Management of Change (MOC) Checklist
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This Template was installed 3 times.
Change Identification & Initiation
Initial assessment and formal initiation of the Management of Change process.
Describe the Proposed Change
Change Category (e.g., Equipment, Process, Procedure)
Date of Change Request
Requestor Name
Estimated Impact Level (1-5, 1=Low, 5=High)
Change Urgency (e.g., Routine, Expedited, Emergency)
Briefly describe the reason for this change.
Risk Assessment & Hazard Analysis
Evaluation of the potential risks and hazards associated with the proposed change.
Describe the potential hazards associated with the change.
Assign a Risk Severity Rating (e.g., 1-5, with 5 being highest).
Assign a Probability/Frequency Rating (e.g., 1-5, with 5 being highest).
What type of hazard is present? (e.g., Safety, Environmental, Quality, Operational)
Which safety procedures/precautions may be impacted?
Upload any supporting documentation (e.g., process hazard analysis, safety data sheets).
Describe the existing controls/safeguards for identified hazards.
Describe any additional controls or safeguards needed to mitigate the identified risks.
Impact Assessment
Determining the impact of the change on processes, equipment, personnel, and other relevant areas.
Describe the potential impact on Production Output (quantify where possible).
Estimated impact on cycle time (increase/decrease in minutes).
Which departments/areas are potentially affected?
Describe any potential impact on equipment reliability or maintenance requirements.
What is the anticipated impact on personnel workload?
Identify any potential impact on product quality and/or customer satisfaction.
Estimated cost impact (increase/decrease) due to the change.
Will this change impact existing safety procedures?
Review & Approval
Formal review of the change proposal by relevant stakeholders and securing necessary approvals.
Change Review Committee Selection
Reviewer Comments & Concerns
Date of Review
Reviewer Rating (1-5, 5 being highest)
Approval Status
Justification for Approval/Rejection
Reviewer Signature
Approval Date
Planning & Implementation
Detailed planning and execution of the change, including resource allocation and task assignments.
Detailed Implementation Plan Description
Estimated Implementation Duration (Days)
Planned Start Date
Planned Completion Date
Resources Required (Select all that apply)
Implementation Schedule (e.g., Gantt Chart)
Contingency Plans (If Implementation Deviates from Plan)
Implementation Method
Training & Communication
Ensuring all affected personnel are properly trained and informed about the change.
Affected Personnel Groups
Communication Plan Description
Training Completion Deadline
Number of Personnel Trained
Training Content Summary
Training Format
Training Materials
Trainee Acknowledgment
Verification & Validation
Confirming that the change has been implemented correctly and meets the intended objectives.
Were all affected procedures reviewed and updated?
Number of equipment checks completed as per validation plan:
Date of initial validation check:
Describe any deviations from the validation plan and corrective actions taken:
Was the process capability confirmed after change?
Attach validation data/reports:
Does the new configuration meet performance expectations?
Validation Sign-off:
Documentation & Record Keeping
Maintaining comprehensive records of the entire MOC process.
Change Description (Detailed)
Original Change Request Document
Date of Change Request Submission
Risk Assessment Documentation Summary
Unique Change ID Number
Documents Reviewed and Approved (Check all that apply)
Deviation Notes (if applicable)
Change Authorizer Signature
Post-Implementation Review
Evaluating the effectiveness of the change and identifying areas for improvement.
Summary of Implementation Experience
Estimated Time Savings (Hours/Shift)
Estimated Cost Savings (USD)
Unexpected Issues Encountered During Implementation
Did the change achieve the originally stated objectives?
What aspects of the change were most successful?
Recommendations for Future Changes of Similar Nature
Date of Review Completion
Reviewer Signature
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