MANAGEMENT OF CHANGE
Dolphin Atlantic, Inc. — Safety Management System
SECTION 1

General Information

1. MOC Number
Generating…
Override:
2. Date Initiated
3. Initiator / Department
4. Status
5. Date Closed
SECTION 2

Description of Change

SECTION 3

Justification for Change

Event Triggering Event Description Category
SECTION 4

Scope

Describe the breadth of the change: Departments/functions affected; Aircraft, systems, processes involved; External parties impacted.

Department Impacts / Functions Affected / Processes Involved / External Parties Impacted
SECTION 5

Hazard Identification & Safety Risk Assessment

Risk / Hazard Consequence Likelihood Severity Initial Risk Mitigation / Control Res. Likelihood Res. Severity Residual Risk Status
Risk Matrix Reference — SMS Manual §3.12 & §3.13
Likelihood \ Severity E — Catastrophic D — Hazardous C — Major B — Minor A — Negligible
High: E5, D5, C5, E4, D4, E3 Medium: A5, B5, C4, B4, D3, C3, E2, D2, E1 Low: all others
SECTION 6

Safety Impact & Human Factors Assessment

SECTION 7

Risk Control Measures

List procedural or administrative controls, updated SOPs, checklists, or manuals. Link each control to the hazard it addresses.

Hazard Ref Risk Control Risk / Hazard Responsible Party Due Date Status
SECTION 8

Implementation & Evaluation

Hazard Ref Action Responsible Party Due Date Status
SECTION 9

Stakeholder Approval / Sign-Off

SECTION 10

Communication Plan

Select all communication types that apply. Each selected type will expand for responsible party and status.

REMARKS

Additional Remarks

SIGNATURE

Initiator Signature

Sign here
Your name will appear as your signature
Please provide your signature.
Dolphin Atlantic, Inc. — Safety Management System — Internal Use Only