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Change Request: Initiator Information

This change request document summarizes a proposed change to an existing project. It includes information about the initiator of the change request, a description of the original plan and proposed change, and an impact review assessing the technical, budget, schedule, performance, and contractual impacts of the change. Key stakeholders must review and approve the change request for it to be implemented.

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mcsmani
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45 views2 pages

Change Request: Initiator Information

This change request document summarizes a proposed change to an existing project. It includes information about the initiator of the change request, a description of the original plan and proposed change, and an impact review assessing the technical, budget, schedule, performance, and contractual impacts of the change. Key stakeholders must review and approve the change request for it to be implemented.

Uploaded by

mcsmani
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Change Request

Project Name Project Reference Number Prepared By (print) Preparers Initials

Customer

Contact

Contacts Phone #

Date Prepared

INITIATOR INFORMATION
INITIATORS NAME CHANGE REQUEST NO. DATE

DEPARTMENT/COMPAY

TELEPHONE

FAX

E-MAIL

BASELINE DESCRIPTION
ORIGINAL PLAN

PROPOSED CHANGE
DESCRIPTION OF CHANGE

RATIONAL FOR CHANGE

MODIFIED ACTIVITIES
WBS NO. ACTIVITY NAME/TITLE

WBS NO.

ACTIVITY NAME/TITLE

WBS NO.

ACTIVITY NAME/TITLE

OTHER REFERENCES

IMPACT REVIEW
MEETING DATE

TECHNICAL IMPACT

BUDGET IMPACT

SCHEDULE IMPACT

PERFORMANCE IMPACT

CONTRACT IMPACT

APPROVALS
NAME (PRINT) SIGNATURE DATE

TELEPHONE

FAX

E-MAIL

CHANGE CONTROL BOARD (CCB) ACTION


Approve and forward for customer concurrence Deny
SIGNATURE, CCB CHAIRPERSON

CUSTOMER DECISION
Approved Tabled Disapproved
COMMENTS (IF APPROPRIATE)

CUSTOMER SIGNATURE
NAME (PRINT) SIGNATURE DATE

TELEPHONE

FAX

E-MAIL

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