STATEMENT OF FITNESS TEMPLATE

SECTION A: Asset Restart following:

 A planned overhaul/turnaround and unplanned deliberate shutdowns.
Reference is made to the procedure HSS.35.05.15 STATEMENT OF FITNESS MANAGEMENT
PROCEDURE for further guidance.
SoF ID: SoF-YYYY-MM-DD-Area-Equipment Tag
Shutdown Title:
Plant Area:
Plant Unit(s):
Back Ground Brief details of the Shutdown activity driver(s) and work scope.
Information:

Start-Up Brief details on if start of the Train/Unit will be done in sections hence a
Strategy: SoF for each of the section start-up.
State the identification and mitigation strategy to capture areas of
conflict as we go for start-up of each section, knowing the potential for
continuing jobs (Cold / Hot work) in other sections.
Units/Equipment
Exempted from
MC/PSSR/CSU

It is confirmed that the following criteria have been met as a minimum requirement necessary
for the facility to reintroduce hydrocarbons.

Applicable
Statement of Fitness requirements specified in AI-PSM Application manual item
Yes No
7.1 have been met where applicable (refer to SoF pre start-up checklist for
applicability):
a Process Safety risks have been identified and documented and are
managed to ALARP
c HSSE critical equipment meets its Technical Integrity requirements
d All outstanding punch list items are captured in PSSR checklist, and
categorized accordingly. Asset is aware of all open B and C items.
h Modifications are complete and have been authorized as specified in the
Management of Change procedure:
 STATEMENT OF FITNESS TEMPLATE

TAs Endorsement to Start Operations

The undersigned agree to the statements above and agree that the current Fitness of the Plant
is adequate to progress with Start-Up as per agreed sequence and agree to ensure post start-
up assurance checks for their discipline.
Concurrence (provide name, signature and date).

In case the TA1 does not sign personally, delegate can sign according to the Manual of
Technical Authority.
Supported by TA 1 Name Sign Date