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6ChangeRequestTemplate EPMO 03162009

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CHANGE REQUEST TEMPLATE

Project Name:
Project Manager:
Requested by: Date:
Submitted by: Date:
Evaluated by: Date:
Decided by: Date:

Change Request #: Change Title:

Details:

Description:
Justification:
Cause:
Priority:

Evaluation:

Scope:
Schedule:
Cost:
Quality:
Risk:
Project Management:
Evaluator’s Priority:
Alternatives:
Recommendations:

Implementation Options (provided by the project manager):

Decision/Rationale:
€ Approved
€ Denied
€ Place on Hold

Describe the rationale for the decision and who was involved.

6- Change Request Template draft v01.00 01.22.2009.doc


Project Name Project name
Project Manager Project manager name Organization Organization name
Requested by Requestor name Organization Organization name
Submitted by Submitter name Date Date
Requested
Evaluated by Evaluator name Date Date
Evaluated
Decided by Name of decision maker Date Decided Date
Change Request Identification (Provided by the Change Management Coordinator)
Change Number entered by project manager
Request #
Change Title Enter a brief descriptive title for the change request

Change Request Details (Provided by the requestor / Stakeholder)


Description Provide a detailed description of the change being requested. Be
specific. Include a preliminary estimate of the impact of the change on
the project and its deliverables. Note whether the change creates new
deliverables or project objectives. Note any timing issues related to
implementing the change.
Justification Provide a business case for the change, including the impact of not
implementing it.
Cause Note anything that could be helpful to understanding the cause of this
change so that the root cause of related changes can be identified and
addressed.
Priority Select among the priority categories established for this project. E.g.
high, medium, low.

Evaluation (Provided by the Change Management Team) Include as appropriate:


Scope Discuss impacts on project scope, including whether this is a change
to the product requirements, and for large impact changes whether
the change is in keeping with the projects overall business case. Note
whether the change violates a requirement or is out of scope as
implied by the project’s business case.
Schedule Discuss impacts on project schedule and note, in particular, whether
the impacts occur on the project’s critical path.
Cost Discuss impacts on the project budget. Include a detailed cost
analysis.
Quality Discuss impacts on the project’s quality objectives and how the
change affects quality assurance and control activities.
Risk Describe any new risks introduced by this change and its impact on
the project risk plan.
Project Discuss the impact this change has on how the project is organized.
management
Evaluator’s Select among the priority categories established for this project if this
priority differs from the requestor’s priority and note why it is different.
Alternatives and Describe compelling alternatives to this change, if any, what would
recommendation support the choice of each alternative, and which choice the
evaluation team recommends.
6- Change Request Template draft v01.00 01.22.2009.doc
Implementation Options (Provided by the project manager)
Given the current state of the project, list options for implementing the change in light of
the project’s driving constraints.
Decision/Rationale: (Sponsor and/or Stakeholder)
€ Approved
€ Denied
€ Place on Hold

Describe the rationale for the decision and who was involved.

6- Change Request Template draft v01.00 01.22.2009.doc

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