Project Change Request Sample

Change request
1. BASIC INFORMATION ON THE CHANGE REQUESTED
Project name
Insert project identification, programme or tasks which the
change concerns.
Identification of
changes
Insert the description of the change requested.
Request placed by
Anybody
Contact
details
Insert your contact
details
Description of
requested change
Explain the change including the proposed action.
Date of raising the
request
dd/mm/yyyy
dd/mm/yyyy
Priority
Low
Medium
High
Essential
Justification for
change
Justify why you are requesting that this change should be carried
out
Comments
Insert any other potential comments.
Annexes or references
Yes
No
Name of the annexe or
reference
Insert the identification of the annexe or reference related to the
change proposed.
2. ANALYSIS OF THE CHANGE REQUEST
Impact on the
objective/outputs
What will the impact of the change on project objectives and
outputs be?
Impact on the budget
What will the impact on the project budget be?
Impact on the time
schedule
What will the impact on the time schedule of the project be?
Other impacts
What other impacts will the change bring?
Comments
Insert any other potential comments.
Recommendations
Y/N; procedure
Insert your recommendations, if and how the change should be
implemented.
Analysis carried out
by
Project manager
Date
dd/mm/yyyy
3. DECISION ON CHANGES
Decision
Authorised
Authorised
with
amendments
Rejected
More
information
Justification of the
decision
Insert your justification.
Comments
Insert any other potential comments.
Who will provide
information
Insert the name of the person responsible for informing the stakeholders
about the change.
Approved by
Depending on change classification
Date
dd/mm/yyyy
Page 1/2
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Project Change Request Sample PDF

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