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Management of Change Procedure Template

A Management of Change template helps safety managers identify and control occupational health and safety risks that arise from organizational change. Use this MOC template to review work processes and identify changes and the risks that may occur. Help your organization comply with regulatory and industry standards for workplace health and safety with Lumiform.
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Management of Change Procedure Template

Management of Change


Who initiated the change?

Description of the change initiated?

Area of change

Proposed date as well as time for implementation of this change?


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?


Will the change alter existing hardware and or control software?

Will this modification also change on-site emergency response procedures?


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?


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?


Is the adaptation permanent or temporary?

Other comments?



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