Management of Change (MOC) Checklist

1. Who is requesting the change?

2. Write a summary of the requested change:

3. List the affected equipment/machinery:

1. List the affected procedures, tests, and/or inspections:

2. List the affected reactive chemicals/materials, if applicable:

1. Safety & Health

2. Environment

3. Loss Prevention

4. Operations

5. Human Resources

1. Emergency (Initiate and Finalize as soon as possible)

2. Permanent

3. Temporary (Include length of time in comments)

1. Facility Additions or Modifications (Include details in comments)

2. Equipment Change or Modification (Include details in comments)

3. Work Practices or Best Practices (Include details in comments)

4. IT/Computers/Systems (Include details in comments)

5. Subcontractor (Include details in comments)

6. Role/Responsibility (Include details in comments)

7. Procedure/Process/Method/Operation (Include details in comments)

8. Chemical/Contaminant/Product (Include details in comments)

9. Personnel Addition or Removal (Include details in comments)

10. Policy or Standard (Include details in comments)

11. Documentation or Records (Include details in comments)

12. Individual’s Role or Job Description (Include details in comments)

13. Other (Describe in Comments)

1. Biological

2. Chemical/Contaminant/Product

3. Stored Energy/Electrical/Gas

4. Preparation/Training/Skills

5. Access/Egress

6. Emergency Planning

7. Ergonomic

8. Physical/Cuts/Burns/etc.

9. Confined Space

10. Psychological

11. Has a complete change risk assessment been performed?

1. Do you have a MOC Leader/Coordinator ready to run point on this change?

2. Do you have knowledgeable change reviewers ready to review the proposed changes?

3. Do you have a change finalizer, if different from MOC Coordinator?

4. Does the description of the proposed change and all affected systems provide enough information?

5. Have you identified all affected roles and personnel?

6. Have you identified all affected contractors and temporary personnel?

7. Has a change request been submitted?

8. Has a change request been reviewed?

9. Has a change request been approved?

10. Have process engineering, technician, or manager personnel been consulted, if needed?

11. Has an equipment specifications and Maintenance/Parts technician consulted, if needed?

12. Will you be able to comply with all Federal, State, and Local safety and engineering standards during this change?

13. Have all potential hazards and gaps been reviewed and discussed?

1. List all the reviewers who have reviewed the change:

2. List all concerns brought up by reviewers:

3. Have concerns been addressed? How?

4. Has the change been approved?

5. Has the change been initiated?

6. Date of Initiation

1. Pre-startup Safety Review (PSSR) conducted?

2. Did the PSSR expose any new, existing, or potentially existing hazards?

3. Have all known new, existing, or potentially existing hazards have been evaluated and mitigated?

4. Training Program completed or updated?

5. Training methods provided: one-on-oneor independent review

6. Training methods provided: group, presentation or classroom setting

7. Training methods provided: group, hands-on learning

8. New job/role procedures written and approved?

9. New tests/inspections written and approved?

10. Have all affected personnel been notified and trained on the change?

11. Have all affected contractors been notified and trained on the change?

12. Have all Work Plans, HASPs, Procedures, Policies, MOC history page, and Documentation been updated?

13. Have you updated your emergency plan, if applicable?

14. Has the change review team reviewed the PSSR?

15. Has startup been approved?

1. Have new safety audits been conducted?

2. Have gaps in safety procedures or audits been identified and addressed?

3. Have all affected personnel been asked to provide feedback after the change?

4. Have all gaps in training been addressed?

5. Have all gaps in emergency and/or special procedures been resolved?

1. Has the change been fully implemented?

2. Has MOC been fully documented?

3. Has the change been reviewed for effectivness?

4. Was this change effective?

5. Is the change accomplishing its original intent?

1. Has the temporary change been returned to its normal status?

2. Has the temporary change been made permanent?

3. Write Comments or Remarks here: