MANAGEMENT OF CHANGE No:

PROCEDURE LEVEL 2
Date:
TITLE
Equipmen
Change Relates to Process Safeguarding New installation Organization Procedure
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DESCRIPTION Of PROPOSED CHANGE

JUSTIFICATION: WHY IS THE CHANGE REQUIRED/BUSINESS BENEFIT:

HOW WILL THE CHANGE BE MADE/IMPLEMENTED/CONTROLLED :

Change Requested by:

Signature Date

Comments by Technical Authority

Comments by Technical Authority

Process and Method

Hardware Design
Material Selection
Legal Requirements
Relevant Drawings
Process Feasibility
Technically Approved
by : Signature Date

EHS Requirements - Attach any Supporting Documents

Risk Assesment
Yes/No
Job Hazard Analysis
Yes/No
Health/Ergonomics Risk Assesment
Yes/No
Environment Aspect Impact
Assesment Yes/No
Legal & Security Risk Assessment
Yes/No
Occupational Hygiene Surveys
Yes/No
Energy Consumption and Impact
Assessment Yes/No
Social Impact Assesment
Yes/No
Emergency and Contingency
Assesment Yes/No
Specific PPE Requirements
Yes/No
Other EHS Concerns-

EHS Approval by: Signature Date

Change Authorized by: Signature Date
Change Approved by HOD: Signature Date
Approval accepted by: Signature Date
Change Completed by: Signature Date
Change Audited/Verified by (EHS) Signature Date
Change Accepted by: Signature Date
Post-implementation EHS
approval : (If applicable) Signature Date
Documentation Update: Signature Date
Change Signed Off by : Signature Date

Post-implementation Observations

Made by : Signature Date

Post-implementation
Corrective / Mitigation measures

Made by : Signature Date

Procedure