Example: Sample Change Request Form
This is an example of the type of information that may be on a change request form.
Relationships
Related Elements
Description
Main Description

Submitter Name and Title
Name and role of the stakeholder who is submitting the request.

Reference Number
A reference tracking number that is associated with the contract or statement of work, used for tracking purposes.


Dates
For tracking purposes, the form may have several dates:

  • Submission date
  • Assigned to review date
  • Approval dates
  • Closed date

Problem Control Report
Unique numbers used to track the request.

Subject
The title of the request.

Description
Detailed description of the request that should include the purpose of the request.

Documents
Supporting materials that are attached to the change request submission.

Benefits
These define the benefit of executing the request (for example, to save money, fix a defect, or improve customer satisfaction and achieve business value). A best practice is to quantify the benefits.

Cost or price
The cost associated with the request should be documented.

Approvals
The list of approvers. This is unique to your organization. Typically, the list includes funding or sponsor management, and those who have reviewed the request and provided recommendations on how to best handle the change request.