Change Request and Impact Analysis Form

Change Details

Priority (High / Low)

Problem
Change Description
Request Number Date Raised

Description of changes required

Project Name

Initiator’s Name

Analysis Section (To be filled by the project leader)

Impact Description: (Attach extra sheets if required)

Implementation Effort
Impact on Milestone
Impact on Final Acceptance Date

Rework on design and coding

Technical impact

Schedule impact
Dates ho wmuch delay
Design incl Coding & Testing (Specify
Analysis
DB Unit Testing type)
Effort Impact <> Man
<> Man Days <> Man Days <> Man Days
Days
Total Effort: < > Man Days
Risk Analysis
Configuration ID Name
Configurable items Impacted

Is client’s approval required? (Yes

/ No)

Approval Section

Recommendation of PM/BUH
Recommendation of the
Customer
E-mail approval reference
Verification Section (To be filled by the PM after completion of the change)

Remark
Closure date & Signature