Pha what if worksheets

“What-If” Worksheet
1
Facility Name: xxxxx
System: Ammonia RefrigerationSystem Drawings: specific drawingnumbers
Sub-System / Node:Pressure Vessels:Receivers e.g., 1-6, Cascade Receiver EquipmentID#: detailed equipmentidentifiers)
Date: enter date
What If Consequences Safeguards C F RR Recommendations
1. What if the equipment's
preventative maintenance
PM program for PRVs is
insufficient or non-
existent?
2. What if the set pressure
of the equipment PRV is
more than the design
pressure of the
equipment?
3. What if the PRV
capacity is too low ?
4. What if the PRV opens
below its set-pressure?
5. What if the PRV fails to
lift at/above its set-
pressure?
6. What if liquid (rain)
accumulates in the PRV
discharge?
7. What if a PRV lifts and
no follow -up action is
taken?
8. What if there is a closed
stop valve before/after a
PRV?
9. What if a PRV
discharges into
piping/systemthat is not
vented to atmosphere?
10. What if the PRV is not
"connected above any
normal operating liquid
level" in the vessel?
11. What if the inlet and
outlet stop valves are
closed w ith vesselnearly
full of NH3 (L)?

2
Date: enter date
12. What if inlet and outlet
stop valves are closed
w ith vesselnearly empty
of NH3 (L)?
13. What if an access
flange gasket fails on main
receivers?
14. What if there is
excessive heat applied
onto or into the vessel?
15. What if plugs, caps, or
blind flanges are missing
on drain or purge valves?
16. What if level gauges
are not protected from
impact?
17. What if small bore
tubing/piping is impacted?
18. What if the equipment
experiences external
corrosion?
19. What if the sight glass
breaks?
20. What if a criticalvalve
is not labeled or easily
identified?
21. What if a vesselis
impacted by a vehicle?
22. What if valves are not
accessible?
23. What if High level
sw itch/transmitter fails to
indicate high level?
25. What if Low level
sw itch / transmitter fails to
indicate low level?

3
Date: enter date
27. What if there is liquid
hammer on the supply
valve?
28. What if there is a high
level condition?
29. What if the w rong PRV
is installed?

4
Sub-System / Node:Pressure Vessels e.g., Oil Drain Receiver/ Distiller 1-2;Cascade
Oil Drain Receiver, etc.
EquipmentID/Design Intent: detaileddrawing numbers
Date: enter date
1. What if the equipment is
not provided w ith a
Pressure Relief Valve
(PRV)?
existent?
pressure of the
equipment?
4. What if the PRV
pressure?
7. What if liquid (rain)
discharge?
taken?
PRV?
10. What if a PRV
discharges into

5
Date: enter date
normal liquid level” in the
vessel?
outlet valves are closed
w ith vesselnearly fullof
NH3 (L)?
of NH3 (L)?
flange gasket fails?
impact?
corrosion?
identified?

6
Date: enter date
excessive oil
concentration in the
vessel?
23. What if you fail to
drain the oil out of the
vesselas required?
24. What if there are other
contaminants in the
system(i.e. w ax, debris,
w ater, etc.)
25. What if pressure
vessels are not marked
w ith design information?
26. What if the vessels fill
w ith oil?
27. What if there is a high
temperature on the distiller
steam jacket w hile
isolated?
28. What if (L) NH3 is
dumped into hot oil (240
F)?
29. What if the still is
needed to be used for
H20?
30. What if there is low
pressure steam?
31. What if the steam
jacket leaks?
32. What if the steam
temperature causes the oil
to flash inside the still?
33. What if an employee
is exposed to ammonia
w hile draining a vessel?

7
Sub-System / Node:Pressure Vessels – e.g., suctionTraps Cascade SuctionTraps,
etc.
EquipmentID#: detailed equipmentnumbers
Date: enter date
1. What if the equipment is
not provided w ith a
Pressure Relief Valve
(PRV)?
existent?
pressure of the
equipment?
4. What if the PRV
pressure?
7. What if liquid
discharge?
taken?
PRV?
10. What if a PRV
discharges into

8
etc.
Date: enter date
normal liquid level" in the
vessel?
outlet valves are closed
w ith vesselnearly fullof
NH3 (L)?
of NH3 (L)?
flange gasket fails?
impact?
corrosion?
identified?
22. What if the vessel
overfills?

