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Project Change Request Form: Put Your Logo Here

This document is a template for a project change request form. It contains sections for requestor information, an initial review, an initial impact analysis, impact analysis results, a final recommendation, and signatures. The form is used to document any proposed changes to a project's scope, schedule, budget, or quality.

Uploaded by

Umesh Prasad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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88 views3 pages

Project Change Request Form: Put Your Logo Here

This document is a template for a project change request form. It contains sections for requestor information, an initial review, an initial impact analysis, impact analysis results, a final recommendation, and signatures. The form is used to document any proposed changes to a project's scope, schedule, budget, or quality.

Uploaded by

Umesh Prasad
Copyright
© © All Rights Reserved
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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Put your Put your Project Change Request Form Template

Rev. 2.1, 10/07/2004


logo here organization
name here

PROJECT CHANGE REQUEST FORM

Project Name:
Prepared by:
Date (MM/DD/YYYY):
Control No. (from CR Log):

Create links to referenced documents (e.g., Link_To_… ): use Insert Î Hyperlink on your toolbar.
Refer to the Change Management Plan for instructions on how to use this document.

1. Requestor Information
Fill in with appropriate information or place an “X” next to those that apply:

Area of Change:
Scope [ ] Schedule [ ]
Budget [ ] Quality [ ]

Is this Change the result of a Risk Management Action?


No [ ] Yes [ ] Risk ID:
Proposed Change Description and References: Provide information below concerning the
requested change. Create links to any supporting
documentation.

Description:

Justification:
Hyperlinks: Link_To_Supporting_Document1
Link_To_Supporting_Document2

Impact of Not Implementing


Proposed Change:

Alternatives:

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Put your Put your Project Change Request Form Template
Rev. 2.1, 10/07/2004
logo here organization
name here

2. Initial Review Results of the Change Request


Initial Review Date: Assigned to:
(MM/DD/YYYY)

Action Comments
Approve for Impact Analysis [ ]
Reject [ ]
Defer Until (MM/DD/YYYY) [ ]
Express Approval [ ]

3. Initial Impact Analysis


Baselines Affected:
Configuration Items Affected
(e.g. product specifications):
Cost / Schedule Impact Analysis Required? (check one) Yes [ ] No [ ]
Impact on Cost:
Impact on Schedule:
Impact on Resources:
Risk associated with
implementing the change:
Risk associated with not
implementing the change:
Final Review Results:
Review Date: (MM/DD/YYYY)
Priority: (check one) High [ ] Medium [ ] Low [ ]

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Put your Put your Project Change Request Form Template
Rev. 2.1, 10/07/2004
logo here organization
name here

4. Impact Analysis Results


Specific Requirements Definition:

Additional Resource Requirements (insert rows as needed): Work Days Cost

Totals
Impact of Not Implementing the Change:
Alternatives to the Proposed Change:

5. Final Recommendation

6. Project Change Request Form / Signatures


Project Name:

Project Manager:

I have reviewed the information contained in this Project Change Request Form and agree:

Name Title Signature Date


(MM/DD/YYYY)

The signatures above indicate an understanding of the purpose and content of this document by those
signing it. By signing this document, they agree to this as the formal Project Change Request Form.

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