Sample Change Control Form
Sample Change Control Form
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|Date of Request: |
| Change Request Initiator (name, location, phone): |
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|Description of Change: |
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|Reason for Change: |
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|How does the proposed change affect the safety vulnerabilities? (Safety, Health, and Environmental Considerations): |
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|Resulting Changes (to existing O&M procedures, inspection and testing procedures, process/facility documents/drawings, safety plans, training |
|requirements, etc.): |
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|Project Manager Approval (name and date): |
|Facility Operations Manager Approval (name and date): |
|Line Management Approval (name and date): |
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