9
etc.
Date: enter date
23. What if liquid
crossoverline betw een
new side and old side
liquid pumps isn’t open?
24. What if one suction
trap is taken out of
service?
reverse flow through the
suction trap?

10
Facility Name: xxxxxx
System: Ammonia RefrigerationSystem Drawings:specific drawingnumbers
Sub-System / Node:Ammonia Pumps e.g., LiquidNH4 Pumps EquipmentID#: specific equipment numbers)
Date: enter date
1. What if the pump prime
is lost and pump runs dry?
2. What if a valve at the
pump discharge is closed?
3. What if a pump suction
valve is closed?
4. What if the pump fails or
is turned off?
5. What if the checkvalve
fails closed?
6. What if a pump seal
fails/no oil in casing?
7. What if a checkvalve
fails open?
8. What if NH3 (L) is
isolated in a pump?
on purge or drain valves?
accessible?
identified?
excessive bearing wear?
excessive heat on motor?
reverse flow to the pumps?

11
Facility Name:xxxxxx
Sub-System / Node:Compressors e.g., ScrewCompressors;Screw Booster
Compressors ]
EquipmentID:specific equipment numbers
Date: enter date
What If Hazard /Consequences Safeguards C F RR Recommendations
1. What if there is no
pressure relief valve (PRV)
on this equipment? What if
the relief valve is not
w orking?
(hereafter referred to as
"PM") program for PRVs is
insufficient or non-existent?
3. What if the set pressure of
the equipment PRV is more
than the design pressure of
the equipment?
4. What if the PRV capacity is
too low ?
6. What if the PRV fails to lift
at/above its set-pressure?
7. What if liquid or other
blockage accumulates in the
PRV discharge piping?
8. What if a PRV lifts and no
follow -up action is taken?
PRV?
10. What if a PRV discharges
into piping/systemthat is not

12
Compressors ]
Date: enter date
11. What if a sealing
component (e.g., packing, O-
rings, mechanical seals,
gaskets/ flanges, etc.) fails?
12. What if a compressor
discharge valve is closed?
suction valve is closed?
insufficient flow of oil, or other
coolant, for cooling to the
compressor?
15. What if the discharge
checkvalve is in an open
position and the compressor
is not running?
16. What if the compressor
cut-outs/ safeties/ interlocks
are not periodically tested or
inspected?
17. What if the compressor is
inadequately lubricated, or oil
degrades over time?
blind flanges are missing on
purge or drain valves?
19. What if compressors load
up too quickly?
20. What if a compressor is
(GeneralCompressor Facility
Siting)
accessible?

13
Compressors ]
Date: enter date
22. What if the ammonia is
too cold/hot?
23. Oil drain valve is
inadvertently opened?
24. Compressor is not
isolated properly before
w orking on unit?
lube oil pump/cycling oil
pumps fails?
26. What if the compressor oil
filter is clogged?
27. What if Oil Separator
heating elements fail?
Overheat?
28. What if the slide valve
malfunctions?
29. What if thermo siphon
fails?
30. What if the sump-pump
fails/sanitary sewer backs
up?
31. What if there is a
catastrophic suction line
header failure?
mounting/foundation is loose
or fails?
floods?

14
Facility Name:xxxxx
Sub-System / Node:Compressors e.g., Recip. Pumpout Compressors) EquipmentID:specific equipment numbers
Date: enter date
pressure relief valve (PRV)
on this equipment? What if
the relief valve is not
w orking?
(hereafter referred to as
"PM") program for PRVs is
insufficient or non-existent?
3. What if the set pressure of
the equipment PRV is more
than the design pressure of
the equipment?
4. What if the PRV capacity is
too low ?
6. What if the PRV fails to lift
at/above its set-pressure?
blockage accumulates in the
PRV discharge piping?
8. What if a PRV lifts and no
follow -up action is taken?
PRV?
10. What if a PRV discharges
into piping/systemthat is not
11. What if a sealing
component (e.g., packing, O-
rings, mechanical seals,
gaskets/ flanges, etc.) fails?

