This document outlines a checklist and template for submitting project change requests. The checklist includes considerations for how the change may impact deliverables, requirements, procedures, and technical or client needs. The template requires a description of the change and reason for change, an analysis of the impact on the project schedule and costs, and approval signatures from the client, sponsor, technical lead, and project manager.

1. PROJECT CHANGE REQUEST
Change Management Checklist: <Remove for final document. This section is for reference only>
The checklist is for Project Managers and Project Team Members to help determine the impact of potential
change requests on the project. Document change requests in the Change Control Log. The checklist below
includes, but is not limited the following:
1. When assessing change request:
· Consider the effects of a change request on deliverables.
· Consider the impact of the change on later processes
· Consider the repercussions on deliverables that are already complete
· Consider how the change may affect the user, functional and quality requirements
· Consider how the change may affect procedures currently in place or planned
· Consider the savings or benefits of the options being proposed
· Consider other project documents that may need to be updated
2. When the change is for the Client or for Technical reasons:
· Consder if the change has an effect on the Client
· Consider the seriousness of the change effect on the Client
· Consider is there is a consensus for the change or if the opinions are mixed
· Consider how the potential change will affect the use or appropriateness of any equipment,
machinery, and computer systems currently operated or planned for the project
· Consider the change effect on the planned approach to technical quality procedures or user
acceptance testing
· Consider if additional technical skills, training or specialist advice will be required to
implement the change
3. When the change will affect the Client experience:
· Consider if the change is justifiable
· Consider if the change meets a requirement
· Consider if the change will make the product better to customers
· Consider the impact of the change for the development team and customer
· Consider if the change request is from an individual and whether it effects multiple users
· Consider if anyone will be negatively effected by the change
· Consider if the change request will result in additional changes
(Document Date) PAGE 1 OF 3 Project Change Request
Template Version 2.0

2. PROJECT CHANGE REQUEST
Project Work ID <Remedy ID>
Project Title: <Meaningful Title for Project>
Prepared by: <Name of Project Manager>
Date of Document: <MM/DD/YYYY>
Change Request Number: <Assign Number to Request>
Change Request Name: <Brief Title of Change Request>
1. DECRIPTION OF CHANGE
Description of Change
Reason for Change
2. IMPACT OF CHANGE
Effect on Project
Deliverables and
Organization
Effect on Project
Schedule
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Template Version 2.0

3. PROJECT CHANGE REQUEST
Effect on Project Cost
Item Description Hours Dollars
Reduction Increase Reduction Increase
Total Net Change in Cost:
Additional Comments
3. PROJECT CHANGE REQUEST APPROVAL
This statement is used to reach a satisfactory level of mutual agreement among the project manager,
sponsor, and client with respect to the objectives and scope of the project change request before
significant resources are committed and expenses incurred
The signatures below certify that the Project Manager has met with and reviewed this statement with
the individuals below and the information contained herein are accurate.
Name Role Signature Date
Client
Sponsor
Technical Lead
Project Manager
(Document Date) PAGE 3 OF 3 Project Change Request
Template Version 2.0