Scribd
Upload
21 views6 pages

Incident Uploading Template

The document appears to be a template for entering information about process safety incidents. It includes sections for summarizing the incident, key learnings, follow-up actions, and attributes about the incident such as location, fatalities, contributing factors, and chemicals involved.

Uploaded by

Jose Alvarez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
21 views6 pages

Incident Uploading Template

The document appears to be a template for entering information about process safety incidents. It includes sections for summarizing the incident, key learnings, follow-up actions, and attributes about the incident such as location, fatalities, contributing factors, and chemicals involved.

Uploaded by

Jose Alvarez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 6

PSID

Process Safety Incident Database


Incident Entry Template

Summary

Title of Incident:

Location:

Country: United States

Year:

Date:(mm/dd/yyyy)

Fatalities:

Injury count:

Off site consequences: Yes

Amount: None

Description

Description:
Key Learnings

Title (of Learning):

Description (of Learning):

Title (of Learning):

Description (of Learning):

Title (of Learning):

Description (of Learning):

Title (of Learning):

Description (of Learning):

Title (of Learning):

Description (of Learning):

Title (of Learning):

Description (of Learning):


Follow-up Actions

Title (of Follow-up Action):

Description (of Follow-up Action):

Title (of Follow-up Action):

Description (of Follow-up Action):

Title (of Follow-up Action):

Description (of Follow-up Action):

Title (of Follow-up Action):

Description (of Follow-up Action):

Title (of Follow-up Action):

Description (of Follow-up Action):

Title (of Follow-up Action):

Description (of Follow-up Action):


Attributes

Incident Type: (nothing selected)

Source of Ignition:

Arson Auto ignition on Blasting Chemical reaction


release at normal
operating temp.

Collision, traffic Compression ignition Electrical equipment Electrical equipment


accident (vehicles, ship, (not defective)
etc.)

Flare Friction overheating Friction spark Engine

Hot line or equipment Iron sulfide oxidation Lightning Other overheating

Match, cigarette Static Welding, cutting, Sabotage


lighter (not smoking) brazing, etc.

Military action Dismantling Open flame (furnace, Grade or product


etc.) change

Spontaneousignition Idle, out-of-service Vandalism Unknown


/Pyrophorics during not-occup.

{Others}

Type Of Operation:

Type Of Operation Category: (nothing selected)

Operation Type: (nothing selected)

Operation Description: (nothing selected)

Specify(Other):
Phase of Operations:

Batch Operation Blending Blowing out/down Construction During


equip., lines Operation

During water draw-off Loading tank, truck, Construction During Dismantling


road tanker, etc. Shutdown

Hauling Idle, out-of-service Excavating Grade or product


during not-occup. change

Installing minor new Performing non-routine Maintenance, repair Maintenance During


equipment operation Operation

Maintenance During Materials Handling Testing Instruments Performing


Shutdown ESD, etc. non-routine
operation

Pigging Pulling/Running Pipe Purging, gas freeing Pulling Cable

New Process/Product Normal Operation, Packaging Out of Service


Introduction attended

New construction Recycle Rerun Rework


i.e., grass roots

Sampling Shutting down Startup-Normal Startup-Unusual

Shutdown-Emergency Temporary equipment Testing (general) Testing, Hydro, Pneu.


or facilities

Testing Instruments Unloading tank, truck, Upset condition Welding, cutting,


ESD, etc. road tanker, etc. brazing, etc.

Other, specify

Initiating Events:

Initiating Event Category: (nothing selected)

Initiating Events: (nothing selected)

Specify(Other):
Equipment:

Equipment Category: (nothing selected)

Equipment Type: (nothing selected)

(nothing selected)
Equipment Part:

Is this on the Critical Equipment List ?:

Specify(Other):

Contributing Factor:

Contributing Factor Category: (nothing selected)

Contributing Factor: (nothing selected)

Specify(Other):

Chemicals Involved:

Chemicals Involved Category: (nothing selected)

Chemical: (nothing selected)

Release Type: (nothing selected)

Quantity Discharge:

or

Quantity Unknown:

Units: U.S.Barrels

Release Type: Liquid

CAS#:

Specify(Other):

You might also like