15
Facility Name:xxxxx
Date: enter date
discharge valve is closed?
suction valve is closed?
insufficient flow of water, or
other coolant, for cooling to
the compressor?
15. What if the discharge
checkvalve is in an open
position and the compressor
is not running?
cut-outs/ safeties/ interlocks
are not periodically tested or
inspected?
17. What if the compressor is
inadequately lubricated, or oil
degrades over time?
blind flanges are missing on
purge or drain valves?
19. What if compressors load
up too quickly?
20. What if a compressor is
(GeneralCompressor Facility
Siting)
accessible?
22. What if the ammonia is
too cold/hot?
23. Oil drain valve is
inadvertently opened?

16
Facility Name:xxxxx
Date: enter date
24. Compressor is not
isolated properly before
w orking on unit?
lube oil pump fails?
26. What if the compressor oil
filter is clogged?
27. What if Oil heating
elements fail? Overheat?
28. What if the slide valve
malfunctions?
29. What if liquid injection
fails?
30. What if thermo siphon
fails?
31. What if the sump-pump
fails/sanitary sewer backs
up?
catastrophic suction line
header failure?
mounting/foundation is loose
or fails?
floods?
35. What if cooling w ater
freezes in the compressor
head?

17
Facility Name:xxxxx
Sub-System / Node:Evaporative Condensers e.g., Evaporative Condensers EquipmentID#: specific equipment numbers
Date: enter date
1. What if there is no PRV
on this equipment?
existent?
pressure of the
equipment?
4. What if the PRV
pressure?
blockage accumulates in
the PRV discharge piping?
taken?
PRV?
10. What if a PRV
discharges into
11. What if an NH3 stop
valve(s) is closed on the
condenser outlet?
insufficient cooling to the
condenser?

18
Facility Name:xxxxx
Date: enter date
13. What if the condenser
structuralsupports and
enclosure are w eakened?
on purge or drain valves?
15. What if a condenser is
accessible?
17. What if condenser
w ater freezeson
condenser structure?
18. What if there is a tube
leak/ rupture?
19. Pump out valves
inadvertently open?
20. What if non-
condensibles at the
condenser high point
cause a vapor lock?
21. What if fan blade from
the motor breaks off and
ruptures the coil?
22. What if flush pans and
pan strainers are not
maintained? Failed
lubrication of pump
motors? Failed cooling
w ater biological
treatment?
23. What if ammonia is
isolated in the condenser?
24. What if the float
mechanism fails? Failure
of pan level transmitter?

19
Facility Name:xxxxx
Date: enter date
25. What if the continuous
overflow of water is
disrupted?

20
Sub-System / Node:Coolers/Heat Exchangers and Associated Accumulators/Oil
Drains (Water Service): e.g., SSBCooler, 40° WAD Coolers, Water Chillers, WAD
Cooler 1-2, MaltHouse Chillers
EquipmentID: specific equipment numbers
Date:
1. What if Liquid inlet valve
is inadvertently closed?
2. What if the liquid feed
controlvalve sticks closed
or fails to open?
controlvalve sticks open
or fails to close?
4. What if the liquid inlet
strainer is plugged?
5. What if the suction
valve fails closed?
6. What if the relief valve
on the cooler doesn’t
open?
7. What if the tubes or
plates experience
considerable fouling?
8. What if there is an
abnormal demand heat
loading to the coolers?
9. What if
cooler/exchanger
ammonia lines are isolated
at exchanger?
10. What if pressure relief
valve on associated
accumulators are non-
existent or fail to w ork
properly?
11. What if hot CIP liquid
is sent to cooler w ith
ammonia?

21
Drains (Water Service): e.g., SSBCooler, 40° WAD Coolers, Water Chillers, WAD
Cooler 1-2, MaltHouse Chillers
Date:
12. What if w ater
contaminates ammonia?
valve fails open?

22
Drains (Kathene Service): e.g., StartingCellar Kathapacs, Stockhouse Kathapacs
Date:
or fails to open?
or fails to close?
valve fails closed?
open?
plates experience
9. What if
cooler/exchanger
at exchanger?
valve on associated
properly?
11. What if Kathene
valve fails open?

23
Drains (Kathene Service): e.g., StartingCellar Kathapacs, Stockhouse Kathapacs
Date:
13. What if Kathene mist
causes corrosion on
components w ithin the
Stockhouse?
14. What if ice builds up
on cooler and associated
pipe?

24
Drains (Glycol Service): Various specific Glycol Coolesr, ,
Date:
or fails to open?
or fails to close?
valve fails closed?
open?
plates experience
9. What if
cooler/exchanger
at exchanger?
valve on associated
properly?
11. What if Glycol
valve fails open?

