UltraTech Cement Limited

Unit: Gujarat Cement works

Management of Change

Dear all,
Please note that Mr. Ajay Maniya has been transferred to Cement Mill Section on
06 April 2019. He has been made aware and well communicated about the job related
SOP’s, Procedures and Instruction. Associated hazardous & its mitigation has been
communicated to Mr. Ajay Maniya and he understand it very well.

The Following training has been imparted to him.

1. PTW.
2. HIRA/JSA.
3. Working @ Height.
4. Scaffolding.
5. Road Safety.
6. Electrical Standard.
7. LOTOTO.
8. Lifting and Shifting.

These all safety standard related training has been maintained by HR.
He was also made aware of all Inst. Related SOP’s, which has made by the
Instrument section.

Signature Signature
(Individual) (HOS/HOD)
Management of Change: Checklist For Changes
Checklist for Process
Sr. No. Potential Changes Yes/No
1 Is the original design intent being changed? No
2 Has the same change been unsuccessful elsewhere? No
Have risks and hazards associated with this equipment been
3
identified/ No
4 Has there been any change to materials of construction? No
5 Could this change hinder access to other equipment? No
6 Has this design been previously changed? No
Could this change impact the supply or consumption of utilities?
7 Is there an effect on the site commodity balance? No
8 Could this change create any environmental effects? No
Could this change create any new hazards during construction or
9 in later service? No
10 Is there any change to procedures or operating conditions? No
Are there any upstream or downstream effects as a result of the
11
change? No
12 Is overpressure protection required as a result of this change? No
13 Are there any additional features for safety required? No
Is there any impact on existing safety equipment (PSV’s, trips,
14
alarms etc.)? No
15 Is there any impact on fire protection / preventive facilities? No
Will the performance characteristics of the equipment, facility or
16 system be altered? No
Checklist for People
Are there any changes required to training or SOP's as a result of
1
this change?
2 Is training imparted to developed the new skills if required?
3 Is people identify that will be affected by this change?
Is people are aware to involved hazards in area/ operation/
4
material?
5 Is any plan for maintaining appropriate skill required?
6 Is people gone through the IMS & other documentations?
7 Is change of people communicated to others?
Is people/ employees move through the guiding by the manager
8 and supervisors at the change place?
Checklist for Material
Is there any increase in hazardous or flammable material
1
inventory? No
2 Is material affected to operation parameters? No
3 Is metallurgy of material is meets to process requirement? No
Is material affected to people who directly involved with
4
change? No
Change Control Form
Date of Request: 01.12.2018 Dept : Instrumentation
Equipment / Operation affected:
NA

Description of changes:

Change in Responsibility
Is the Change: Temporary For How Long?
Permanent Yes _ _
Results of Environmental Impact & Risk Assessment No
Instrument dept GRA & associated control procedure discussed
No. of Environmental and OH&S hazards identified? Yes

Key hazards: (List below)

Electrical safety, Associated & identified in instrument dept. GRA

Date of Environmental Impact & Risk Assessment Performed

Environmental & OH&S Risk Controls identified:

NA

Other requirements: NIL

a. Special training required? Related training given by HR & safety dept : NA

b. Changes to existing procedures? -No

c. New procedures? -No

d. Change in Role & Responsibility? -Yes

e. Any others? - NIL

Authorization to proceed:

HOD Management Representative: