Management of Change Checklist

Use the Management of Change checklist to assess, plan, document and execute changes in processes, to avoid safety problems and maintain regulatory compliance.

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Health & Safety
Management of Change Checklist

Change Description

Areas That Need Changing

Proposed Length Of Change

Type Of Change

Hazards Present

MOC Initiation & Change Approval

Change Final Approval Process

Pre-Startup Safety Review

Post-Startup Evaluation & Change Finalization

Change Finalization

Temporary Change Resolution

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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Management of Change Checklist

Use the Management of Change checklist to assess, plan, document and execute changes in processes, to avoid safety problems and maintain regulatory compliance.

1. Who is requesting the change (names/titles)?

2. Write a summary of the requested change?

3. List the affected equipment/machinery.

4. List the affected jobs/roles.

5. List the affected procedures, tests, and/or inspections.

6. List the affected reactive chemicals/materials, if applicable.

1. Does Safety and Health need changing?

2. Does the Environment need changing?

3. Does Loss Prevention need changing?

4. Do Operations need changing?

5. Do Human Resources need changing?

1. What is the proposed length of change? •Emergency (Initiate and Finalize as soon as possible) •Permanent •Temporary (Include length of time in comments)

1. Are Facility Additions or Modifications proposed as a type of change? (Include details in comments)

2. Are Equipment Changes or Modifications proposed as a type of change? (Include details in comments)

3. Are Work Practices or Best Practices proposed as a type of change? (Include details in comments)

4. Are IT/Computers/Systems proposed as a type of change? (Include details in comments)

5. Are Subcontractors proposed as a type of change? (Include details in comments)

6. Are Role Changes proposed as a type of change? (Include details in comments)

7. Are Procedures/Processes/Methods/Operations proposed as a type of change? (Include details in comments)

8. Are Chemicals/Contaminants/Products proposed as a type of change? (Include details in comments)

9. Are Personnel Addition or Removal proposed as a type of change? (Include details in comments)

10. Are Policies or Standards proposed as a type of change? (Include details in comments)

11. Are Documentation or Records proposed as a type of change? (Include details in comments)

12. Are individual’ Roles or Job Descriptions proposed as a type of change? (Include details in comments)

1. Are biological hazards involved in this change?

2. Are Chemical/Contaminant/Product hazards involved in this change?

3. Are Stored Energy/Electrical/Gas hazards involved in this change?

4. Are Preparation/Training/Skills involved in this change?

5. Is Access/Egress involved in this change?

6. Is Emergency Planning involved in this change?

7. Are Ergonomic issues involved in this change?

8. Are Physical/Cuts/Burns/etc. hazards involved in this change?

9. Is Confined Space involved in this change?

10. Are Psychological issues involved in this change?

11. Has a complete change risk assessment been performed?

1. Do you have an 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 the 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 have they been addressed?

4. Has the change been approved?

5. Has the change been initiated?

6. Date of Initiation

1. Is a 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 been evaluated and mitigated?

4. Has the training Program been completed or updated?

5. Is a one-on-one or independent review provided?

6. Is a group, presentation, or classroom setting provided?

7. Is a group, hands-on learning setting provided?

8. Are new job/role procedures written and approved?

9. Are 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 the 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 effectiveness?

4. Was this change effective?