Management of Change (MOC) Procedure Template

• Site/Facility

• Conducted on

  Date

• Prepared by

• Location
  Address

Information

• Site

• Change Initiator

• Discription of proposed change

• Area of Change

• Areas/Departments effected by the 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, flammable or combustible materials?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Will the change have an impact on the quality of maintenance? Completions of work orders and/or PMs.

  Yes

  No

  N/A

Operating Personnel

• Will the change require new personnel or the transfer of existing personnel?

  Yes

  No

  N/A

• Has a supervisor or manager's area of responsibility changed?

  Yes

  No

  N/A

• Do personnel require additional training to accommodate the change?

  Yes

  No

  N/A

External Personnel on the site

• Does the change require contractor personnel to be employed onsite?

  Yes

  No

  N/A

• Does the change require new contractors be employed onsite?

  Yes

  No

  N/A

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

  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

EHS

• Will the change impact an existing environmental permit?

  Yes

  No

  N/A

• Will the change require a new or altered environmental permit?

  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 impact existing JSAs?

  Yes

  No

  N/A

• Does the change require the development of new JSAs?

  Yes

  No

  N/A

• Will the change require new or additional PPE?

  Yes

  No

  N/A

• Is there any negative impact on fatality risks?

  Yes

  No

  N/A

Completion

• Is the change Permanent or Temporary?

  Permanent

  Temporary

• Comments

• Name and signature

  Sign