Facility Change Request Form (FCR)
Change Title:
Date:
-
Month
-
Day
Year
Date
AFE #:
Field/Facility:
Initiator:
FCR Coordinator
FCR Coordinator Email:
example@example.com
Details of Facility Change:
Estimated Cost:
Justification:
Conceptual Approval (Ops Super or Engineering Super)
Name
Signature:
Project Risk Classification:
A
B
C
Assessed By:
Name
Date:
-
Month
-
Day
Year
Date
Process Hazard Analysis Required:
Yes
No
Major Risk Review Required:
Yes
No
Environmental Review Required:
Yes
No
Critical Alarm Requirements:
Yes
No
Detailed Facility Design Required:
Yes
No
Design Review with Operations Personnel Required:
Yes
No
Regulatory Agency Permits Required:
Yes
No
Drawings Required:
Yes
No
Design Checklist Required:
Yes
No
Training Checklist Required:
Yes
No
Functional Checklist Required:
Yes
No
Start-up Checklist Required:
Yes
No
Maintenance Checklist Required:
Yes
No
Additional Comments:
Approvals:
Engineering
Operations
Safety
Environmental
Other
Signatures of All Approvers:
Submit
Should be Empty: