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PM05 - Change Request V1.0

This document is a change request form for Project ABC. It provides information on the requestor, proposed change description and justification. It details the initial review results and whether the change was approved, rejected or deferred for further analysis. An initial impact analysis was then conducted to determine what baselines, configuration items, costs and schedules would be affected. Finally, the document presents the results of the full impact analysis, recommendations, and signatures approving the change.

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Nur Iklil Fairuz
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123 views3 pages

PM05 - Change Request V1.0

This document is a change request form for Project ABC. It provides information on the requestor, proposed change description and justification. It details the initial review results and whether the change was approved, rejected or deferred for further analysis. An initial impact analysis was then conducted to determine what baselines, configuration items, costs and schedules would be affected. Finally, the document presents the results of the full impact analysis, recommendations, and signatures approving the change.

Uploaded by

Nur Iklil Fairuz
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 ODT, PDF, TXT or read online on Scribd
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<Company Name>/<Project Name>

<Project ABC> Change Request A. General Information


Project Id: Project Name: Prepared by: Modification: Date and Version: Organization: Control Number: Date and Version: [From Control Log] dd/mm/yyyy/ Ver# dd/mm/yyyy/ 1.0

B.

Requestor Information

Proposed Change Description and References to Supporting Documentation:

Justification:

Impact of Not Implementing Proposed Change:

Alternatives:

C.

Initial Review Results of the Change Request


Assigned to:

Initial Review Date: Approve for Impact Analysis Reject Defer Until: Reason:

D.

Initial Impact Analysis

Baselines Affected:
Version 1.0 Page 1 PM05: Change Request

<Company Name>/<Project Name>

Configuration Items Affected: Cost / Schedule Impact Analysis Required? Impact on Cost: Impact on Schedule: Impact on Resources: Final Review Results: Review Date: Classification: HIGH MEDIUM LOW Yes No

E.

Impact Analysis Results

Specific Requirements Definition:

Additional Resource Requirements

Work Days

Cost

TOTAL
Impact of Not Implementing the Change:

Alternatives to the Proposed Change:

Final Recommendation:

F.

Signatures [Integrated Change Control]


Name/Title Signature
Page 2

Date
PM05: Change Request

Version 1.0

<Company Name>/<Project Name>

Version 1.0

Page 3

PM05: Change Request

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