25
Drains (Glycol Service): Various specific Glycol Coolesr, ,
Date:
pipe?

26
1
System: Ammonia RefrigerationSystem Drawings: NA
Drains (CO2 Service):
EquipmentID: NA
Date:
or fails to open?
or fails to close?
valve fails closed?
open?
plates experience
considerable
fouling/internalice build
up?
9. What if
cooler/exchanger
at exchanger?
valve on associated
properly?
11. What if CO2

27
Drains (CO2 Service):
EquipmentID: NA
Date:
valve fails open?
pipe?

28
Drains (productService):
EquipmentID: NA
Date:
or fails to open?
or fails to close?
valve fails closed?
open?
product pipe experience
9. What if
cooler/exchanger
at exchanger?
valve on associated
properly?
11. What if Product
valve fails open?

29
Drains (productService):
EquipmentID: NA
Date:
pipe?
14. What if spray nozzles
are clogged or fall off?
15. What if hot CIP liquid
is sent to cooler w ith
ammonia?

30
Sub-System / Node:Coolers/Heat Exchangers and Associated Accumulators (NH3/NH3
Service
EquipmentID: NA
Date:
or fails to open?
or fails to close?
valve fails closed?
open?
plates experience
9. What if
cooler/exchanger
at exchanger?
valve on associated
properly?
11. What if ammonia
valve fails open?

31
Sub-System / Node:Coolers/Heat Exchangers and Associated Accumulators (NH3/NH3
Service
EquipmentID: NA
Date:
pipe?

32
Sub-System: AHUs: EquipmentID: NA
Date:
1. What if hot gas solenoid
valve sticks closed or fail
to open?
2. What if hot gas solenoid
valve sticks open or fails
to close?
3. What if hot gas strainer
is plugged?
4. What if hot gas isolation
of valve is inadvertently
closed?
5. What if pump dow n
cycle does not function
prior to defrost?
6. What if forklift operator
hits the evaporator w ith a
forklift?
7. What if solenoid fails
closed?
open?
9.. What if an isolated
evaporator containing
NH3(L) experiences a
temperature rise from
ambient or applied heat?
10. What if Fan blades
break loose and puncture
the coils?
11. What if Fan motor is
running in reverse
direction?

33
Sub-System: AHUs: EquipmentID: NA
Date:
13. What if the small bore
14. What if the additional
w eight of ice on an
evaporator breaks/deflects
structuralsupport?
accessible?
16. What if a gasket on the
refrigerant-side fails?
17. What if a tube/coil
leaks and NH3 is at a
higher pressure?
18. What if a tube/coil
leaks and NH3 is at a
low er pressure?
19. What if frost is not
removed from the bottom
row s during hot gas
defrosting?
20. What if ice builds up in
the drain pan?

34
System: Ammonia RefrigerationSystem Drawing: N/A
Sub-System / Node:Piping and Valves EquipmentID: NA
Date: enter date
1. What if piping
corrosion?
2. What if there is
inadequate piping
support?
3. What if ice builds up on
piping?
4. What if multiple PRV
discharges occur in piping
& header has insufficient
capacity?
5. What if NH3 (l)
accumulates in return
piping?
6. What if the piping layout
does not accommodate
thermal expansion or
contraction?
7. What if piping is
8. What if ice builds-up on
piping that penetrates a
load bearing w all?
9. What if piping is
mislabeled/ unlabeled?
10. What if a valve is over
tightened causing the
bonnet to lift slightly?
11. What if a valve sealing
component leaks?
12. What if valves are left
in the closed or open
position for a long period
of time w ithout cycling?

35
Date: enter date
13. What if plugs, caps or
14. What if the packing nut
backs off during opening
of the valve?
15. What if the screwed
bonnet backs off during
operation or maintenance
of the valve?
16. What if a sealcap
cannot be removed from a
valve?
17. What if bonnet
unseats or is removed
w hen sealcap is turned?
18. What if an automated
valve opens/closes with
excessive force?
identified?
20. What if criticalvalves
are not accessible?
21. What if piping fails to
meet applicable codes?
22. What if manholes or
access points or not
adequately sized?
23. What if there is no or
inadequate insulation to
prevent thermal burns?
24. What if there are
bumping or tripping
hazards?

