Request for Hydrogen Safety Panel Support

Requesting Organization

Contact Name

Position

Phone

Project Title

Scope/Summary of Project:

Select HSP services requested and specify the expected need by date for each item requested (check all that apply).
Some reviews and assoicated reports may take 6-8 weeks to complete.

Service Requested	Need By Date	Additional Info
Safety Plan Review (Safety Plan Guidance)	Expected Completion Date	Is this Safety Plan Review required by DOE, or is it part of a hydrogen hub?
Preliminary Design/Information Review	Expected Completion Date	Report of HSP Comments Needed?
30% Design Review	Expected Completion Date	Report of HSP Comments Needed?
60% Design Review	Expected Completion Date	Report of HSP Comments Needed?
Final Design Review	Expected Completion Date	Report of HSP Comments Needed?
Other Document Review	Expected Completion Date
Kick-off meeting	Expected Completion Date
HAZOPS Support	Expected Completion Date	Remote or In-Person support? Estimated number of days?
Technical Inquiry/Position Paper	Expected Completion Date
Incident Evaluation Support	Expected Completion Date
Best Practice/Lessons Learned	Expected Completion Date
Application Training	Expected Completion Date
Site Inspection	Expected Completion Date
Other (specify in Additional Comments box below)	Expected Completion Date

Other Justification

Additional Comments

Additional Non-Disclosure Agreement Required?

Yes

If "Yes", please provide details:

Please provide the following additional information for requesting an NDA.

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Non-US Organization?

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