MOC - Safety Review Checklist

• 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

Safety Review

• If the modification affects any ventilation system, will modified ventilation system not comply with appropriate codes and standards?

  Yes

  No

  N/A

• Does the modification alter the normal permitted discharges to the air or water of the facility? If yes, are any changes needed to existing permits?

  Yes

  No

  N/A

• Does the modification require that the onsite inventory of hazardous chemicals be increased? If yes, are any additional safeguards or controls needed?

  Yes

  No

  N/A

• Does the modification require that hazardous chemicals be stored at higher temperatures or pressures than the current configuration?

  Yes

  No

  N/A

• Does the modification require that hazardous chemical detectors be added?

  Yes

  No

  N/A

• Are the indications and alarms in the existing plant inadequate for the modified plant?

  Yes

  No

  N/A

• Does the modification require additional personnel protection measures (e.g., PPE)?

  Yes

  No

  N/A

• Have the modifications created any additional vulnerabilities to external events which did not exist before (vehicle traffic, fire, water accumulation, high wind, etc.)?

  Yes

  No

  N/A

• Is electrical power and other services inadequate to meet the demands of the modified plant?

  Yes

  No

  N/A

• Are the existing site security procedures inadequate?

  Yes

  No

  N/A

• Are the existing eyewash/safety showers inadequate?

  Yes

  No

  N/A

• Has the change been reviewed and approved by appropriate facility management?

  No

  Yes

  N/A

• Other health and safety issues not yet addressed?

  Yes

  No

  N/A

• Is the existing fire suppression system inadequate for the change in chemical inventory?

  Yes

  No

  N/A

• Is the warehouse racking capacity inadequate?

  Yes

  No

  N/A

Completion

• Is the change Permanent or Temporary

  Permanent

  Temporary

• Comments

• Name and signature

  Sign