EXECUTIVE SHIP MANAGEMENT File Ref – QI 37 Q8

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MANAGEMENT OF CHANGE PROCESS

Proposer
Department/Ship: Date:
(Name/Rank):
All temporary and permanent changes to organization, personnel, systems, procedures, equipment, laws & regulation evaluated and managed to ensure that
health, safety and environmental risks arising from these changes remain at an acceptable level.

Section A: Request for Change (By Proposer)

1. Nature of Change: Temporary Permanent
2. Type of Change:
Organization Personnel/Job Equipment Procedure Laws/Regulation Systems/Process
3. Details of the Proposed Change:

4. Options considered for the change (What options were considered before selecting this particular option?):

5. Risk Assessment Completion Risk Assessment Reference No. (From Phoenix)

6. Justification for change (Provide reason for proposed change safer operations, cost benefit, etc.):

7. Support Required (By Office/ Superintendent, Owners, Charterers, Class, Flag, assistance by external parties such as Makers, workshop, technician etc.):
From Whom? What type of support required?

8. Document Changes / Permits required/ Software changes: (Specify Company Manuals, Forms and Checklists, Emergency Response Procedures and
resources, Risk Assessments/ JHA, drawings/ plans (Shipboard and Office), permits to work to be used, Planned Maintenance System (Component Hierarchy,
Jobs & spares), PPE, Posters, Phoenix Modules, etc. Status of completion to be updated in Action Plan):
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In case a new machinery/ equipment is to be installed, is it required to be identified as a critical equipment? Yes / No / Not Applicable
In case a new machinery/ equipment is to be installed which will be operating in the ship’s network or has USB ports, are cyber
Yes / No / Not Applicable
security risks addressed in the risk assessment?
Changes required PIC Target date

9. Target date for Change ( In case of temporary change the date & time of change effected & restored to be mentioned ):
Type of Change Date of implementation Date of restoration to original state
Temporary Change
Permanent Change
10. Personnel affected by change and to be Notified of the change: (If any particular department or individuals are to be notified, only these should be
mentioned and not broadly as ‘ESM’ or ‘Ship staff’. Status of completion to be updated in Action Plan).
a. Personnel affected by change –

Persons/ Departments to be notified Person responsible for notifying Target date

11. Identify any external approvals required (Regulatory Authorities, Classification Society, Owner, Makers, etc.):

12. Training Required (Specific ranks or departments to be mentioned, if applicable. Status of training completion to be updated in Action Plan):
Training Required Dept./Persons to be trained PIC Target date
a. For Shore Staff
b. For Ship Staff

Section B: Evaluation by the Responsible person (Refer table in Section G)

1. Details of the change requested, justification & Risk Assessment (if any) were reviewed and found adequate? Yes / No
If No, provide details
2. Is the change necessary/beneficial? Yes / No
3. Has an action plan been prepared? Yes / No / Not Applicable
(If Yes, Update in Section F)
4. What is the frequency of periodic review to be carried out to ensure progress of the MOC as planned?
5. Comments for above:
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Responsible Person for Change (Name & Rank): Signature / Date:

Section C: Approval for the Change (By Approver) (Refer table in Section G)
1. Were all the MOC process documents including Risk assessment Yes / No
submitted by Responsible person(s) reviewed & found adequate? If No, provide details
2. Additional Resources if any required; reviewed or checked? Yes / No / NA
3. Is the overall estimated cost, if applicable; commensurate to the benefit? Yes / No / NA
4. Target date agreeable? Yes / No
Comments for above:

Signature / Date:

Approved Not Approved

Approving Authority (Name & Rank):

Section D: Implementation (By Responsible person) (Refer table in Section G)

1. Date Completion of change:
2. Mention the type of supporting attached: (Such as photographs [for hull/ structure/
equipment installed/ modified etc.], Risk Assessments, completed Action Plan including
actions to mitigate hazards, Training record, notifications, class approvals, list of the
drawings/plans modified, purchase orders/ invoices of spares/ stores/ supplies, etc.)
3. Has the periodic review been carried out to ensure progress of the MOC as planned in Section B? If No, provide details
Yes / No
in comments below.
4. During the periodic review, have the risk assessment, action items, due dates, etc., been reviewed for taking into
Yes / No
consideration any changes / revision required?
5. Are there any changes to the agreed target date (extension, etc.) and / or process?
(If yes, the risks should be assessed again and re-approved for use by next level of authority as defined in HSEQAM Yes / No
Section 18.6 - Levels of Authority and Records. Provide RA no. and details in comments below)
6. Risk Assessment Completion: Yes / Not Applicable Risk Assessment Reference No. (From Phoenix)
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7. Date of completion of MOC

Comments for above:

Responsible Person (Name & Rank): Signature / Date:

Section E: Verification on completion of Change (Refer table in Section G):

(Verification is to be conducted at least after 3 months of completion of MOC)
1. Was the Management of Change effective? Yes / No
2. Any feedback, recommendations and suggestions for improvement to proposer / responsible person / Senior
Yes / No
management out of this MOC? (If yes provide details)
Comments for above (Including any lessons to be shared):

Verified by (Name & Rank): Signature / Date:

Section F: Action Plan (Indicate the timeline when each item shall be completed below. Include permits to work to be used, actions to be taken for
mitigating the hazards/impacts identified in Risk Assessment [under various aspects such as Health and Safety, Environmental, Commercial,
etc.], notifications, Deviation from voyage instructions, Flag/ Class/ Owners/ Charterers/ Makers approvals, Spares/ Stores/ Supplies, manning levels/
human resources, workshop/ technician assistance, Changes to Company Manuals, Forms and Checklists, Emergency Response Procedures and
resources , Risk Assessments/ JHA, drawings/ plans (Shipboard and Office), PPE, Posters, Planned Maintenance System, Phoenix Modules, new
Software introduction, hull/ ship structure modification, etc. A confirmation to be done on name of location of Documents, manuals, plans and drawing
which were changed upon completion of MOC and relevant index is updated)
No. Actions to be taken Person In Charge Target date Completion date

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Section G: Level of authorities for MOC

Department Affected Responsible Person Approver Verification upon completion by

Ship Technical Superintendent Ref HSEQA Manual Fleet Manager/ Technical Support Manager
Technical Technical Superintendent section 18.6 Fleet Manager/ Director Technical
HSEQA HSEQA Superintendent Manager, HSEQA / General Manager, HSEQA
Crew Fleet Personnel Superintendent GM, Crew / Asst. Director, Crew / Director, HR & Crew
Account Assistant Accounts Manager Accounts Manager/ General Manager, Finance
IT System Administrator Manager, IT / General Manager, Finance
More than one dept. As appointed by Asst. Managing Director Managing Director/ General manager, HSEQA

Section H: Periodic review of MOC

Date Attendees Comments Revised Action Plan / Date