Title: Revision Number: Issue Date: Section:

0 OCT 2011 MOC

MANAGEMENT OF CHANGE Prepared By: Approved By: Document No.
DPA MD SOM – APP

Management of Change Request

Name of Vessel Date Initiated: MOC NO:

Originator Master Ext No:

Date Required:

1. Description and Reason for Change

2. Type of Change

Emergency Urgent Temporary Permanent Date due: _______________________

(Note: period not to exceed 06 months)

3. Nature of Change

Equipment Procedural Operating Parameters Safety System Chemical/haz. Material

4. Evaluation Process ( Refer to section 8 – page 3 of 3 )

RA MATRIX 1. Before Change Higher Medium Low

2. After Change Higher Medium Low

Is - “ After Change” RA matrix Medium or Higher? (Yes or No) ____________

Has multiple MOC been issued for this equipment? (Yes or No) ____________ Existing MOC No:__________

For MOC extension – Is there incremental risk since last RA done? (Yes or No) ___________

Note: If any of the above answer is ‘Yes’ , then additional control measures are to be in place and RA
conducted to bring the level of risk to ‘ALARP’ and Change Form to be submitted to personnel listed in item
5 for approval.

RA MATRIX Higher Medium Low

5. Review/Approval Process
Approval /Disapproval Action Name/Signature Date Comments, if any

Master * _____________________ ____________ ___________________

Ch/Eng * ______________________ ____________ ____________________

Superintendent * ______________________ ____________ ____________________

OM * ______________________ ____________ ____________________

GM ______________________ ____________ ____________________

KENCANA NAUTILUS SDN BHD (8 8 2 4 5 9 - A)

Level 6, Menara SapuraKencana Petroleum, Solaris Dutamas, Jalan Dutamas 1, 50480 Kuala Lumpur, Malaysia.
T +603 6209 8000, F +603 6209 3859, www.sapurakencana.com
Title: Revision Number: Issue Date: Section:
0 OCT 2011 MOC
MANAGEMENT OF CHANGE Prepared By: Approved By: Document No.
DPA MD SOM – APP

Management of Change Request

6. Implementation
Resources required to implement the change Name Completion date
Before The Change
Tool box meeting conducted
Materials/parts ordered
Obtain necessary Permit to work where applicable
Provide training on special precautions/procedures and notify
/communicate to all affected parties.
Master Ch. Engineer
Chief officer WKO WKE
Deck Crew Engine Crew
Catering Crew Others
Carrying out the change
Making the change such as installing replacing / opening / closing /
Bypassing / resetting / reconfiguring functions and etc

After the change

Check / verify that running conditions / operations are in
Accordance to planned / agreed objective
Update procedures / Safety management system manual
7. Close Out Process
For Temporary Change
Restore operations to original limits /conditions
Run and determine operations
Reuse original and discard temporary updated documentation.
MOC Extended Ref:
MOC converted to permanent MOC Ref:
For Permanent Change
Verify SMS manual, HSE case etc have been updated
File this MOC iunder „close section/file‟
Lessons learnt sharing via Safety Alert
For Close Out
MOC close out has been communicated to affected personnel
Approve to review prior to close – out
Final Close Out by Master

KENCANA NAUTILUS SDN BHD (8 8 2 4 5 9 - A)

Level 6, Menara SapuraKencana Petroleum, Solaris Dutamas, Jalan Dutamas 1, 50480 Kuala Lumpur, Malaysia.
T +603 6209 8000, F +603 6209 3859, www.sapurakencana.com
Title: Revision Number: Issue Date: Section:
0 OCT 2011 MOC
MANAGEMENT OF CHANGE Prepared By: Approved By: Document No.
DPA MD SOM – APP

Management of Change Request

8. MOC Risk Evaluation

Date MOC No. Extension

STEP 1: Hazard /Risks “ Before Change “ Risk Level

1. List down potential hazards/risks associated with operating under „ Current Defective or Deficient
Conditions‟. If this Change is not carried out ( use hazards identification tools such as JHA, toolbox
meeting, HEMP, safety meetings. What if etc.)
2. Evaluate the risk level for these hazards/risks ( use RA and SMS manual, BR 40, Regulation 13)
3. Consider existing safety protection in place such as shutdown system and LSA/FFA

STEP 2: Hazard/Risks “ After Change “ but prior to additional mitigation (s) Risk Level
1. List down potential hazards/risks associated with operating under the „ new conditions „ after making
the change
2. Evaluate the risk level for these hazards / risks (use RA matrix)

STEP 3: Mitigation (s) Risk Level

1. List the recommended additional mitigation (s) including special procedures and precautions
2. Evaluate the same hazards listed in step 2, taking into consideration the recommended additional
mitigation (s)

Master, Chief Engineer or superintendent to communicate and provide training associated with the
proposed change prior to implementing the change..
Remarks (if any)

1. This form to be completed as required (Please refer to MOC Procedure).

2. Retention Period – At least 05 years.
KENCANA NAUTILUS SDN BHD (8 8 2 4 5 9 - A)
Level 6, Menara SapuraKencana Petroleum, Solaris Dutamas, Jalan Dutamas 1, 50480 Kuala Lumpur, Malaysia.
T +603 6209 8000, F +603 6209 3859, www.sapurakencana.com