Document 1Q84oqNxOR43kO6ykvg0z0xbd

CHECKLIST (ATTACHMENT 1) Rococd Number NOTIFICATION QF PROCESS CHANGE CHECKLIST Type Change Major Q Moderate Q MinorEi) Originator: Date of Origination: _________________________ Propr' * Date of Change h i 7' * Permanent ^ Temporary_____ From Area: J^C-hU......----------------------------------- Followup Required: JLjO__. To ......- Temo MOCReturned to Originiial Status: ! Yes DNo Descripti n and Location of Change Ljs&ffZAAy.____ **v? ^ %;&<<?- ___________________ djtxN&Li. *ltr-- (/b fci' Technical Ban* for Change: Impact on: Type ofChange: Safety Alarm Instrument Loss Prevention Addition or Removal ofEquipment Equipment/Material Modification Environment Job Procedure Chemical Shutdown Point Process Computer Control Piping Modification Other ..... <^J~J^o/ro'- --J Health Pre-Modification Checklist: Applicable n/A Initials Consult piping and equipment specifications. Perform Reactive Chemicals testing. 3/21/96In-Progress? Add materials involved to Toxic Substance Control Act (TSCA) inventory. Calculate impact on F&EI and CEI Comply with Engineering Practices. Comply with Technology Center guidelines. Comply with Dow LAD Environmental Project Checklist. Comply with Safety and Loss Prevention requirements. Consult maintenance. (Name) __________________________ Consult instrument and electrical technician. (Name)___________ _____________________ Consult parts technician.(Name)_ Evaluate and modify relief system.(Name) Contact Industrial Hygiene.(Name)_______ Contact Process Engineering. (Name)___ Complete required reviews. (Name them)____ Consult Computer programming support (Name) Consult Operations (Name)__ _ Contact Environmental (Name).. Champs work order (List) ,, Review Training Needs With Operations Supervisors or Technologist (Name) Consult With Quality Person to determine ifproduct MOC Required (Name) ____ Other........... .........................--_________________ Approvals: Originator \\ V,, in. Date First Reviewer Date ^{r/f,..Final Reviewr liySignatUK ,, Date, Post-Modification Checklist: (Before startup) App Na Init . ____ Perform pre-startup audit. ___ _____ Complete or update training program. Job procedures written and approved. Instrument loop drawings Electrical drawings. ____ P&ID's, process flow sheets and plot plans updated. _____ Personnel trained on the change. Training Documentation Attached ------ Critical instrument checklist updated. ____ MOD check sheet completed, computer code and documentation changed. Complete and Update P|ant Files and eq)uipmecnt ftiles ^ * DO A 0PS599 1,117/% CONFIDENTIAL