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Management of Change Checklist
Section 1: Change Description
1. 1. Who is requesting the change (names/titles)?
2. 2. Write a summary of the requested change?
3. 3. List the affected equipment/machinery.
4. 4. List the affected jobs/roles.
5. 5. List the affected procedures, tests, and/or inspections.
6. 6. List the affected reactive chemicals/materials, if applicable.
Section 2: Areas That Need Changing
1. 1. Does Safety and Health need changing?
Yes
No
N/A
2. 2. Does the Environment need changing?
Yes
No
N/A
3. 3. Does Loss Prevention need changing?
Yes
No
N/A
4. 4. Do Operations need changing?
Yes
No
N/A
5. 5. Do Human Resources need changing?
Yes
No
N/A
Section 3: Proposed Length Of Change
1. 1. What is the proposed length of change? •Emergency (Initiate and Finalize as soon as possible) •Permanent •Temporary (Include length of time in comments)
Yes
No
N/A
Section 4: Type Of Change
1. 1. Are Facility Additions or Modifications proposed as a type of change? (Include details in comments)
Yes
No
N/A
2. 2. Are Equipment Changes or Modifications proposed as a type of change? (Include details in comments)
Yes
No
N/A
3. 3. Are Work Practices or Best Practices proposed as a type of change? (Include details in comments)
Yes
No
N/A
4. 4. Are IT/Computers/Systems proposed as a type of change? (Include details in comments)
Yes
No
N/A
5. 5. Are Subcontractors proposed as a type of change? (Include details in comments)
Yes
No
N/A
6. 6. Are Role Changes proposed as a type of change? (Include details in comments)
Yes
No
N/A
7. 7. Are Procedures/Processes/Methods/Operations proposed as a type of change? (Include details in comments)
Yes
No
N/A
8. 8. Are Chemicals/Contaminants/Products proposed as a type of change? (Include details in comments)
Yes
No
N/A
9. 9. Are Personnel Addition or Removal proposed as a type of change? (Include details in comments)
Yes
No
N/A
10. 10. Are Policies or Standards proposed as a type of change? (Include details in comments)
Yes
No
N/A
11. 11. Are Documentation or Records proposed as a type of change? (Include details in comments)
Yes
No
N/A
12. 12. Are individual’ Roles or Job Descriptions proposed as a type of change? (Include details in comments)
Yes
No
N/A
Section 5: Hazards Present
1. 1. Are biological hazards involved in this change?
Yes
No
N/A
2. 2. Are Chemical/Contaminant/Product hazards involved in this change?
Yes
No
N/A
3. 3. Are Stored Energy/Electrical/Gas hazards involved in this change?
Yes
No
N/A
4. 4. Are Preparation/Training/Skills involved in this change?
Yes
No
N/A
5. 5. Is Access/Egress involved in this change?
Yes
No
N/A
6. 6. Is Emergency Planning involved in this change?
Yes
No
N/A
7. 7. Are Ergonomic issues involved in this change?
Yes
No
N/A
8. 8. Are Physical/Cuts/Burns/etc. hazards involved in this change?
Yes
No
N/A
9. 9. Is Confined Space involved in this change?
Yes
No
N/A
10. 10. Are Psychological issues involved in this change?
Yes
No
N/A
11. 11. Has a complete change risk assessment been performed?
Yes
No
N/A
Section 6: MOC Initiation & Change Approval
1. 1. Do you have an MOC Leader/Coordinator ready to run point on this change?
Yes
No
N/A
2. 2. Do you have knowledgeable change reviewers ready to review the proposed changes?
Yes
No
N/A
3. 3. Do you have a change finalizer, if different from the MOC Coordinator?
Yes
No
N/A
4. 4. Does the description of the proposed change and all affected systems provide enough information?
Yes
No
N/A
5. 5. Have you identified all affected roles and personnel?
Yes
No
N/A
6. 6. Have you identified all affected contractors and temporary personnel?
Yes
No
N/A
7. 7. Has a change request been submitted?
Yes
No
N/A
8. 8. Has a change request been reviewed?
Yes
No
N/A
9. 9. Has a change request been approved?
Yes
No
N/A
10. 10. Have process engineering, technician, or manager personnel been consulted if needed?
Yes
No
N/A
11. 11. Has an equipment specifications and Maintenance/Parts technician consulted if needed?
Yes
No
N/A
12. 12. Will you be able to comply with all Federal, State, and Local safety and engineering standards during this change?
Yes
No
N/A
13. 13. Have all potential hazards and gaps been reviewed and discussed?
Yes
No
N/A
Section 7: Change Final Approval Process
1. 1. List all the reviewers who have reviewed the change
2. 2. List all concerns brought up by reviewers
3. 3. Have concerns been addressed? How have they been addressed?
4. 4. Has the change been approved?
Yes
No
N/A
5. 5. Has the change been initiated?
Yes
No
N/A
6. 6. Date of Initiation
Section 8: Pre-Startup Safety Review
1. 1. Is a Pre-startup Safety Review (PSSR) conducted?
Yes
No
N/A
2. 2. Did the PSSR expose any new, existing, or potentially existing hazards?
Yes
No
N/A
3. 3. Have all known new, existing, or potentially existing hazards been evaluated and mitigated?
Yes
No
N/A
4. 4. Has the training Program been completed or updated?
Yes
No
N/A
5. 5. Is a one-on-one or independent review provided?
Yes
No
N/A
6. 6. Is a group, presentation, or classroom setting provided?
Yes
No
N/A
7. 7. Is a group, hands-on learning setting provided?
Yes
No
N/A
8. 8. Are new job/role procedures written and approved?
Yes
No
N/A
9. 9. Are new tests/inspections written and approved?
Yes
No
N/A
10. 10. Have all affected personnel been notified and trained on the change?
Yes
No
N/A
11. 11. Have all affected contractors been notified and trained on the change?
Yes
No
N/A
12. 12. Have all Work Plans, HASPs, Procedures, Policies, MOC history page, and Documentation been updated?
Yes
No
N/A
13. 13. Have you updated your emergency plan, if applicable?
Yes
No
N/A
14. 14. Has the change review team reviewed the PSSR?
Yes
No
N/A
15. 15. Has the startup been approved?
Yes
No
N/A
Section 9: Post-Startup Evaluation & Change Finalization
1. 1. Have new safety audits been conducted?
Yes
No
N/A
2. 2. Have gaps in safety procedures or audits been identified and addressed?
Yes
No
N/A
3. 3. Have all affected personnel been asked to provide feedback after the change?
Yes
No
N/A
4. 4. Have all gaps in training been addressed?
Yes
No
N/A
5. 5. Have all gaps in emergency and/or special procedures been resolved?
Yes
No
N/A
Section 10: Change Finalization
1. 1. Has the change been fully implemented?
Yes
No
N/A
2. 2. Has MOC been fully documented?
Yes
No
N/A
3. 3. Has the change been reviewed for effectiveness?
Yes
No
N/A
4. 4. Was this change effective?
Yes
No
N/A
5. 5. Is the change accomplishing its original intent?
Yes
No
N/A
Section 11: Temporary Change Resolution
1. 1. Has the temporary change been returned to its normal status?
Yes
No
N/A
2. 2. Has the temporary change been made permanent?
Yes
No
N/A
3. 3. Was the temporary change effective?
Yes
No
N/A