Certa Change Request

• Proposed Change Title

• Date of Request

  Date

• Prepared by

• Version No.

• Location

• Type of Change

  Select Plant Equipment Process Technology Procedural Organisational People Other (select 'add note' to enter details)

  • Plant
  • Equipment
  • Process
  • Technology
  • Procedural
  • Organisational
  • People
  • Other (select 'add note' to enter details)

• Change Status

  Select Permanent Temporary

  • Permanent
  • Temporary

• Description of Proposed Change

• Justification of Change

• Anticipated Start Date of Change

  Date

• Potential hazards or risk of not implementing proposed change

• List any control measures required for the proposed change to maintain safe operation (including additional personnel, equipment etc.)

• Is asset replacement part of this change? (if your answer is yes, notify facilities@certaireland.ie)

  Yes

  No

  N/A

• Who will this change impact (e.g., Certa staff/departments, contractors, landlords etc.

• Have personnel listed in the previous question been notified about this change? If not, you must add it as an action below.

  Yes

  No

  N/A

• Stakeholder Impact - List the Potential Benefits

• Stakeholder Impact - List the Potential Adverse Effects

• Staff & Operations Impact - List the Potential Benefits

• Staff & Operations Impact - List the Potential Adverse Effects

• List any other actions required as part of this change (individual/group responsible) / due date and raise actions on OSHENS. Link to OSHENS >>> https://dccenergy.oshens.com/OilIreland/Login/Default.aspx <<<

• Please select your Department and await approval & sign off from your Director below before proceeding with change.

  Select Facilities Operations I.T. HR Lubricants Commercials Unmanned Retail Finance HSE

  • Facilities
  • Operations
  • I.T.
  • HR
  • Lubricants
  • Commercials
  • Unmanned Retail
  • Finance
  • HSE

• Once your Department is selected from the above list, exit iauditor and do NOT select 'Complete inspection'. Final step is to be completed by Director only.

To be Completed by Director

• Do you approve this change request?

  Yes

  No

• If change has been approved, add signature and select 'Complete Inspection'.

  Sign