Change Request Form

This form is divided into three sections. Section 1 is intended for use by the individual submitting the
change request. Section 2 is intended for use by the IT team to document/communicate their initial
impact analysis of the requested change. Section 3 will be filled by implementer.

1.) REQUESTOR - GENERAL INFORMATION

CR No.
Type of CR
Business unit
Department
Requestor Name
Description of Request

CR-DDMMYY-001
Enhancement/ Change
Defect
[BU name]
[Department name]
[Enter requestor name]
[Enter a detailed description of the change being requested]

Date Submitted
Priority
Reason for Change

[DD/MMM/YYYY]
Low
Medium
High
[Enter a detailed description of why the change is being requested]

Other Artifacts Impacted

[List other artifacts affected by this change]

Assumptions and Notes

[Document assumptions or comments regarding the requested change]

Comments

[Enter additional comments]

Approver Name and dept.

[Enter approver name and department]

Approved/Rejected
Attachments or References Yes
Link:

No

2.) IT TEAM ANALYSIS

Impact description
Technical risks
Technical risk description
Alternative to change
Alternative description
Duration of CR

[Yes]/[No]
[Enter the description of technical risk]
[Yes]/[No]
[Enter the alternative description if there is any]
[Functional][in HRS]
[Technical][in HRS]
[QA][in HRS]
[Production][in HRS]
[Total][in HRS]

SOW
Effected BU/Deptt/Users
Expected Date of
Implementation
IT Comments

[Enter the name of effected BU with deptt and approximate count of users]
[Enter the expected date of implementation of required change ]
[Enter additional comments]

3.) Change details (to be filled in by implementer)

Date

Change completed
Change made by
Change reviewed by
Change verified by

[DD/MMM/YYYY]
[DD/MMM/YYYY]
[DD/MMM/YYYY]

[yes][No][yet to start]
[Technical person name]
[Enter reviewer name]
[Enter tester name]

Note:
CR form should be save in following format only <CR No.>-<DDMMYY>