36
Date: enter date
25. What if relief valves
sizing is not based on
w orstcase event?
26. What if bolts are not
torqued properly?
27. What if a liquid
ammonia spill causes
vapors to be released
through the drainage
systemw ithin the facility?

37
System: Ammonia RefrigerationSystem Drawing: NA
Sub-System / Node:Instruments and Controls EquipmentID:NA
Date: enter date
1. What if instrumentation
is broken or incorrectly
installed?
2. What if the
instrumentation tubing is
improperly supported/
protected?
3. What if the PLC fails?
4. What if there is
inadequate PM on
instrumentation/ controls?
What if instruments have
not been proof tested?
electricalinstruments in
hazardous atmospheres?
6. What if there is not a
failsafe design for
instruments and alarms?
7. What if instruments
contain radioactive
materials?
8. What if critical
interlocks/alarms are not
set at the correct
activation levels?
9. What if MCC room is
too hot or cold?
10. What if overload
protection fails?
11. What if
instrumentation/controls
are located in corrosive
atmospheres?
operator interface failure?

38
System: Ammonia RefrigerationSystem Drawing:NA
Sub-System / Node:Start Up EquipmentID:NA
Date: enter date
lube oil levels are
inadequate?
2. What if the w rong
compressor lube oil is
used?
3. What if the lube oil
temperature is too low ?
4. What if a NH3 is
delivered to hot
equipment?
5. What if the systemis
not pumped dow n prior to
an extended shutdown?
6. What if there is
inadequate storage for the
existing NH3 inventory?
7. What if start-up
procedures are
inadequate?
8. What if equipment sits
idle for extended periods
of time?

39
Sub-System / Node:Emergency Situations EquipmentID:NA
Date: enter date
1. What if the facility has
not planned for a loss of
electric pow er?
fuelsupply to the facility?
steam supply?
instrument air?
facility w ater?
6. What if there are no
assigned responsibilities in
the event of an emergency
situation?
7. What if there are no
isolation valves for
securing the systemin the
event of an emergency
situation?
8. What if the emergency
ventilation systemis non-
existent, inadequate or
inoperable during an
emergency situation?
9. What if the refrigeration
computer controlindicates
a process upset?
10. What if the employee
emergency notification
systemis non-existent,
inadequate or inoperable
during an emergency
situation?

40
Sub-System / Node:Emergency Situations EquipmentID:NA
Date: enter date
11. What if emergency
equipment is non-existent,
inadequate, inoperable,
poorly located, or
incorrectly used?
inadequate
communication during an
emergency situation?
13. What if emergency
equipment is incompatible
betw een emergency
response teams?
14. What if the PM
program for emergency
equipment is non-existent
or inadequate?
15. What if the fire
suppression systemis
non-existent, inadequate
or inoperable?
16. What if the
refrigeration computer
does not indicate an upset
condition and there is
one?
17. What if the
refrigeration computer
display fails?
18. What if a criticalissue
is not identified in the
criticalalarm database?

41
Sub-System / Node:Charging System (performed on xxx type of basis) EquipmentID:NA
Date: enter date
1. What if a valve betw een
the tank truckand the
receiver is closed w hile
the unloading pump is
running? (Unloading
Hose/ Unloading Line)
2. What if the unloading
hose fails or the
connection is faulty?
(Unloading Hose/ Tank
Truck)
3. What if NH3 (L)
backflow sfromthe
refrigeration systemto the
tank truck?
4. What if the systemis
overfilled during charging?
5. What if the tank truck,
the unloading hose, and
the unloading line are
exposed to hazards from
moving traffic?
6. What if the line is not
vented or the unloading
valves are not closed prior
to disconnecting the
unloading hose?
7. What if the bleed valves
on either the NH3 (L)
transfer or equalizing lines
are not fitted w ith blind
flanges/plugs?
8. What if NH3 is trapped
betw een the tanktruck
cap and tank truck
discharge valve?

42
Sub-System / Node:Charging System (performed on xxx type of basis) EquipmentID:NA
Date: enter date
9. What if the driver pulls
aw ay while the unloading
hose is still connected?
10. What if the tank truck
driver unloads the truck
w ithout notifying the
facility?
11. What if the charging
operation is left
unattended?
12. What if something
else is delivered to the
ammonia system?
13. What if adequate
lighting isn’t provided
during loading/unloading?

