Request For Change No : RFC-domain-XXX

Related Ticket No :
Initiation (to be filled-in by Change Technician)
Originator Name/PID/Tel.
Date o Request
Re!ie"ed #$ %&u'er!isor(
Date re!ie"ed
Pro'osed Date and
Time or change
Date :
Start : End :
(To be filled in by Change Manager)
Priorit$
Categor$
)''ro!ed Date and Time or change :
Date :
Start : End :
In case of an emergenc$ change !lease also !hone the Change "anager #
&$stem%s( / Data#ase%s( )ected Related *usiness )''lication%s(
Technician grou's required
(highlight in blue and bold)
+ocation
Syso!s $ Telecom $ %"& $ CC $ local IS (indicate location)
&ther (e'g' e(ternal s)!!lier) (indicate) : Database team
Reason or Change (bac*gro)nd !roblem to be sol+ed maintenance b)siness benefit etc' ,gi+e details-)

Descri'tion o 'ro'osed Change (.or* to be done com!onents to be changed etc')
Inormation or 'riorit$ setting Pro'osed 'riorit$
Im!act of c)rrent !roblem :
(im!act descri!tion
/b and ty!e of )sers im!acted
etc')
%0 1 Emergency
%2 1 3igh
%4 1 "edi)m
%5 1 6o.
(
3
i
g
h
l
i
g
h
t
)
Ris* if change not done or
delayed :
&ther comment :
Inormation or categor$ setting Pro'osed categor$
Im!act of change to ser+ice :
C2 1 "a7or
C4 1 Significant
C5 1 "inor
C8 1 Information
(
3
i
g
h
l
i
g
h
t
)
Do.ntime for )sers :
Ris* of change itself
(com!le(ity ris* and im!act of
fail)re etc')
Estimated effort ("an-3o)r) :
When form is filled at least until there, send to Managers Mail ID
Change Request Form Template - 2.1
!'2 of 4
Change Plan (to be filled-in by Change Technician)
Test Plan
!tion item Responsibility Target "ate
Im'lementation 'lan
!tion item Responsibility Target "ate
Change Re!ersal Plan
!tion item Responsibility Target "ate
,eriication Task Im'lemented #$ ,eriied #$ (after im!lementation)
Documents / Names o Data#ases to #e u'dated -odiied #$ (after im!lementation)
When form is filled until there, submit to Managers ID
Change Request Form Template - 2.1
!'4 of 4