Saudi Aramco SA-373-ENG (06/2016)

SAUDI ARABIAN OIL COMPANY

HIPS Authorization Form
General Location Data
1 Class: ZHIPS 4 Maintenance Plant
2 Object SSX 5 Location
Startup
6 ABC Indicator A Critical
3 date:
7 Functional Location
Organization ‐ HIPS Characteristics
8 HIPS MAWP PSIG
9 HIPS Pressure Rating # Class
10 MAWP of the vessel/Pipe Line protected PSIG
11 Vessel/Pipe Line being protected ASME Pressure Rating # Class

THIS DRAWING AND THE INFORMATION CONTAINED HEREIN ARE THE SOLE PROPERTY OF SAUDI ARAMCO. NO REPRODUCTION IN FULL OR IN PART SHALL BE OBTAINED FROM THIS DOCUMENT WITHOUT THE WRITTEN CONSENT OF ITS OWNER.
12 High Pressure TRIP Set point PSIG
13 Low Pressure TRIP Set point (If applicable) PSIG
14 HIPS Full Response Time Seconds
15 Process Safety Time Seconds
16 Inspection Frequency (Full Proof Test) Months
17 Number of Logic Solvers
18 Number of Pressure Sensors
19 Number of Final Elements
20 Mean Time To Repair( MTTR) Hours
Leak Test Function Frequency (Seat Leakage test available, N/A 3 Months 6 Months 9 Months 12 Months
21 attach in WF) (N/A Offshore Oil Applications)
22 HIPS Information
23 Logic Solver
3 Months 6 Months 9 Months 12 Months High Trip Set point 
24 Inspection Frequency Number of 
value
outputs used
25 Tag No. Type Model Manufacturer PSIG
26 E/PE SS/E RL/HY

27 E/PE SS/E RL/HY

28 Sensors
29 Inspection Frequency 3 Months 6 Months 9 Months 12 Months Sensor  Set point value
30 Tag No. Type Model Manufacturer Pressure Range PSIG (High Trip)
E-PT HI/LO-PT E-PS
31
E-PT HI/LO-PT E-PS
32
33 E-PT HI/LO-PT E-PS

34 E-PT HI/LO-PT E-PS

35 E-PT HI/LO-PT E-PS

36 E-PT HI/LO-PT E-PS

37 Final Elements 
38 Enter valve data (For Offshore Oil Applications ‐ Use line Item 62 to 92 ) Final Element (ZV Valves only)
39 Tag No. Type Model Manufacturer Testing Schedule
40 Partial Stroke

41 3 Months 6 Months

42
9 Months 12 Months
43
Not applicable
44
45 Full Stroke Test (if different from full 
proof test frequency, Offshore Gas)
46
47 3 Months 6 Months
48
9 Months 12 Months
49
50 Actuators (N/A for OFFSHORE OIL)
51 Tag No. Type Model Manufacturer Partial Stroke capability
52 PN HY EM Yes NO

53 PN HY EM Yes NO

54 PN HY EM Yes NO

55 PN HY EM Yes NO

56 PN HY EM Yes NO

57 PN HY EM Yes NO

58 PN HY EM Yes NO

59 PN HY EM Yes NO

60 PN HY EM Yes NO

61 PN HY EM Yes NO
SHT.NO. REV.NO.
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Saudi Aramco SA-373-ENG (06/2016)

SAUDI ARABIAN OIL COMPANY

HIPS Authorization Form

62 Final Elements Offshore OIL (Relays‐HV switchgear)

63 Tag No. Type Model Manufacturer Coil Voltage Fail Safe

64 Undervoltage Interposing Yes NO

65 Undervoltage Interposing Yes NO

66 Undervoltage Interposing Yes NO

67 Undervoltage Interposing Yes NO

68 Undervoltage Interposing Yes NO

69 Undervoltage Interposing Yes NO

THIS DRAWING AND THE INFORMATION CONTAINED HEREIN ARE THE SOLE PROPERTY OF SAUDI ARAMCO. NO REPRODUCTION IN FULL OR IN PART SHALL BE OBTAINED FROM THIS DOCUMENT WITHOUT THE WRITTEN CONSENT OF ITS OWNER.
70 Undervoltage Interposing Yes NO

71 Undervoltage Interposing Yes NO

72 Undervoltage Interposing Yes NO

73 Undervoltage Interposing Yes NO

3 Months 6 Months 9 Months 12 Months

74 Relay Inspection Frequency
75 HIPS Output to WSD Solenoids ‐ Non Safety Loop (OFFSHORE OIL Only.Note: will have same inspection frequency as line item 74)
76 Tag No. Type Model Manufacturer Coil Voltage Fail Safe
77 Yes NO

78 Yes NO

79 Yes NO

80 Yes NO

Adjustable Frequency Drives Final Elements : Can be contact in the AFD or in breaker supplying AFD
81 (OFFSHORE OIL Only. Note: will have same inspection frequency as line item 74)
Model: Insert AFD model if the
Manufacturer: Insert AFD manufacturer if contact is in the
contact is in the AFD, otherwise AFD Final Element Contact type
Tag No. AFD,otherwise insert relay manufacturer used in the breaker supplying
insert relay model used in the Volt Free /interposing or undervoltage
82 the AFD
breaker supplying AFD
83 Volt free/interposing Undervoltage

84 Volt free/interposing Undervoltage

85 Volt free/interposing Undervoltage

86 Volt free/interposing Undervoltage

87 Volt free/interposing Undervoltage

88 Volt free/interposing Undervoltage

89 Volt free/interposing Undervoltage

90 Volt free/interposing Undervoltage

91 Volt free/interposing Undervoltage

92 Volt free/interposing Undervoltage

93 Additional Info
HIPS Trip Push Button Flow line number for 
Offshore  GAS / ESD PB for  SAT date MCC signed date Onshore HIPS or WHP  Trunkline HIPS is connected to:
94 Khuff Gas WSD number for offshore HIPS

95 Tag No.

96

97 Push Button Test Frequency ESD Set point Unit

98 3 Months 6 Months PSIG

99 For Onshore OIL (Requirements as per Letter  P&CSD T348/2012)
9 Months 12 Months Number of HIPS per Trunkline HIPS Architecture
100

101 1oo2 1oo3

102

Project Engineer Initiator
SHT REV
103 Date
NO. NO.
Name ,signature & badge number:

Senior Project Engineer
104 Date 2 of 2
Name , signature & badge number: