ORM - Management of Change

• Site conducted

  Select

• Brief Description of Change Request

• Resource / Equipment :

• Proposed Date and Time to implement change

  Date

• Detailed Description of Change Request

Safety

• Has a Risk Assessment been conducted?

  No

  Yes

  Not applicable

• Include Risk Assessment with MOC Submission to ORM.

• Will the Standard Operation Procedure (SOP) or Job Safety Analysis (JSA) need changed?

  No

  Yes

  Not applicable

• Contact ORM and request specific modifications that will be needed to the SOP/JSA.

• Will Employees need trained to new procedures?

  No

  Yes

  Not applicable

• Develop a training plan prior to implementing the change.

• Will this proposal introduce any hazards into the workplace (e.g. blades, steam or compressed air)?

  No

  Yes

  Not applicable

• List new hazards that will be added with this change.

• Has a lock out / tag out placard been posted? Lock out points identified and labelled ?

  Yes

  No

  Not Applicable

• Work with ORM to develop a LOTO Procedure and to post on equipment.

• Will any ergonomic issues be introduced (e.g. repetitive movements, heavy lifting, awkward postures)?

  No

  Yes

  Not applicable

• Describe ergonomic issues specific to this change.

• Will this involve changing the application or use of an existing chemicals?

  No

  Yes

  Not applicable

• Describe chemical application/usage changes.

• Will this proposal require additions or enhancements to PPE?

  No

  Yes

  Not applicable

• List the additional PPE Requirements for this change.

• Industrial hygiene testing recommended for Air, Noise or Vibration?

  No

  Yes

  Not applicable

• List Industrial Hygiene testing required.

• Does the process /change include the use of flammables or combustibles?

  No

  Yes

  Not applicable

• List type of chemical, its use and quantity to be used.

• Is there a fire risk associated with the change or process?

  No

  Yes

  Not applicable

• Describe fire risk.

• Will Arc Flash Labeling need modified/changed?

  No

  Yes

  Not applicable

• Contact Engineering to ensure Arc Flash Survey is updated and new labels are generated.

• Are additional specific procedures or postings required?

  No

  Yes

  Not applicable

• Describe procedures or postings that are required.

Environmental

• Is any Environmental Legislation affected by this process?

  Regulation not affected

  Yes, Review Regulation

• Describe Environmental Legislation that will be effected.

• Will quantities of chemical usage increase or change?

  No

  Yes

  Not applicable

• List chemicals and the quantity they will increase.

• Is there a risk of discharge of organics/chemicals to Waste Water?

  No

  Yes

  Not applicable

• Describe Waste Water risk.

• Is there any potential for a spill from the change or process?

  No

  Yes

  Not applicable

• Describe spill risk.

• Can any of the waste generated be recycled?

  No

  Yes

  Not applicable

• List waste that can be recycled.

• Are new or specific recycling, hazardous waste or additional garbage bins required ?

  No

  Yes

  Not applicable

• List describe quantity and types of containers/bins needed.

• Are there any hazardous wastes or by-products from this process or change?

  No

  Yes

  Not applicable

• Describe hazardous waste or by products generated.

• Does this process need to be added to the Environmental Aspects list?

  No

  Yes

  Not applicable

• Contact ORM to have this process added to the Environmental Aspect List.

Actions to be completed prior to change

• Action 1

• Action 2

• Action 3

• Action 4

Final Analysis

• Is the change Permanent or Temorary

  Permanent

  Temporary

Signature

• Add signature

  Sign