43
Sub-System / Node:Human Factors EquipmentID:NA
Date: enter date
1. What if a drain/purge
valve is left open by
mistake by operator?
2. What if oil is manually
drained or sampled from
equipment w ith NH3
pressure on the system?
3. What if there is
inadequate isolation prior
to maintenance?
steps on NH3 line?
5. What if the employees
must performmaintenance
on equipment w hile
operating?
6. What if cut-ins are
made into lines that are
not evacuated?
leans a ladder/tie off
against an NH3 line?
8. What if one PRV is
removed for maintenance
and another PRV lifts
relieving into the PRV
discharge header?
strikes equipment, piping,
or valves w ith a hammer,
w rench, etc.?
applies externalheat to
equipment, piping, valves,
etc.?

44
Date: enter date
unexplained system
noises and no subsequent
reporting or response?
12. What if equipment
fails to w orkas indicated
(i.e. red light equals
closed, green light equals
open, etc)?
13. What if the control
display/layout is
confusing? What if all
necessary information is
not available at panel?
14. What if criticalstep
procedures are not easily
accessible?
15. What if process
information is not clear,
concise, and/or
accessible?
16. What if upper and
low er limits are changed
w ithout authorization?
17. What if the actuation of
criticalcontrols is
confusing (e.g., flip-up for
off)?
insufficient space in the
controlroom for normal
operator control
responsibilities?
insufficient space for
maintenance on
equipment?

45
Date: enter date
20. What if criticalsystem
equipment or controls are
inaccessible?
21. What if the w ork
environment is too cold,
noisy, or dark?
follow -up and
communication
mechanism for safety
action-items?
mechanism for employees
to express human factor-
related concerns?
resource allocated to
human factors analyses?
25. What if human factors
issues are not
systematically addressed
by management?
26. What if human factors
issues are not
systematically addressed
as part of new
designs/modifications?
27. What if an employee's
responsibility is not w ell-
defined?
28. What if an employee is
stressed due to shift w ork
and overtime schedules?
29. What if the skill levelof
an employee is
inadequate or ill-defined?

46
Date: enter date
30. What if operator
training is not complete,
inadequate, and/or job
prerequisites not met?
assistance to address
substance abuse or
mental health problems?
32. What if job task are
too frequent?
not frequent enough?
too complicated?
35. What if operators do
not have time to complete
routine tasks?
36. What if employees
have to w orkalone or in
isolated areas?
37. What if there is not a
clear understanding of the
chain of authority?
38. What if a procedure is
not periodically review ed
and updated?
39. What if plant brew ers
aren’t properly trained on
ammonia process as
applicable to their job
duties?

47
Sub-System / Node:Facility Siting EquipmentID:NA
Date: enter date
1. What if a line,
equipment, or equipment
support is impacted by a
vehicle?
2. What if the machinery
room ventilation does not
w orkduring a pow er
failure?
room ventilation discharge
does not take into account
air flow around the
building, prevailing w inds
and surrounding
structures?
3a. What if intakes are
located near sources of
contaminants?
3b. What if ducts do not
have appropriate access
openings, fire dampers, or
fire resistant insulation?
3c. What if comfort heating
and cooling is not
adequate?
situated for isolating the
major components of the
system?
5. What if externalevents
have not been accounted
for in the systemdesign?
6. What if ignition sources
are present in a
machinery/vesselroom
w ith an explosive mixture
of NH3?

48
Date: enter date
7. What if an NH3 release
is draw n backinto the
facility by HVAC
equipment?
room is sited adjacent to a
large employee
population?
9. What if the controlroom
is sited adjacent to
machinery room?
insufficient access or
egress (especially
elevated locations) for
maintenance or
emergencies?
11. What if a criticalsafety
system(e.g., fire monitor,
safety shower, eye wash
gas detector, etc.) is
poorly located and/or
identified?
11a. What if first aid
stations and supplies are
not readily available?
11b. What if a self-
contained breathing
apparatus is not provided
or readily available for
emergency situations?
12. What if there is no site
security system?
13. What if flammables are
not segregated from
ignition sources?

