MONITORING-CONTROLLING
CHANGE REQUEST
Project Name Project ID Project Manager
Business Process Owner Project Sponsor Project Executive Sponsor
CHANGE INFORMATION
Change request # Request Type Date Requested Date Needed
Enter Change request # Enter Scope, Time, or Cost Enter date the change is Enter date the change is
if a change is required change requested needed
Project Role Requestor/Source Name Contact Info Change Priority
Enter the person’s role Enter the person’s name – Enter contact info – email, Enter high, medium, or
on the project i.e. the request source phone number, mobile low for change priority
CHANGE PROPOSAL & JUSTIFICATION
Description of Change Request
Enter the change being requested - Describe it in detail so it is clear to the Change Control Board over the project
Business and/or Technical Justification
Enter the justification for the change – business, technical, operational, a combination of justifications, etc.
Impact of Not Making the Change
Enter what will happen if the change is not approved and the decision to accept the change is not made now
IMPACT ANALYSIS
Schedule Impact
Change Control Board (CCB) will enter how the change impacts the baseline schedule and the rest of this form
Resources Impact Estimated Effort Required WBS Line Item or Deliverable
Enter the resources impacted by the Estimate hours in work effort for the Enter WBS line # or deliverable
change and if morel are needed change to be name to identify impact to schedule
implemented/completed
Cost Impact
[Link] Revised: 11/11/2019
Project Change Request 1 of 2
Enter how the change impacts the baseline cost
Estimated Cost Estimated Benefits
Enter the estimated costs to implement the change Enter the estimated cost benefits of making the change
Performance Impact
Enter the impact to the performance of the project and team if the change is made
Portfolio, Program, and Other Project Impacts
Enter the impact of the change to any programs, the project portfolio, or other projects that have related dependencies
to this project
CONCLUSION
Alternatives
Enter any alternatives generated by the Change Control Board to determine if there are options to the requested
change
Recommendations
Enter any recommendations the Change Control Board has whether authorizing or not authorizing the requested
change
AUTHORIZATION AND COMPLETION
Change Status
☐ Accepted Date: ☐ Rejected Date: ☐ Deferred Date:
APPROVAL SIGNATURES
Project Executive Sponsor Date:
Project Sponsor Date:
Business Process Owner Date:
Project Manager Date:
[Link] Revised: 11/11/2019
Project Change Request 2 of 2
