Use this change order form template for requesting, approving and documenting alterations to the project. This template is divided into three sections intended for: individual submitting the change request, project manager communicating their initial impact analysis of requested change and Change Control Board (CCB) to document final decision.
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Change Order Form Template
[This form is divided into three sections. Section 1 is intended for use by the individual submitting the change request. Section 2 is intended for use by the Project Manager to document/communicate their initial impact analysis of the requested change. Section 3 is intended for use by the Change Control Board (CCB) to document their final decision regarding the requested change.]
SUBMITTER - General Information
Brief description of request (Enter detailed description of the change being requested)
Priority level
Reason for change
Take photo evidence of item/areas affected and needed to modify
Assumptions and notes regarding the requested change
Name & Signature of Submitter
PROJECT MANAGER - Initial Analysis
Hour impact
Duration impact
Schedule impact
Attachments or references (i.e ., photos of drawings, specifications, schedule etc)
List down estimated cost of labor and the necessary materials needed
Name & Signature of Project Manager
CHANGE CONTROL BOARD - Decision
Decision
Specify Conditions
Decision Date & Time
Approval Signature
Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.