PROJECT CHANGE REPORT SAMPLE

PROJECT TITLE	PROJECT SPONSOR
Project PLS Update	Change Corporation

CHANGE REQUEST

ORIGINATOR NAME	DATE OF REQUEST	CHANGE ID NO.
Jane Doe	October 1st	00000
CONTACT INFORMATION	(555) 000-0000 / Jdoe@changecorp.com
ITEMS TO BE CHANGED	Production line software
ARGUMENT REFERENCE(S)	See Control Report 00011 – September 8th
CHANGE DESCRIPTION	Production line software needs updating
ESTIMATED FINANCIAL IMPACT	Approximately $8,000	ESTIMATED TIMELINE IMPACT	Seven days
PRIORITY / CONSTRAINTS	High priority / speed and effectiveness of the software update

CHANGE EVALUATION

ASPECTS AFFECTED	Production	WORK REQUIRED	Software update
RELATED REQUESTS	Not applicable
EVALUATOR NAME	SIGNATURE	DATE EVALUATED
T. Smith	T. Smith	October 9th

CHANGE APPROVAL

SELECT ONE	COMMENTS
X	ACCEPTED
REJECTED
HOLD
APPROVED BY	SIGNATURE	DATE APPROVED
H. Jones	H. Jones	October 11th

CHANGE EVALUATION

ASSET
IMPLEMENTED BY	SIGNATURE	DATE EXECUTED
K. Grant	K. Grant	October 17th

CHANGE CONTROL FORM

CHANGE ID	AUTHORIZED BY	CHANGE DESCRIPTION	DATE EVALUATED	DATE EVALUATED	DATE APPROVED	DATE EXECUTED
00000	Project Manager	Updating production line software	October 9th	October 9th	October 11th	October 17th

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