Draft Project Change Request Form Page 5

Section 4: Project Manager Change Recommendation

Project Manager:

Recommendation and Why:

Email and Phone:

Project Name:

Change Request Name:

Change Request Number:

Date:

Impacts on Project Scope or Quality Goals, Deliverables, Milestones:

Estimated Cost in Dollars, Resources, or Time, and Cost Justification:

Risk Incurred by Not Doing the Change:

Risk Incurred By Doing the Change:

Other Impacts Including: Dependencies, Independent or 3

Party Quality Auditing,

Vendors, ETS, Partners or Stakeholder Coordination, Business or IT Process Impacts:

PM Modification to the Change Request – can include contingency, rollback, testing or

communication considerations.

10/30/14

Version 1.0

Page 5

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Parent category: Business