Change Request Form

Change Request Form

[This form is divided into three sections. Section 1 is intended for use by the individual submitting the change request. Section 2 is intended for use by the Functional Manager to document/communicate their initial impact analysis of the requested change. Section 3 is intended for use by the Change Control Board (CCB) to document their final decision regarding the requested change.]

1.) SUBMITTER - GENERAL INFORMATION
CR#	001
Type of CR	Enhancement	Defect
Project/Program/Initiative
Submitter Name
Brief Description of Request
Date Submitted
Date Required
Priority	Low	Medium	High		Mandatory
Reason for Change
Assumptions and Notes
Comments
Attachments or References	Yes	No
	Link:
Approval Signature			Date Signed

2.) Functional MANAGER - INITIAL ANALYSIS
Schedule Impact	[WBS]
Cost Impact	[Cost]
Comments
Recommendations
Approval Signature				Date Signed

3.) CHANGE CONTROL BOARD – DECISION
Decision		Approved	Approved with Conditions		Rejected		More Info
Decision Date
Decision Explanation		[Document the CCB’s decision]
Conditions		[Document and conditions imposed by the CCB]
Approval Signature				Date Signed