Chemical Introduction Authorization Generator

Project & Facility Information

Basic project identification for the authorization header.

Facility / Site Name *

Company / Owner *

Process Unit / Area *

Project Number / Name

Site Location

Authorization Date

Chemicals Being Introduced

List each PSM-covered chemical. Include the OSHA TQ for reference — helps confirm applicability at startup.

Chemical Name Max Inventory OSHA TQ (lbs)

PSSR Verification — 29 CFR 1910.119(i)

Check each item to confirm it has been completed and verified prior to authorization. All five items are regulatory requirements.

1910.119(i)(1): Construction and equipment per design specifications Punch list items formally closed or risk-accepted in writing; as-built P&IDs confirm installed configuration matches HAZOP basis.

1910.119(i)(2): Safety, operating, maintenance, and emergency procedures in place and adequate Written procedures field-validated against as-built equipment; emergency response plan is facility-specific and active.

1910.119(i)(3): PHA recommendations have been resolved or documented All HAZOP/PHA action items classified; Class 1 items closed with evidence; open items formally risk-accepted by authorized personnel.

1910.119(i)(4): MOC requirements have been met All construction, pre-commissioning, and commissioning MOC packages formally closed with updated documentation attached.

1910.119(i)(5): Employee training has been completed Qualification records document demonstrated competency for all operating personnel on current procedure revisions.

Conditional Items & Open Actions

Document any items conditionally accepted as open at the time of authorization. Each must have a formal risk acceptance, responsible owner, and completion commitment date.

Open items accepted for post-startup completion (one per line, or "None")

Conditions of authorization / operating restrictions at startup (or "None")

Authorizing Signatories

The authorization must be signed by the plant manager or equivalent site authority. Additional signatures provide defense-in-depth documentation.

Plant / Site Manager (Authorizing Official) *

Title

PSM Program Owner / Coordinator *

Title

Project Manager

Title

Operations Superintendent / Supervisor

Title

Additional Notes (Optional)

Additional context or authorization scope notes