Corrective action request form checklist

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Any issues found need to be corrected at the earliest for a smooth flow of operations. The action taken should be logged in detail and it should eliminate the root cause to prevent any recurrence. Evaluations are performed on the action taken to ensure effectiveness.

General

Types of wastes produced

Yes No Na

Type of change

Describe the change

Document of MOC

Is the environment department notified?

Yes No Na

Is there a need to increase the production limits on ECA permits?

Yes No Na

Is spill possible due to change?

Yes No Na

Are fire accidents possible due to change?

Yes No Na

Is there involvement of flammables or combustibles in the change process?

Yes No Na

Is there involvement of acids, corrosives or alkalies in the change process?

Yes No Na

Is there involvement of designated substances in the change process?

Yes No Na

Is there an increase in the number of chemicals or metals used?

Yes No Na

Is substance notification requirements, NPRI, Spill plan verified?

Yes No Na

Is waste generated recyclable?

Yes No Na

Does the change produce any hazardous wastes or by-products?

Yes No Na

Are additional waste bins needed?

Yes No Na

Is energy usage increased?

Yes No Na

Type of energy

Number of extra waste bins needed

The equipment energy saving ratings

Any other equipment which is more energy efficient

Is addition to the environmental aspects list needed?

Yes No Na

Is addition to the significant environmental aspects list needed?

Yes No Na

Is there a need of a controlled environment?

Yes No Na

Is the change documented?

Yes No Na

Does the change exhaust to outside?

Yes No Na

Exhaust number/stack

Yes No Na

Is there a need for an exhaust system or air scrubber?

Yes No Na

Does it affect Environmental Legislation?

Yes No Na

Is there a pre-requisite for the change?

Yes No Na

Are permits/certificates or testing necessary before implementation?

Yes No Na

Is there a need for industrial hygiene testing for air, noise, or vibration?

Yes No Na

Measure internal noise

Yes No Na

Is there an ESA sticker on electrical equipment?

Yes No Na

Has the engineer completed all pre-start safety reviews?

Yes No Na

Are all non-conformances corrected?

Yes No Na

Has the line engineer completed the ergonomic design checklist?

Yes No Na

Has the engineer completed hazard assessment/risk assessment?

Yes No Na

Do all equipment abide by regulations for industrial establishments?

Yes No Na

Are lock-out / tag-out signs posted?

Yes No Na

Is identification and labeling of lock-out points done?

Yes No Na

Is filling of operator instruction sheets done?

Yes No Na

Is filling of pre-use inspection sheets done?

Yes No Na

Are additional specific procedures required?

Yes No Na

Are additional emergency responses required?

Yes No Na

Are additional postings required?

Yes No Na

Are additional PPE required?

Yes No Na

Additional PPE

Describe the update needed for the EEHS training plan for this change

Sign off

Comments

Auditor name

Auditor signature

SIGNATURE

Date

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