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
/ Click here to enter text. /TRC CR Champion
/ Click here to enter text. /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 ☐ AbstainReasons 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)
/ Click here to enter text. /Yes
/No
/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 #:
/ Click here to enter text. /Suggested MAHCChange(s):
/ Click here to enter text. /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:
/ Click here to enter text. /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:
/ Click here to enter text. /Summary of CMAHC Member Comments:
/ Click here to enter text. /Summary of the Pros/Cons and/or Benefits/Deficits of the CR and the Thought Process of the TRC Review of the CR:
/ Click here to enter text. /TRC Recommendationto Board of Directors:
/ Click here to enter text. /Recommended Future Action:
/ Click here to enter text. /03-26-2017