PROCESS HAZOP RECORD SHEET

Plant: ______________________________ Team: _______________________________ Date: __________________________ Sheet _______ of ___________

NODE: _____________________________________________ Process Condition/Criteria: _______________________________________________________
Record No: Category: Guideword: ______________________________________________________________________________________________________________________
Cause/s: _______________________________________________________________________________________________________________________________________________________________________________
Consequence/s: __________________________________________________________________________________________________________________________________________________________________________
Safeguards: ____________________________________________________________________________________________________________________________________________________________________________
Recommendations: R ____________________________________________________________________________________________________________________________ Type Who
R ____________________________________________________________________________________________________________________________ Type Who
Frequency Severity Risk Legal
Record No: Category: Guideword: ______________________________________________________________________________________________________________________
Cause/s: _______________________________________________________________________________________________________________________________________________________________________________
Consequence/s: __________________________________________________________________________________________________________________________________________________________________________
Safeguards: ____________________________________________________________________________________________________________________________________________________________________________
Recommendations: R ____________________________________________________________________________________________________________________________ Type Who
R ____________________________________________________________________________________________________________________________ Type Who
Frequency Severity Risk Legal
Record No: Category: Guideword: ______________________________________________________________________________________________________________________
Cause/s: _______________________________________________________________________________________________________________________________________________________________________________
Consequence/s: __________________________________________________________________________________________________________________________________________________________________________
Safeguards: ____________________________________________________________________________________________________________________________________________________________________________
Recommendations: R ____________________________________________________________________________________________________________________________ Type Who
R ____________________________________________________________________________________________________________________________ Type Who
Frequency Severity Risk Legal
Record No: Category: Guideword: ______________________________________________________________________________________________________________________
Cause/s: _______________________________________________________________________________________________________________________________________________________________________________
Consequence/s: __________________________________________________________________________________________________________________________________________________________________________
Safeguards: ____________________________________________________________________________________________________________________________________________________________________________
Recommendations: R ____________________________________________________________________________________________________________________________ Type Who
R ____________________________________________________________________________________________________________________________ Type Who
Frequency Severity Risk Legal
Severity (People) Severity (Rands) Frequency RISK MATRIX
A Fatality 1 2 3 4 5
A- Fatality A- R1 Million -R10 Million 1. Once a week
B Reportable 2 3 4 5 6

Severity
B - Reportable B - R100 000 - R1 Million 2. Once a month
C Injury 3 4 5 6 7

C - Injury C - R10 000 - R100 000 3.Once a year D Minor/dressing 4 5 6 7 8

E None 5 6 7 8 9
D - Minor D - R0 - R10 000 4. Once in 10 years
Once Once Once Once Once
a a a in a
week month year 10 yrs lifetime
E - None E - R0 5. Once a lifetime 1 2 3 4 5
Frequency