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CAQA Hydra Chemical and Refining · Simulated workplace

Management of Change Request Template

TemplateControlled document
HYD-TPL-160
v2.2
Document ownerTechnical Services Manager
Version2.2
Approved7 November 2025
Next review7 November 2026
StatusCurrent

Purpose. Used by the person proposing a change to describe it, assess its hazards and its effect on the safety case and record the review, approval, actions and close-out.

1.When to use this template

Use this template for every change listed in the management of change policy, whether permanent or temporary. Complete the description and the initial hazard assessment before submitting to the Technical Services Manager for classification. Do not start the change until the request is approved and the pre-implementation actions are complete.

2.Describing the change

State what will change, why, where and when, and what the plant or process looks like before and after. Attach marked-up drawings, control logic changes, data sheets and the current procedure. For a temporary change, state the expiry date and how the change will be reversed.

3.Hazard assessment

Identify the hazards the change introduces or alters using the checklist, and for each hazard state the control measure and whether it is an existing safety case control or a new one. Consider the effect on safe operating limits, relief and venting, materials compatibility, alarms and trips, operating procedures, maintenance, emergency response and the environment.

  • Overpressure, overtemperature and runaway reaction
  • Loss of containment and materials compatibility
  • Alarm and trip settings and safety system logic
  • Operability, human factors and procedures
  • Fire, explosion and toxic release scenarios
  • Environmental discharges and emissions
  • Effect on the safety case and its control measures

4.Review and approval

The classification determines the review. Record the reviewers, the study method, the findings and the actions with owners and dates. The approver must confirm that all pre-implementation actions are complete before signing the approval to implement.

5.Implementation and close-out

Record the pre-start-up safety review, the updates to drawings, procedures, training, the safety critical equipment register and the safety case information, and the date the change was closed. Temporary changes must be closed by reversal or by a new permanent change request.

6.Complete the template

HYD-TPL-160 v2.2 · CAQA Hydra Chemical and RefiningUncontrolled when printed. Simulated document created by CAQA for training and assessment.