REQUEST FOR CHANGE FORM
Submission
Date: Request For Change No.:
Initiator's Name: ID No: Phone Ext:
email address: Section/Unit:
Department: Division:
Preferred Change Date:
Duration of Change: (Hours/days)
Priority Level: Emergency High Medium Low
Description
Description of Change:
Business Reasons:
Areas of Impact
Platform Affected Component
FOC
Networks
Service Desk
Applications
Operating Systems
Servers
Impact on Project success: Critical High Medium Low
Back‐out/Recovery Plan Description:
Back-Up Required: Back-Up Completed Successfully :
Impact Analysis
Comment on Scope Creep:
1
Impact Assessment Result:
Additional time on Project:
Cost:
Training Requirement (if any):
Ownership
Change Owner: ID No: Phone Ext:
Email Address: Unit:
Department: Division
Pre Review Approvals
Role Staff ID Name Remark Signature/Date
Supervisor
Line
Manager
HOD
Change Board Review
Reviewed By: Date: Sign:
Comments:
Modified Approved Rejected Deferred
Justification:
Approved By: Date:
Planned Implementation Date: Date of Completion:
Completed By:
GGM’s Endorsement
2
Implementation results
Post Implementation Approvals
Role Staff ID Name Remark Signature/Date
Supervisor
Line
Manager
HOD
Post Implementation Change Review:
Change Reviewer
Change Approver
GGM’s Endorsement
