[PROJECT NAME]CHANGE REQUEST FORM

CHANGE REQUEST FORM

for

[Project Name]

Document Overview
Prepared By: / Author’s Name
Prepared For: / Department Name
Date Created: / Month, Day, Year
Last Updated: / Month, Day, Year
Revision Log
Revision / Date / Initials / Description of Revision
1.0 / MM/DD/YYYY / Initial Draft

Here are some typical questions to consider when evaluating a change request:

  • Does this change add to or alter the business requirements?
  • Is there a work-around, or is this change necessary for the overall success of the project?
  • Does this change require an increase in funding?
  • Will this delay the project end date?
  • Even though this change may have a negative impact on this project, does it result in significant business upsides that make it worthwhile?
  • Does enacting this change now make more sense than delaying it? Will the delay end up costing the company more money in the end?
  • Have all the affected stakeholders been considered, and do they endorse the change?
  • Are there contractual ramifications to consider? For example, will commitments with outside vendors be unfulfilled because of this change?

A. TO BE COMPLETED by the ORIGINATOR

Change Request #: / Requested Date: Month Day, Year
Requested By: First Name Last Name
Requesting Department:
Requester Priority (Check one): / Emergency (24 hrs) / High (3 days) / Routine (10 days)
Project Manager: / First Name Last Name / Phone: / xxx-xxx-xxxx
Project Name:
Change Request Title: / Title of Change Request
Description of Change: / Brief, succinct description of requested change
Type of Change: / See last page of this template
Associated Benefit(s): /
  1. Benefit 1
  2. Benefit 2
  3. Benefit 3
  4. Benefit 4

Associated Disadvantage(s) /
  1. Disadvantage 1
  2. Disadvantage 2
  3. Disadvantage 3

Risk(s) of Not Implementing: /
  1. Risk 1
  2. Risk 2
  3. Risk 3
  4. Risk 4

Testing Requirements:
Acceptance Criteria: / Should include technical and customer-defined criteria
Additional Work/Re-work Required: / Describe work effort/additional resources needed

B. TO BE COMPLETED by the PROJECT MANAGER

Spending Category / Request / Descripton / Assumption
Hardware
Hardware Maintenance
Software License fees
Software Maintenance
Consulting / External Resources
Misc expenses /
$0
$0
$0
$0
$0
$0
Project Total /
$0
INTERNAL RESOURCES / TIME in HOURS / Descripton / % Utiz. / No. / Assumption
Name / Function 1
Name / Function 2
Name / Function 3
Internal Resource Hours
Purchasing
Is there a PO In place today? Yes / No
If yes, give PO Number: ______
Current Amount of PO:
Increase Needed in PO:
PO Balance after Change Order:
Purchasing Contact: / $ ______
$ ______
$______
______
PO Balance after Change Order /
$ ______

C. TO BE COMPLETED by the ASSESSMENT TEAM

Review Date: / Reviewer:
Estimate to Investigate:
Proposed Solution:
Alternative Solutions Reviewed: /
  • Solution 1
  • Solution 2
  • Solution 3

Impact of Change on System/Project: /
  • Impact 1
  • Impact 2
  • Impact 3
  • Impact 4

Total Estimate to Implement: /
  • Functional/Configuration
  • Technical/Development
  • Testing
  • Documentation
  • Training
  • Other

Reviewer Comments:
Disposition: / Approved / Rejected / Deferred
Disposition Rationale:

Type of Change:

ACArchitecture and Standards. Any change activity initiated to comply with strategic changes in the preferred architecture or the organization's technical standards.

CACorrective Action. Any change activity associated with the correction of defects. Also includes change activity initiated to bring an application up to quality standards.

DIDiscretionary. Refers to change activity that is submitted by either the project team or the client, not explicitly needed to meet the baselined requirements.

DPDefect Prevention. Any change activity associated with preventing the introduction of defects into the system.

ENEnhancement. Any change activity associated with adding new functionality to an existing application. Include cross reference to approved requirements and/or requirements traceability matrix.

PSProduction Support. Any activity associated with a production environment not otherwise associated with a particular change event.

RGRegulatory. Any change activity required by a regulatory body other than University of Chicago.

RTRun Time Improvements. Any change activity initiated for the purpose of performance improvement or cost reduction not related to specifications.

XXOther. Any other change.

CHANGE REQUEST FORMSIGN-OFF PAGE

PHASE: Manage

This Change Request Form [ Version x.x] has been reviewed and found to be consistent with the specifications and/or documented project requirements. The signature(s) below confirm acceptance of this document and/or work product by the signing authority /ies.

Organization: University of Chicago______Contractor______
Approved by:
Name:: ______
Signature:______
Title: / Dept:
Date:
Organization: University of Chicago______Contractor______
Approved by:
Name:: ______
Signature:______
Title: / Dept:
Date:

This document is a copy, effective only on the downloaded date. The official,updated template always resides on the PM101 site.

File Name: PM101-Change Request Form Page 1 of 6

Last saved: 11/17/18