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Change Control Request Form Change Request Number:: General Information

This change control request form is used to document proposed changes to a project. It collects information about the requested change including a description, justification, and potential impacts. It also tracks the change control team's evaluation and recommendation, and final management approval or rejection of the change. If approved, it notes the alternative selected for implementation.

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arunrpatil046545
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1K views2 pages

Change Control Request Form Change Request Number:: General Information

This change control request form is used to document proposed changes to a project. It collects information about the requested change including a description, justification, and potential impacts. It also tracks the change control team's evaluation and recommendation, and final management approval or rejection of the change. If approved, it notes the alternative selected for implementation.

Uploaded by

arunrpatil046545
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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[Office Name] Change Control Request Form

[Project Name] [Version Number] | [Revision Date]


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Change Control Request Form


Change Request Number: <assigned by BSSO>
General Information

Requestor Name Date

Office

Contact Phone Email Fax

Change Request Definition - (Fill in this section before Change Control Team requests an evaluation)

Description – Describe the proposed change.

Justification – Justify why the proposed changes should be implemented.

Impact of Not Implementing – Explain the impact if the proposed change is not implemented.

Change Request Evaluation Analysis (Fill in this section after Change Control Team confirms evaluation is needed)

Check each that apply


Project Schedule Configuration Item Product Deliverables affected
Project Costs Project Charter Design Deliverables affected
Project Scope Requirement Deliverables Construction Deliverables affected

Impact Description – Describe the impact for each of the items checked. List all deliverables affected by change request

Alternatives – If applicable - provide up to three alternatives that could be implemented instead of the proposed change.

Project Delivery Methodology (PDM)


CCRF v1.2-8/30/2012 1
[Office Name] Change Control Request Form
[Project Name] [Version Number] | [Revision Date]
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Change Control Team Recommendations

Review Date Team Members Notes Recommendation

Evaluate
Approve
Reject
Defer Until: [DATE]

Approve
Reject
Defer Until: [DATE]

Rationale for Recommendation – State the rationale for recommendation.

Change Request Final Management Approval

Final Approval Date Name Title Recommendation

Approve
Reject

Special Instructions – Provide any additional information regarding the final recommendation.

Alternative Selected and Implemented – Provide a brief description of the alternative selected

Project Delivery Methodology (PDM)


CCRF v1.2-8/30/2012 2

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