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Management of Change Procedure Template

A Management of Change Procedure Template is a document that outlines the steps to be taken when making changes to a system, process, or organization. It helps to ensure the changes are managed in a safe, efficient, and effective manner.

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Management of Change
Information
Who initiated the change?
Description of the change initiated?
Area of change
Proposed date as well as time for implementation of this change?
Technique
Does the change result in any deviations to the original design of the machine/plant?
Does the change result in deviations to maintenance, equipment, operating methods, or safety devices?
Does the change negatively affect pressures, temperatures, vibrations, emissions, lubrication, or even ergonomics?
Will the change provide the impetus for new construction, modification of existing facilities, or decommissioning?
Will the change require or involve excavation, soil contamination, or groundwater contamination?
Will the change affect, result in, or generate radioactive, hazardous, or even mixed wastes such as new or modified carcinogens, corrosives, radioactive, biological, or even infectious chemicals or agents?
Will the change require the use of large quantities of flammable liquids?
Will the change require flammable liquids to be heated above or near their flash point?
Will the change require the use of storage tanks or the storage of large quantities of hazardous, radioactive, flammable, or combustible materials?
Does the change involve certain high-energy sources (e.g., radiation, electromagnetic radiation, lasers, compressed gases, propellants, and/or explosives)?
Does the change affect the schedule of inspections prior to their start?
Does the change affect the validity of certificates, exemptions, or even permits?
Operation
Will the change alter existing hardware and or control software?
Will this modification also change on-site emergency response procedures?
Quality
Will the change affect the quality of the product or service?
Will the change affect the quality of maintenance?
Operating Personnel
Has there been a change in personnel?
Have areas of responsibility changed?
Do staff need additional training to handle these changes?
External Personnel
Does the change require the employment of additional outside personnel outside of the current contract, if applicable?
Does the change require an adjustment in the scope of work for the contractor's staff?
Does the change also require a change in the contractor performing the work?
Regulations, Standards, or Code of Practice
Is the change the result of a significant adjustment to regulations, standard operating procedures, or code of conduct?
Is the adjustment as a result of a customer requirement or standards?
Consequently, is a change in procedures and/or training material required?
Is this not included in the procedures or code of conduct?
Organizational Structures
Does the change require significant changes to the organizational structure?
Suppliers, Community and/or Customers/Users
Are there additional health, environmental or safety risks to suppliers, customers, users or the community?
Is there additional financial risk to shareholders?
Are there potential legal ramifications between suppliers, customers, users, and the community?
Other
Is there additional health and safety risk to personnel?
Is there additional risk to the environment, such as change in current environmental condition due to new or changed air emissions, solid waste, or liquid effluent, or does the change affect the approved environmental management system?
Will the adaptation require new or additional PPE?
Is there an adverse impact on the likelihood of fatal hazards?
Confirmation
Is the adaptation permanent or temporary?
Other comments?
Name
Signature
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A Management of Change Procedure Template is a document used to establish a systematic process for managing and evaluating changes to an organization. It helps ensure that any changes are properly documented, communicated, and evaluated against pre-set goals and objectives. The template consists of a set of questions, forms and checklists to ensure that all aspects of the change process are properly managed, including identifying the need for change, analyzing the impact of the change, developing and implementing a plan, monitoring and evaluating the results, and communicating the outcomes. This template is a useful tool to ensure the smooth and successful transition of any change within the organization.
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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