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Change Request Form (example)

[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 Project Manager to document/communicate their
initial imact analysis of the requested change. Section ! is intended for use by the "hange "ontrol
#oard $""#% to document their final decision regarding the requested change.&
1.) SUBMITTER - GENERA INF!RMATI!N
CR" ["'((1&
T#$e o% CR Enhancement Defect
&ro'e(t)&rogram)In*t*at*+e
Su,m*tter Name [)ohn *oe&
Br*e% -es(r*$t*on o%
Request
[+nter a detailed descrition of the change being requested&
-ate Su,m*tte. [mm/dd/yyyy&
-ate Requ*re. [mm/dd/yyyy&
&r*or*t# Low Medium High Mandatory
Reason %or Change [+nter a detailed descrition of ,hy the change is being requested&
!ther Art*%a(ts Im$a(te. [-ist other artifacts affected by this change&
Assum$t*ons an. Notes [*ocument assumtions or comments regarding the requested change&
Comments [+nter additional comments&
Atta(hments or
Re%eren(es
Yes No
*n/0
A$$ro+a1 S*gnature [.roval Signature& -ate S*gne. [mm/dd/yyyy&
2.) &R!3ECT MANAGER - INITIA ANA4SIS
5our Im$a(t [/hrs& [+nter the hour imact of the requested change&
-urat*on Im$a(t [/dys& [+nter the duration imact of the requested change&
S(he.u1e Im$a(t [0#S
&
[*etail the imact this change may have on schedules&
Cost Im$a(t ["ost& [*etail the imact this change may have on cost&
Comments [+nter additional comments&
Re(ommen.at*ons [+nter recommendations regarding the requested change&
A$$ro+a1 S*gnature [.roval Signature& -ate S*gne. [mm/dd/yyyy&
6.) C5ANGE C!NTR! B!AR- 7 -ECISI!N
-e(*s*on Approved Approved with
Conditions
Rejected More nfo
-e(*s*on -ate [mm/dd/yyyy&
-e(*s*on E8$1anat*on [*ocument the ""#1s decision&
Con.*t*ons [*ocument and conditions imosed by the ""#&
A$$ro+a1 S*gnature [.roval Signature& -ate S*gne. [mm/dd/yyyy&
U& Tem$1ate 9ers*on0 !!"#$"$% &age ! of !
[2nsert aroriate disclaimer$s%&