Business MOC Impact Analysis

BUSINESS MOC IMPACT ANALYSIS

WHEREAS, Company Name:

WHEREAS, Requester Name:

WHEREAS, the parties intend to document and evaluate the operational, financial, compliance and stakeholder impacts of a proposed Management of Change ("MOC") and to record required mitigations, approvals and responsible parties effective as of Effective Date:

SUMMARY OF CHANGE

Change Title:

SCOPE OF WORK

REASON FOR CHANGE

IMPACTED BUSINESS FUNCTIONS & SYSTEMS

Select impacted functions (check all that apply):

Operations    Finance    IT    Human Resources    Legal    Sales/Commercial

RISK ASSESSMENT

For each risk category, indicate impact level and whether mitigation is required.

Safety — Impact Level:   Mitigation Required:

Financial — Impact Level:   Mitigation Required:

Operational — Impact Level:   Mitigation Required:

Reputational — Impact Level:   Mitigation Required:

Regulatory / Compliance — Impact Level:   Mitigation Required:

Overall Risk Rating:

ESTIMATED COST & PAYMENT TERMS

TERM AND TERMINATION

Term Start Date:    Term End Date:

Termination for Cause: Termination for Convenience:

CONFIDENTIALITY

Both parties acknowledge that analysis, plans, cost estimates, and any proprietary information disclosed in connection with this MOC are Confidential Information. Each party shall protect Confidential Information with at least the same degree of care it uses to protect its own confidential information, but not less than reasonable care, and shall not disclose it except to employees, consultants or contractors with a legitimate need to know and who are bound by confidentiality obligations no less protective than this clause.

Confidentiality Acknowledged By:

GOVERNING LAW

This Impact Analysis and any dispute arising out of it shall be governed by and construed in accordance with the laws of:

ENTIRE AGREEMENT

This document, together with any referenced attachments or appendices executed contemporaneously, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

IMPLEMENTATION SCHEDULE & TRAINING

Training Required: Documentation Updates Required:

REGULATORY / COMPLIANCE IMPACT

Regulatory Impact Identified: If checked, provide description below and cite applicable obligations.

STAKEHOLDER NOTIFICATION PLAN

ADMINISTRATIVE APPROVALS

Requester Approval Name:

Requester Approval Date:

Department Head Approval Name:

Department Head Approval Date:

Compliance / Legal Review Completed: Compliance Reviewer Name:

Attachments / Appendices:

Certification: The undersigned certify that this Impact Analysis accurately reflects known impacts, risks and required mitigations for the proposed change and that the actions set forth will be managed in accordance with applicable company policies and the law.

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