PROJECT CHANGE CONTROL TEMPLATE

PROJECT TITLE	PROJECT SPONSOR

CHANGE REQUEST

ORIGINATOR NAME	DATE OF REQUEST	CHANGE ID NO.
CONTACT INFORMATION
ITEMS TO BE CHANGED
ARGUMENT REFERENCE(S)
CHANGE DESCRIPTION
ESTIMATED FINANCIAL IMPACT	ESTIMATED TIMELINE IMPACT
PRIORITY / CONSTRAINTS

CHANGE EVALUATION

ASPECTS AFFECTED	WORK REQUIRED
RELATED REQUESTS
EVALUATOR NAME	SIGNATURE	DATE EVALUATED

CHANGE APPROVAL

SELECT ONE	COMMENTS
ACCEPTED
REJECTED
HOLD
APPROVED BY	SIGNATURE	DATE APPROVED

CHANGE EVALUATION

ASSET
IMPLEMENTED BY	SIGNATURE	DATE EXECUTED

CHANGE CONTROL FORM

CHANGE ID	AUTHORIZED BY	CHANGE DESCRIPTION	DATE EVALUATED	DATE EVALUATED	DATE APPROVED	DATE EXECUTED

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