MONITORING-CONTROLLING

CHANGE REQUEST

Project Name Project ID Project Manager

Business Process Owner Project Sponsor Project Executive Sponsor

CHANGE INFORMATION
Change request # Request Type
Enter Change request # Enter Scope, Time, or Cost
if a change is required change
Project Role Requestor/Source Name
Enter the person’s role Enter the person’s name –
on the project i.e. the request source
Date Requested
Enter date the change is
requested
Contact Info
Enter contact info – email,
phone number, mobile
Date Needed
Enter date the change is
needed
Change Priority
Enter high, medium, or
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

PMPreps.com 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:

PMPreps.com Revised: 11/11/2019

Project Change Request 2 of 2