CMAHC Technical Review Committee (TRC)Change Request Evaluation Form

CR #:Click here to enter text.

/ MAHC Section #: Click here to enter text.
MAHC Code page #: Click here to enter text.
MAHC Annex Page #:Click here to enter text.

Submitter Name, Organization

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TRC CR Champion

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CR Type

/ ☐Clarification/Edit ☐ Updated Information
☐ Move Section ☐Add/Delete Section ☐ New Section

Document Posted for Voting

/ ☐ Posted as Submitted
☐ Posted as Submitted, TRC Modifications Not Acceptable to Submitter
☐ Posted with Approved TRC/Submitter Modifications
☐ Posted with TRC Modification; Submitter did not respond within required timeframe (sent 1 email/week for 3 weeks)

TRC Recommendation

/ ☐ Yes Vote ☐ No Vote ☐ Abstain

Reasons forNo Vote or Abstaining TRC Recommendation

(Check all that apply) / ☐Incomplete ☐Revolution not Evolution ☐Prohibitive Cost Impact
☐Additional Research/Improvement Needed
☐Negative Health Impact ☐ TRC Unable to Reach Consensus

Explanatory Notes (If any)

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Yes

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No

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Change Request (CR) Review Criteria

☐ / ☐ / Is this CR complete?
☐ / ☐ / Is the CR editorial?
☐ / ☐ / If above question is “Yes,” does it improve the clarity and interpretation of the MAHC?
☐ / ☐ / Does it follow the CDC style sheet?
☐ / ☐ / Is the CR science-based?
☐ / ☐ / Is the CR best practice-based?
☐ / ☐ / Does the CR need to be improved to be accepted?
☐ / ☐ / Can the CR be easily improved by the TRC?

Supporting Documentation

☐ / ☐ / Is supporting documentation (peer-reviewed, scientific rationale and/or data) provided to support CR?
☐ / ☐ / Has supporting documentation been evaluated/reviewed?
☐ / ☐ / Does the documentation support the CR?
☐ / ☐ / Is the supporting documentation scientifically reputable and sound?
☐ / ☐ / Has the CR been proposed/addressed previously (i.e., submitted during individual module public comment or knitted version public comment), or as a 2015 CR?
☐ / ☐ / If yes, does CR provide additional/or different supporting documentation than previous public comment?

Impact of Change

☐ / ☐ / Will the change increase cost of construction or operation? Please quantify in notes.
☐ / ☐ / Is there a positive public health impact?
☐ / ☐ / Is there a negative public health impact?
☐ / ☐ / Does this change request demonstrate "evolution" rather than "revolution"?

CR SUMMARY REPORT

CR #:

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Suggested MAHCChange(s):

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Does TRC RecommendCode/Annex Language Different from Original CR Submission?

/ ☐Yes
☐No /

If Yes, Are Changes Approved by Submitting Author?

/ ☐Yes
☐No

If Yes, TRCRecommended MAHC Language:

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Review Process and Rationale

(include ALL TRC viewpoints if consensus was not reached)

TSC Consulted?

/ ☐ Yes
☐ No If Yes, TSC Name? Click here to enter text.

Summary of Internal TRC and TSC (if used) Discussion:

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Summary of CMAHC Member Comments:

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Summary of the Pros/Cons and/or Benefits/Deficits of the CR and the Thought Process of the TRC Review of the CR:

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TRC Recommendationto Board of Directors:

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Recommended Future Action:

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03-26-2017