of

information relevant to subsequent HAZOP studies and to establish contacts with functional engineers and specialists in various relevant departments and outside authorities who may impose constraints on the development of the project design.

c) Relevant information shall include the potential hazards of the fluids and the

chemicals involved, either individually or in mixtures, and data defining the effects of these hazards. Additionally, the target criteria of acceptability for process risks are established together with an evaluation of the site location, highlighting potential risks to the environment and possible interactions with existing plants and facilities.

d) The study should commence as soon as preliminary process flowsheets are available. A2.1.2 Procedure When the Project Engineer is satisfied that the project concept is adequately defined

and a list of process streams and chemicals with their physical properties and quantities is prepared, a HAZOP Study 1 meeting shall be arranged. This study also determines the need for contact with outside authorities and engineering consultants.

A2.1.3 Documentation a) On completion of HAZOP Study 1 it shall be the responsibility of the Project

Engineer to ensure that a HAZOP Study 1 report is issued to all concerned parties, including a copy to Adviser Risk Management. The report shall be a brief summary of the findings of the study team and forms the commencement of the HAZOP study files for the project .

b) The study may have called for actions which could take some time to complete.

However, the report should be distributed to the members of the HAZOP team through their department managers as soon as practicable whilst giving details of the information still lacking. These actions should be reviewed at the commencement of HAZOP Study 2.

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Appendix 2(Cont'd) A2.2 HAZOP Study 2 A2.2.1 Introduction a) It shall be the responsibility of the Project Manager / Project Engineer to ensure that a

HAZOP Study 2 is carried out if deemed necessary by the Project Manager or the Engineering Superintendent-at-interest.

b) The objective of the study is to ensure that no significant safety hazard endangers the

viability of the project. A significant hazard is defined as an event or situation which could seriously affect the project in terms of capital cost, location of plant, failure to meet the criteria set in HAZOP Study 1 or adverse interactions with outside authorities.

c) The study should commence during the process specification stage when a

description of the process, process flow diagrams and outline operating instructions are available.

A2.2.2 Procedure a) Working through the PFD's (process flow diagrams) the initial step is to identify the

significant hazards and represent them for action in the form of problem briefs listed on HAZOP Study Work Sheets. These are directed to the relevant members of the project team, for design consideration. Where problem briefs indicate the need for a quantitative assessment the HAZOP team shall produce, through combined effort, the logic diagram for a fault tree analysis.

b) Quantification of the hazards identified will show how the proposed design meets the

target of acceptability for hazards in HAZOP Study 1. c) It is the responsibility of the Project Engineer to ensure that any modifications to the

design, carried out as a result of the study, are the most cost effective solutions to the problem, and are safe so far as is reasonably practicable.

A2.2.3 Documentation a) It shall be the responsibility of the Project Engineer to issue a HAZOP Study 2 report

to all concerned parties, including a copy to Adviser Risk Management. b) The report is a statement that the plant can be built in accordance with the criteria

established in HAZOP Study 1 and should be prepared and issued before Expenditure Request preparation.

c) Any areas lacking firm definition shall be identified. d) Documentation produced during HAZOP Study 2 shall be filed in the HAZOP study

files for the project.

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Appendix 2(Cont'd) A2.3 HAZOP Study 3 A2.3.1 Introduction a) It shall be the responsibility of the Project Manager / Project Engineer to ensure that

HAZOP Study 3 is carried out if deemed necessary by the Project Manager or the Engineering Superintendent-at-interest.

b) The objective of the study is to ensure that the final designs have been reviewed to

identify any potential hazards which could arise through deviations from the design intent. Firm approved Piping and Instrument Diagrams (P&IDs) are essential for this study. Consideration shall be given to transient operating conditions during start-up, shutdown and emergencies and, therefore, outline operating and maintenance instructions are required for the study.

A2.3.2 Procedure a) When the Project Engineer is satisfied that the P&IDs reflect the definitive scope, he

shall initiate HAZOP Study 3. b) The study shall be carried out in a series of meetings where the P&IDs are examined,

line by line and vessel by vessel, using guideword lists to identify areas of concern. Problem briefs (listed on HAZOP Study Worksheets) are produced in the meeting, outlining the problems identified, and these are directed to members of the design team or specialists for action. Problem briefs shall be produced where the problem cannot easily be resolved at the meeting.

c) The Project Engineer shall be responsible for the administration of the problem brief

procedure and for ensuring that actions recommended are the most cost effective solutions.

A2.3.3 Documentation a) It shall be the responsibility of the Project Engineer to issue a HAZOP Study 3 report

to all concerned parties, including a copy to Adviser Risk Management. b) Documentation, in the form of minutes of the HAZOP meeting, completed problem

briefs listed on HAZOP Study Worksheets and supporting documents, shall be filed in the project hazard study files.

c) Ideally HAZOP3 Worksheets should contain a record of all parameter deviations

discussed and all issues considered. It is not sufficient to record items by exception, i.e. only those items which required follow-up.

d) This study may be carried out after Expenditure Request preparation if all significant

hazards have been identified and dealt with in HAZOP Studies 1 and 2. No detailed drafting (Isometric and Piping Plan drawings) should be carried out before completion of HAZOP Study 3.

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APPENDIX 3 HAZOP PARAMETERS

SPECIFIC PARAMETERS

Flow Temperature Pressure Composition Phase Level Viscosity Velocity Inventory Vibration

GENERAL PARAMETERS Relief Structural Civil Small Bore Piping Maintenance Testing/Inspection Instrumentation Sampling/PipeSupports Drains and Vents Services/Utilities Dead Legs/Redundant Items Corrosion Erosion Material Spec Safety/ Fire water Emergency Escape Purging/Inerting Isolation Area Classification Lighting Grounding Spacing Distance Access Roads Effect Distance Toxicity Fire Hazard Explosion Hazard Ignition Sources Noise Warning/Evacuation Workover/Maint. Frequency Reliability/Availability Operating Procedures RED/ Maintenance Procedures MIP/Disaster Recovery Plans Mothballing Start-up/Shutdown/ESD Mechanical/Constructibility MOC/RFC/Change Log/EMPAC Worklist Hot Tap / Work Permit Standards Compliance (CES/API/NFPA) Operability Insulation Drawings Human Factors Environment

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APPENDIX 4

SEVERITY, LIKELIHOOD, AND RISK RANKING DEFAULT VALUES PER PHAWORKS SEVERITY LIKELIHOOD 1. Serious 1. High 2. High 2. Moderate 3. Medium 3. Medium 4. Low 4. Low 5. None 5. Very Low RISK RANKING

SEVERITY 1. 2. 3. 4. 5. 1.00 2.00 3.00 4.00 5.00 2.00 4.00 6.00 7.00 8.00 3.00 6.00 7.00 8.00 9.00 4.00 7.00 8.00 9.00 10.0

LIKELIHOOD

1.002.003.004.005.00 5.00 8.00 9.00 10.0 10.0