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Change Request Form

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Saurabh Ghorpade
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39 views2 pages

Change Request Form

Uploaded by

Saurabh Ghorpade
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Change Request Form

Change Request Form


Document of Record for a project change request
Project Name XXXXXX Project ID Number
Project Sponsor Project Manager
Created by Person submitting the change Scope Change Number 001
request (must match Change Log
entry)
Date of Request Implementation by:

Change Request Detail - The Change Request form is the document of record for a change request. It
provides the business reasons and justification for the change and assesses the risk and impact of the change.

Type of Change Description of the change requested with rationale


Business Change or Need
Funding Source Plan Change
Scope Change or Need
Schedule Change
Error Correction
Regulatory Requirement
Other
Priority 1 – Critical: “I can’t move forward until this change is resolved.”
2 – High: “I’m fine for right now, but unless this change is resolved by the due
date, I won’t be able to move forward.”
3 – Normal: “I’m fine for the right now, but this may impact my ability to move
forward in the near future.”
4 – Low: “This change is not impacting my ability to move forward.”

Benefits of Proposed Changed The additional benefits the proposed change would have.

Alternatives List any alternatives/work-around to the change that exist.

Impact Severity 1 - Critical Impact: Threatens the success of the program


2 - High Impact: Significant disruption to program schedule, cost, or quality
3 - Normal Impact: Progress disrupted with manageable extensions to short-
term schedule and cost
4 - Low Impact: Exposure is slight
List of Impacted Deliverables

Financial Impact ($)


Estimated Cost of the Change
Schedule Impact (days)
Time Required for the Change
Resources Required for Change
Impact Summary

1 Change Request Form


Change Request Form

Authorization
Who has the authority to approve this type of change? Advisory Board Business Office
Steering Committee Customer/
Stakeholder
Executive Sponsor Other:
Change Requests Status Change Request Open
Change Request Approved
Change Request Rejected
Change Request Closed
Deferred for review at later Date:
date
Fiscal Reviewed and Approved by Date:
If funding is sourced separately by a department
Authorizing Signature Date:

Project Manager Signature Date:

2 Change Request Form

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