49
Date: enter date
14. What if the control
room is not designed
and/or sited w ith
consideration of possible
process incidents?
15. What if a population
(other than controlroom
personnel) is not sited w ith
consideration of buffer
zones fromincidents?
16. What if the site's
normally prevailing w ind
direction is not considered
w hen situating
equipment/populations?
17. What if the emergency
plan, the evacuation
routes, and assembly
points are not sited w ith
consideration of possible
incident locations?
18. What if there is poor
access to portable or fixed
firefighting equipment?
access or fire alarms are
located poorly?
protection of computer
installations?
21. What if ammonia or
LEL monitors are located
poorly?
inadequate clearances
and access formaterials
or personnelmovement?

50
Date: enter date
23. What if pow ered
industrial vehicles are not
provided w ith appropriate
hazard classification?
24. What if necessary
rigging points for cranes,
hoist, or slings are not
provided?
25. What if pressure
vessels or storage tanks
fail to meet appropriate
code?
26. What if storage tanks
or pressure vessels do not
receive NDT?
27. What if tanks and
storage vessels do not
receive proper routine
visualinspection?
inadequate guarding on
rotating equipment?
29. What if radiation
sources are not properly
shielded or employees are
exposed to beams of
radiation during routine
tasks?
30. What if floor finish is
non-appropriate for use?
31. What if extreme
w eather eventssuch as
floods, tornado, blizzard,
hurricane, earthquake, etc.
have not been taking into
account?

51
Date: enter date
32. What if indication
lights for exits, fire boxes,
safety showers, etc do not
function?
33. What if there are an
insufficient number of
ammonia sensors?
34. What if there are an
insufficient number of E-
stops?
pow er outage and re-start
that automatically re-starts
the ammonia system?
36. What if out of service
equipment is not properly
abandoned in place?

52
System: Ammonia RefrigerationSystem Drawing:specific drawingnumbers
Sub-System / Node:Auto Purgers, Cascade Purgers EquipmentID:specific equipment numbers)
Date: enter date
1. What if there is
insufficient cooling of or
insufficient cooling w ater
flow ?
2. What if the air release
float mechanism in the
NH3 condensing chamber
fails open/closed?
and multiple condensers
are going to the auto
purger?
4. What if oil drain valves
are open w hen not
supposed to be?

53
System: Ammonia RefrigerationSystem Drawing:
Sub-System / Node:PumpOut of System EquipmentID:
Date: enter date
1. What if the NH3
pumpout/evacuation for a
length of piping or for a
piece of equipment is
incomplete?
2. What if the valve used
to controlflow formanual
pump out is actuated too
quickly?
3. What if a pumpout
compressor fails during
pumpout situation?
4. What if the cooling
medium (w ater)to the
pump out compressor is
lost?
5. What if the oil still is
overfilled during pumpout?
6. What if w ater supply to
Ammonia Vent Scrubber is
low during pumpout?
7. What if high ammonia
concentration is in the flow
fromcompressors towards
Ammonia Vent Scrubber?
8. What if loss of pow er
during pump out situation?
9. What if w ater
accumulates through the
Ammonia Vent Scrubber?
10. What if you get flow
fromsuction traps backto
the Ammonia Vent
Scrubber?
11. What if you leave
pumpout valve open?
12. What if you can’t
pumpout equipment?

54
System: Ammonia RefrigerationSystem Drawing:
Sub-System / Node:PumpOut of System EquipmentID:
Date: enter date
13. What if the
packing/nozzle in the
scrubber is fouled or not
functioning properly?
2 2 C
14. What if a pump out
valve is inadvertently
opened w hile under
vacuum?
4 1 C

55
Sub-System / Node:Past Accidents / Changes (MOCs) EquipmentID:NA
Date: enter date
Review of incidents during
last 5 years
Review of MOCs fromlast
5 years

56
Table 1
IIAR Risk Matrix
Process Hazard Analy sis
IIAR RISK MATRIX
Frequency MAG. RISK-R ED U CTIO N PRIORITY
Events expected to
occur yearly with
respect to system.
4 C B A A
Events expected to
occur several times
during lifetime of
the system.
3 C B B A
Events expected to
occur no more than
5 times during the
lifetime of the
system.
2 D C B B
Events not expected
to occur during
lifetime of system.
1 D D C C
1 2 3 4
Consequences MAG.
Restricted to
local vicinity,
with potential
injuries
requiring no
more than first
aid.
Potential for
injury requiring
physician’s care.
Potential for
single life
threatening
injury or fatality.
Potential for
multiple life
threatening
injuries or
fatalities.

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