Request For Change Form Abc Biofuels
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1Request For Change Form
ABC Biofuels
Anywhere, USA
RFC No.
Date Requested
Target Date
Unit:_________________________________
Equipment:________________________________________
1. Description of change (include technical basis for change)
Originator
Supervisor
2. Safety, Health, and Environmental Reviews Required
Req'd Responsible
Target
Date
Initials
Y/N
Party
Date
Complete
Process Safety (specify method)
________________
Y
Occupational Safety
Environmental
3. Procedures to be Revised
Req'd Responsible
Target
Date
Initials
Y/N
Party
Date
Complete
Start-up
Shut dowm
Emergency Shutdown
Normal Operation
Maintenance procedure
Emergency Reponse
Other (e.g. administrative)
4. Personnel to be affected by the change
5. This RFC has been
_____
Denied
____ Approved
Comments:
Management of Change Coordinator
This material was produced under grant SH-19479-09-60-F-36 from the Occupational Safety and Health
Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S.
Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement
by the U.S. Government
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Parent category: Business