Management of Change (MOC) Procedure Template

• Site/Facility

• Conducted on

  Date

• Prepared by

• Location
  Address

Information

• Change Initiator

• Discription of proposed change

• Area of Change

• Proposed Date and Time to implement Change?

  Date

Engineering

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Operating and Design

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

  Yes

  No

  N/A

• Will this alter emergency response used on site?

  Yes

  No

  N/A

Quality

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Operating Personnel

• Have personnel changed?

  Yes

  No

  N/A

• Has a person's area of responsibility changed?

  Yes

  No

  N/A

• Do people require additional training to accomodate the change?

  Yes

  No

  N/A

External Personnel on the site

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Regulations, Standards, or Code of Practice

• Is the change as a result of a significant change in regulations, standard operating procedures, or any code of practice?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Not covered in procedures or code of practices?

  Yes

  No

  N/A

Organisational Structures

• Will the change require significant alterations to the organisational structure?

  Yes

  No

  N/A

Suppliers, Community and/or Client/User

• Are there any added health, safety, and environmental risk to the suppliers, clients, users or the community?

  Yes

  No

  N/A

• Is there any added financial risk to the shareholders?

  Yes

  No

  N/A

• Are there any legal implications between the suppliers, clients, users and or community?

  Yes

  No

  N/A

Other

• Is there any added risk to personnel with regards to health & safety

  Yes

  No

  N/A

• Is there any added risk to the environment such as altering existing environmental status by generating any new or altered airborne emissions, liquid effluents, or solid debris, or affect the approved environmental management system?

  Yes

  No

  N/A

• Will the change require new or additional PPE?

  Yes

  No

  N/A

• Is there any negative impact on any of the fatal risks?

  Yes

  No

  N/A

Completion

• Is the change Permanent or Temporary

  Permanent

  Temporary

• Comments

• Name and signature

  Sign