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Change Request Template v1.1

This document is a change request form that contains sections for requesting information, assessing impacts, and obtaining approvals for proposed changes. It requests details about the change, its benefits and risks. It also requires analyzing the impact on timelines, costs, and other projects. Sign-offs are needed from the business sponsor, project manager, and change control manager before routing the form for review.

Uploaded by

Nikhil Satav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as XLSX, PDF, TXT or read online on Scribd
414 views6 pages

Change Request Template v1.1

This document is a change request form that contains sections for requesting information, assessing impacts, and obtaining approvals for proposed changes. It requests details about the change, its benefits and risks. It also requires analyzing the impact on timelines, costs, and other projects. Sign-offs are needed from the business sponsor, project manager, and change control manager before routing the form for review.

Uploaded by

Nikhil Satav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
You are on page 1/ 6

Document: Change Request Form

Page: 1
Version: 1.0
Issue Date:
Technical Maintenance Request
Author:
Approval:

Project Change Management Form (ONLY For Project Support changes)


Instructions: Please complete this form electronically, save it and then route it according to Section 5 - Routing. You may only
enter information in the fields with yellow shading. You must select from available choices in some fields.

Section 1. Requestor Information


Name*: ile Phone*:
Project*: ork Phone*:
Team*: e-mail*:
estor's Manager/Supervisor*:
Section 2. Request Details
ate Request Submitted*:
UAT Completed?* Yes No If No, Explain.

Reason for Change*

Risk if Not Implemented*

Source (name of env, DB, environment, DB,


snapshot, server, source snapshot, server, source
Object (to be acted on) lib(branch + label), etc.) lib, etc.)

Section 3. Implementation Procedures


A. Pre-implementation Steps

Step # Actions Start Date Start Time Person(s)

B. Implementation Steps
Step # Actions Start Date Start Time Person(s)

C. Revert Steps (To be completed ONLY if implementation is UNSUCCESSFUL)

Step # Actions Start Date Start Time Person(s)

Section 4. Requested Completion Timeframe (when you want the work performed):
Standard Maintenance Windows are Mondays & Thursdays after 5pm Central Time.
Requesting a EMERGENCY window requires 'Schedule Approvals' (see Section 4).

Place an 'X' in One Box and Enter Associated Date or Dependency


STANDARD Maintenance Window: (Date - Wednesday only)
EMERGENCY Maintenance Window: (Day,Date and Time or)
(Dependency)

Section 5. Contacts
A. Technical Contacts Daytime After Hours
Contact Contact
Name Responsibility Num. Num.

B. Business Contacts Daytime After Hours


Contact Contact
Name Responsibility Num. Num.

C. Vendor Contacts Daytime After Hours


Contact Contact
Name Responsibility Num. Num.
D. Escalation Contacts Daytime After Hours
Contact Contact
Name Responsibility Num. Num.

Section 6. Approvals
Environment/Approver/Backup ApprSignatures (circle or print name Date
t

Environment
Approvals*

Project Manager Signature Date


Schedule
Approvals
(only required if
an Change Control Manager Signature Date
EMERGENCY
Maintenance
Window is PMO Lead Signature Date
chosen in
Section 3)

Section 7. Routing
1. For ALL requests: e-mail the completed form to "enter name" (internally) or "enter
email address"
(externally)
2. For EMERGENCY and attend the next
requests: Change
Email ControltoMeeting.
the request the distribution list - <project distrib
"enter email address" (externally) and attend the next Change Control Meeting.
2. For 8.
Section EMERGENCY requests: Email
Change Management TeamtheUserequest
Only to the distribution list - <project
distribution list>
signed Request Number: ed Into Tracking Document By:
* Denotes Mandatory Fields
Document: Functional Chg Mgmt Form
<Project number / name> Page: 1
Version: 1.0
Issue Date: 17-Dec-07
Functional Scope Change Request
Author:
Project Change Management Form (ONLY For Project Approval:
Business Functional
changes)
Instructions: Please complete this form electronically, save it and then route it according to Section 6 - Routing. You may only
enter information in the fields with yellow shading. You must select from available choices in some fields.

Section 1. Requestor Information


Name*: ile Phone*:
Department*: ork Phone*:
Change Impact Area*: e-mail*:
estor's Manager/Supervisor*:
Section 2. Request Details (to be completed with stakeholder input)
ate Request Submitted*:
Request Description*:

efits of Making Change*:

Risk if Not Implemented*:

Alternates to Change:

Section 3. Impact Analysis (to be completed by the project manager)


A. Impact Analysis to this Project:
B. Impact Analysis Cost Estimate: C. Impact to Project Timeline:

C. Impact Analysis on Other Projects / Programs:

D. Recommended Resolution:

Section 4. Functional / Technical / Documentation Impacts


A. Functional Requirement / Process Flow Impacts
Functional Requirement Section / Process Flow Tab( Updated Person(s)

B. Technical Requirement / Configuration Parameter Impact


Technical Requirement Section / Configuration Sheet Updated Person(s)

C. Supporting Documentation
Document Name(s) SharePoint Path / Location

Section 5. Approvals
Business Sponsor / Stakeholder Signatures (circle or print name Date
t

Project Sponsor
Approval*

Project Manager Signature Date

Project Change Control Manager Signature Date


Management
Approvals*
PMO Lead Signature Date
Project
Management
Approvals*

Section 6. Routing
1. For ALL requests: e-mail the completed form to "…." (internally) or
"XXX@YYY.com" (externally) and attend the next Change Control Meeting.

Section 7. Change Management Team Use Only


signed Request Number: d Into Tracking Document By:
* Denotes Mandatory Fields

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