Project Name:
Date Request Submitted:
Title of Change Request
Change Order Number: (To be assigned by Project Admin Office upon submission)
Submitted by:
(Name) (Contact Information)
Change Category: Scope Schedule Cost Technology Other
Is this a critical change? Yes No
Description of change requested:
Events that made this change necessary or desirable:
Justification for the change, why it is needed/desired to continue/complete the project:
Impact of the proposed change on: (define all sections affected if implemented and how)
Scope:
Schedule:
Cost:
Staffing:
Risk:
Other:
Suggested implementation if the change request is approved:
Required recommendations of Change Control Board: Majority needed
Name/Title Date Recommend/Reject Signature
Final approval/disapproval of Chief Information Officer
Name Date Approve/Disapprove Signature Change Request Plan of Action
As with any project a change in the actual project may be necessary. Any and all individuals are to be encouraged to submit a change request that may improve the scope of the project, reduce the time of the project, save on cost, effect staffing needs, or reduce or see the potential for risk. Proper steps though are needed to see that such a change is handled properly. All sections on the Change Request Form must be filled in properly for any consideration.
The following protocol will lay out how a change request will be handled: If any individual may see a need to have a change to a project in development or in progress, regardless to the natural of the request, a Change Request Form is to be filed with the Project Administration Office. The form will be available either from the Project Administration Office and a web version will be made available on the company intranet site. The request will be recorded with a Change Order Number that will be recorded by Project Administration Office