Management of Change

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General info

• Change Initiator

• Discription of proposed change

• Area of Change

• Proposed Date and time to implement Change?

  Date

• Any Change Management must be submitted to the General Manager for approval 48 hrs , prior to the intended change being implemented.

Engineering/Mining Processes

• Will the change bring about alterations to the origanal design of the machine/equipment?

  Yes

  No

• Will the change bring about a change to maintenance, equipment operating methods or safety devices?

  Yes

  No

• Will the change result in a negative impact on pressures , tempretures, lubrication, emmisions, vibration or ergonomics?

  Yes

  No

• Will the change initiate any new construction , modification of existing facilities, or decommissioning activities?

  Yes

  No

• Will the change requie or involve any excavation, soil contamination or contamination of ground water?

  Yes

  No

• Will the change involve, result in or generate radioactive,hazardous or mixed waste such as any new or altered carcinogenic, corrosive, biological ,radioactive, or infectious chemical or agents?

  Yes

  No

• Will the change requier the use of large quantities of flammable liquids?

  Yes

  No

• Will the change require that combustable liquids are heated above or close to their flashpoints?

  Yes

  No

• Does the change require the use of storage tanks or the storage of large quantities of hazardous , radioactive, flammable or combustible materials?

  Yes

  No

• Does the change involve any High -energy sources( e.g. Radiation, electromagnetic, laser, compressed gasses, propellants and/or explosives?

  Yes

  No

• Will the change alter any pre -start inspection schedule?

  Yes

  No

• Does the change alter the validity of of any certification, exemptions, or permissions?

  Yes

  No

Operating and Design

• Will the change alter existing hardware and/or control software?

  Yes

  No

• Will this alter emergency response used on site?

  Yes

  No

Quality

• Will the change have an impact on the quality of the product or service?

  Yes

  No

• Will the change have an impact on the quality of maintenance?

  Yes

  No

Operating Personnel

• Have personnel changed?

  Yes

  No

• Has a person's area of responsibility changed?

  Yes

  No

• Do people require additional training to accomodate the change?

  Yes

  No

External Personnel on the site

• Does the change require additional contractor personnel to be employed outside the current contract?

  Yes

  No

• Will the change require a change in scope of work conducted by contractor personnel?

  Yes

  No

• Will the change require a change in contractor company performing the work?

  Yes

  No

Regulations, Standards or COP's

• Is the change as a result of a significant change in regulations, standards or any Code of Practice?

  Yes

  No

• Is the change as a result of a CLIENt requirement, standard?<br>

  Yes

  No

• Is there a change required to procedures and/or training material?

  Yes

  No

• Not covered in procedures or Code of Practices?

  Yes

  No

Organisational Structures

• Will the change require significantalterations to the organisational structure?

  Yes

  No

Suppliers, Community and/or Client/User

• Are ther any added HSEC risk to the suppliers, clients, users or the community?

  Yes

  No

• Is there any added financial risk to the shareholders?

  Yes

  No

• Is there any legal implecations between the mine and suppliers, clients, users and or community?

  Yes

  No

• Will the change need approval from the OEM?

  Yes

  No

Other

• Is there any added risk to personnel with regards to Health & Safety (Hierarchy of control)

  Yes

  No

• Is there any added risk to enviroment such as altering existing enviromental status by generating any new or altered airborne emmisions, liquid effluents, or solid debris, or affect the approved EMP?

  Yes

  No

• Will the change require new or additional PPE?

  Yes

  No

• Is there any negative impact on any of the Fatal Risks?<br>

  Yes

  No

Final Analysis

• Is the change Permanent or Temporary

  Permanent

  Temporary