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Structural integrity assessment and control (SIA & C) are vital for existing ageing as well as newly built offshore and onshore structures. The SIA & C becomes highly sensitive to interventions under a potential loss of structural integrity (SI) especially when there are inherent constraints present in carrying out engineering work in hazardous environments such as petroleum production and process facilities (P&PFs). The challenges have been further exacerbated by the constantly ageing onshore and offshore structures whilst it is the necessity of carrying out life extension at the verge of their design service lives. Local and international regulations demand the implementation of appropriate strengthening, modification and repair (SMR) plans when significant changes in the SI have been revealed. This chapter presents potential simulation approaches that are possible to utilize for SIA&C in relation to prioritization as well as evaluation of current status of a SIA&C organization.