Change Request Form Template

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This Change Request Form (the “Form”) is submitted by [Requester Name] on [Submission Date].

1. Change Overview

1.1 Change Title. [Short title].

1.2 Change Type.

☐ Standard change (planned)

☐ Emergency change (urgent)

☐ Normal change (requires review)

☐ Other: [Type]

1.3 Department/Team. [Team].

1.4 Requested By. [Name/Role].

1.5 Owner/Implementer. [Name/Role].

1.6 Requested Implementation Date. [Date/Time].

1.7 Maintenance Window (If Any). [Window].

1.8 Systems/Services Affected. [List].

1.9 Environment. ☐ Production ☐ Staging ☐ Dev ☐ Other: [Env].

2. Change Description and Justification

2.1 Description. [Explain what will change in plain language].

2.2 Business Justification. [Why the change is needed].

2.3 Expected Benefit. [Performance, security, cost savings, compliance, etc.].

2.4 Impact if Not Implemented. [Risks or costs of not doing it].

2.5 Dependencies. [Teams, vendors, systems, releases].

3. Risk and Impact Assessment

3.1 Customer Impact. ☐ None ☐ Low ☐ Medium ☐ High. Details: [Describe].

3.2 Availability Impact. ☐ None ☐ Degraded performance ☐ Downtime expected. Duration: [Estimate].

3.3 Security Impact. ☐ None ☐ Improves security ☐ Potential risk. Details: [Describe].

3.4 Data Impact. ☐ None ☐ Potential data changes ☐ Backup required. Details: [Describe].

3.5 Compliance/Legal Impact. ☐ None ☐ Review required. Details: [Describe].

3.6 Overall Risk Rating. ☐ Low ☐ Medium ☐ High.

4. Testing and Validation

4.1 Testing Plan. [Tests to be performed before change].

4.2 Validation Plan. [How you will confirm change success].

4.3 Success Criteria. [Clear measurable outcomes].

4.4 Approvals for Testing (Optional). [Who must approve test results].

5. Implementation Plan

5.1 Implementation Steps.

Step 1: [Action]
Step 2: [Action]
Step 3: [Action]

5.2 Implementation Start/End Time. [Start] to [End].

5.3 Responsible Parties. [Names/roles].

5.4 Communication Plan. Internal/external notice required: ☐ Yes ☐ No. If yes: [Channels and audience].

Step 1: [Action]

Step 2: [Action]

Step 3: [Action]

5.2 Implementation Start/End Time. [Start] to [End].

5.3 Responsible Parties. [Names/roles].

5.4 Communication Plan. Internal/external notice required: ☐ Yes ☐ No. If yes: [Channels and audience].

6. Rollback Plan

6.1 Rollback Trigger. [What conditions trigger rollback].

6.2 Rollback Steps.

Step 1: [Action]
Step 2: [Action]
Step 3: [Action]

6.3 Rollback Owner. [Name/Role].

6.4 Data Recovery Plan (If Applicable). [Backups, restore steps].

Step 3: [Action]

6.3 Rollback Owner. [Name/Role].

6.4 Data Recovery Plan (If Applicable). [Backups, restore steps].

7. Approvals

7.1 Required Approvals.

☐ Engineering/IT

☐ Security

☐ Compliance/Legal

☐ Product/Business owner

☐ Customer support (if customer impact)

☐ Other: [Role]

7.2 Approval Decision.

☐ Approved

☐ Approved with conditions: [Conditions]

☐ Not approved

☐ More information needed: [Info]

7.3 Approver Notes. [Notes].

8. Post-Change Review (Optional)

8.1 Completion Status. ☐ Completed ☐ Partially completed ☐ Rolled back ☐ Cancelled.

8.2 Actual Start/End Time. [Start] to [End].

8.3 Issues Observed. [List].

8.4 Follow-Up Tasks. [Tasks, owners, due dates].

8.5 Documentation Updates. [Runbooks, diagrams, CMDB updates].

Signatures

By signing below, the undersigned approve (or acknowledge) this change request as documented above.

Requester: [Name]

Title/Role: [Title]

Date: [Date]

Signature: ___________________________

Change Owner/Implementer: [Name]

Title/Role: [Title]

Date: [Date]

Signature: ___________________________

Approver 1: [Name]

Title/Role: [Title]

Date: [Date]

Signature: ___________________________

Approver 2 (Optional): [Name]

Title/Role: [Title]

Date: [Date]

Signature: ___________________________

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Change Request Form Template

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Change Request Form Template — quick answers

Reviewed July 2026 Free download, PDF & DOCX

What is a change request form?

A change request form is a standardized document used to propose and document changes — such as system configuration updates, software releases, process changes, or policy updates. It helps teams assess risk, plan implementation, and ensure changes are approved before they happen.

When should a change request form be used?

Use it whenever a change could affect security, availability, cost, customer experience, or compliance—especially for production changes, infrastructure updates, vendor changes, access changes, and policy exceptions. It creates a consistent workflow and an audit trail.

What information should be included in a change request?

Most change requests include a clear description of the change, business justification, affected systems, risk assessment, testing plan, implementation steps, rollback plan, timeline, and approvals. This template includes optional sections for security and compliance review.

How do you avoid risky changes?

Require testing, define success criteria, schedule changes in appropriate maintenance windows, and use a rollback plan. A formal review process also helps catch dependencies and customer impact before deployment.

What is the difference between a standard and an emergency change?

A standard change is planned, reviewed, and scheduled in advance. An emergency change is time-sensitive and needed to fix a critical issue (for example, an active outage or exploited vulnerability). This template includes a field to mark emergency changes and document the reason.

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