Management of Change Screening Form
A practical first-pass screen for plant, process, procedural, software, temporary, and organisational changes.
Change details
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Change title / reference number
Y / N / N/A
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Plant area and affected equipment tags
Y / N / N/A
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Change owner and responsible manager
Y / N / N/A
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Reason for the change
Y / N / N/A
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Proposed implementation date
Y / N / N/A
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Temporary or permanent? If temporary, record expiry date
Y / N / N/A
Replacement-in-kind test
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Same design pressure, temperature, flow, and containment duty
Y / N / N/A
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Same materials of construction, seals, gaskets, and chemical compatibility
Y / N / N/A
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Same function, failure position, operating speed, and capacity
Y / N / N/A
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Same alarm, trip, relief, isolation, and control performance
Y / N / N/A
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Same inspection, maintenance, spares, and competency requirements
Y / N / N/A
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Existing drawings, procedures, and training remain valid
Y / N / N/A
Potential impacts
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Process chemistry, inventory, pressure, temperature, or throughput
Y / N / N/A
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Loss of containment, fire, explosion, toxic release, or reaction hazard
Y / N / N/A
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Relief, flare, vent, drain, bund, or emergency system
Y / N / N/A
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Alarm, interlock, control logic, software, or cybersecurity
Y / N / N/A
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Operating, maintenance, sampling, cleaning, or emergency procedure
Y / N / N/A
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Staffing, shift pattern, role, contractor, or competence
Y / N / N/A
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HAZOP, LOPA, BowTie, QRA, MHI assessment, or emergency plan
Y / N / N/A
Required actions and approvals
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Hazard review method and competent reviewers identified
Y / N / N/A
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Drawings, data sheets, procedures, and inspection tasks listed for update
Y / N / N/A
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Training and communication requirements defined
Y / N / N/A
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Pre-Startup Safety Review required
Y / N / N/A
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Pre-startup actions separated from post-startup actions
Y / N / N/A
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Operations, engineering, maintenance, and process-safety approval recorded
Y / N / N/A
Use note: Adapt this resource to the site's hazards, legal duties, engineering standards, and management system. A checklist does not replace competent technical review.