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Bypass Worksheet
Date Time Bypassed Time Returned
Instrument Equipment Number/Unit: Reason for Modification / Bypass:
Check the Appropriate Box
Type Description
Type 1
Type 2
Type 3 Type 4 Type 5
Additional Actions Required
Alternate Bypass Risk Protection Plan Assessment
Bypass an instrument for repair or maintenance;
instrument is part of fault tolerant system where SIF will still activate upon process demand; repair completed in less than 72 hours Bypass an instrument for repair or maintenance; instrument is part of fault tolerant system where SIF will still activate upon process demand; repair requires more than 72 hours Bypass an instrument for repair or maintenance; instrument is NOT part of fault tolerant system; repair completed in less than 72 hours Bypass an instrument for repair or maintenance; instrument is NOT part of fault tolerant system; repair requires more than 72 hours Bypass for any reason other than instrument repair or maintenance
No
No
No*
YES
YES
No
YES
YES
Per Bypass Risk Assessment * * May be required if the Bypass Risk Assessment indicates that it is necessary
YES
Approvals Description
Initials Shift Supervisor
Reason for bypass is appropriate
Selection of bypass type is appropriate and correct An alternate protection plan has been prepared and is acceptable (if required) A Bypass Risk Assessment has been performed and is acceptable (if required)
