Sample Prestart Safety Review
Date: ______________ PSR Team Leader: ________________________________________
Facility / Process / Equipment:
Type of Startup:
New Construction ______ Process Modification ______
List of Associated PSR Checklist Materials (and location if not attached to this form):
PSR Completion Summary:
The following issues have been resolved and
the undersigned believe the process/facility
is ready for startup.
The construction and equipment meet design specifications.
Safety, operating, maintenance, and emergency procedures are in place and adequate.
For new facilities, the initial PrHA has been performed and recommendations have been
Changes made to modify the process/facility have been reviewed and authorized
under the Management of Change Program.
Authorization For Startup:
DOE Contract Manager
PrHA Team Leader
Others as Required